References

Aveyard H. Doing a literature review in health and social care a practical guide, 3rd edn. Maidenhead: McGraw-Hill/Open University Press; 2014

Beltramini A, Galinski M, Chabernaud JL Pain assessment in children younger than 8 years in out-of-hospital emergency medicine: reliability and validity of EVENDOL Score. Pediatr Emerg Care. 2019; 35:(2)125-131 https://doi.org/10.1097/PEC.0000000000000953

Bendall JC, Simpson PM, Middleton PM. Effectiveness of prehospital morphine, fentanyl, and methoxyflurane in pediatric patients. Prehosp Emerg Care. 2011; 15:(2)158-165 https://doi.org/10.3109/10903127.2010.541980

Booth A, Sutton A, Papaioannou D. Systematic approaches to a successful literature review.London: Sage; 2016

JRCALC clinical practice supplementary guidelines 2017. In: Brown SN, Kumar D, Millins M, Mark J (eds). Bridgwater: Class Professional; 2017

UK ambulance services clinical practice guidelines 2019. In: Brown SN, Kumar D, Millins M, Mark J (eds). Bridgwater: Class Professional; 2019

Browne LR, Studnek JR, Shah MI, Brousseau DC, Guse CE, Lerner EB. Prehospital opioid administration in the emergency care of injured children. Prehosp Emerg Care. 2016a; 20:(1)59-65 https://doi.org/10.3109/10903127.2015.1056897

Browne LR, Shah MI, Studnek JR Multicenter evaluation of prehospital opioid pain management in injured children. Prehosp Emerg Care. 2016b; 20:(6)759-767 https://doi.org/10.1080/10903127.2016.1194931

Centre for Evidence-Based Medicine. Oxford Centre for Evidence-based Medicine. Levels of evidence (March 2009). 2009. https//tinyurl.com/4xad487k (accessed 1 April 2022)

Critchley K, Quigg Z. A cross-sectional study of child injury ambulance call-out characteristics and their utility in surveillance. J Paramed Pract. 2019; 11:(7)282-292 https://doi.org/10.12968/jpar.2019.11.7.282

Dixon-Woods M, Bonas S, Booth A How can systematic reviews incorporate qualitative research? A critical perspective. Qual Res. 2006; 6:(1)27-44 https://doi.org/10.1177/1468794106058867

Galinski M, Picco N, Hennequin B Out-of-hospital emergency medicine in pediatric patients: prevalence and management of pain. Am J Emerg Med. 2011; 29:(9)1062-1066 https://doi.org/10.1016/j.ajem.2010.06.031

Greenhalgh T, Toon P, Russell J, Wong G, Plumb L, Macfarlane F. Transferability of principles of evidence based medicine to improve educational quality: systematic review and case study of an online course in primary health care. BMJ. 2003; 326:(7381)142-145 https://doi.org/10.1136/bmj.326.7381.142

Health and Care Professions Council. Standards of education and training guidance. 2017. https//www.hcpc-uk.org/resources/guidance/standards-of-education-and-training-guidance/ (accessed 1 April 2022)

Huang X, Lin J, Demner-Fushman D. Evaluation of PICO as a knowledge representation for clinical questions. AMIA Annu Symp Proc. 2006; 2006:359-363

Jennings PA, Lord B, Smith K. Clinically meaningful reduction in pain severity in children treated by paramedics: a retrospective cohort study. Am J Emerg Med. 2015; 33:(11)1587-1590 https://doi.org/10.1016/j.ajem.2015.06.026

Johnson TJ, Schultz BR, Guyette FX. Characterizing analgesic use during air medical transport of injured children. Prehosp Emerg Care. 2014; 18:(4)531-538 https://doi.org/10.3109/10903127.2014.916018

Lord B, Jennings PA, Smith K. The epidemiology of pain in children treated by paramedics. Emerg Med Australas. 2016; 28:(3)319-324 https://doi.org/10.1111/1742-6723.12586

Lord B, Jennings PA, Smith K. Effects of the introduction of intranasal fentanyl on reduction of pain severity score in children: an interrupted time-series analysis. Pediatr Emerg Care. 2019; 35:(11)749-754 https://doi.org/10.1097/PEC.0000000000001376

Configurations of EMS systems: a pilot study. 2008. https//tinyurl.com/ywsn5mmx (accessed 1 April 2022)

Murphy A, Barrett M, Cronin J A qualitative study of the barriers to prehospital management of acute pain in children. Emerg Med J. 2014; 31:(6)493-498 https://doi.org/10.1136/emermed-2012-202166

Murphy A, McCoy S, O'Reilly K A prevalence and management study of acute pain in children attending emergency departments by ambulance. Prehosp Emerg Care. 2016; 20:(1)52-58 https://doi.org/10.3109/10903127.2015.1037478

Murphy AP, Hughes M, Mccoy S, Crispino G, Wakai A, O'Sullivan R. Intranasal fentanyl for the prehospital management of acute pain in children. Eur J Emerg Med. 2017; 24:(6)450-454 https://doi.org/10.1097/MEJ.0000000000000389

National Institute for Health and Care Excellence. Fever in under 5s: assessment and initial management. Clinical guideline [CG160]. https//www.nice.org.uk/cg160 (accessed 1 April 2022)

National Institute for Health and Care Excellence. Clinical knowledge summaries: analgesia—mild-to-moderate pain. 2015. https//cks.nice.org.uk/analgesia-mild-to-moderate-pain (accessed 1 April 2022)

Pilbery R, Miles J, Bell F. A service evaluation of paediatric pain management in an English ambulance service. Br Paramed J. 2019; 4:(2)37-45 https://doi.org/10.29045/14784726.2019.09.4.2.37

Porter KM, Dayan AD, Dickerson S, Middleton PM. The role of inhaled methoxyflurane in acute pain management. Open Access Emerg Med. 2018; 10:149-164 https://doi.org/10.2147/OAEM.S181222

Rahman A, Curtis S, DeBruyne B, Sookram S, Thomson D, Lutz S, Ali S. Emergency medical services provider comfort with prehospital analgesia administration to children. Prehosp Disaster Med. 2015; 30:(1)66-71 https://doi.org/10.1017/S1049023X14001277

Rutkowska A, Skotnicka-Klonowicz G. Prehospital pain management in children with traumatic injuries. Pediatr Emerg Care. 2015; 31:(5)317-320 https://doi.org/10.1097/PEC.0000000000000313

Schauer SG, Arana AA, Naylor JF, Hill GJ, April MD. Prehospital analgesia for pediatric trauma patients in Iraq and Afghanistan. Prehosp Emerg Care. 2018; 22:(5)608-613 https://doi.org/10.1080/10903127.2018.1428839

Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008; 8 https://doi.org/10.1186/1471-2288-8-45

Wilczynski NL, Marks S, Haynes RB. Search strategies for identifying qualitative studies in CINAHL. Qual Health Res. 2007; 17:(5)705-710 https://doi.org/10.1177/1049732306294515

Williams DM, Rindal KE, Cushman JT, Shah MN. Barriers to and enablers for prehospital analgesia for pediatric patients. Prehosp Emerg Care. 2012; 16:(4)519-526 https://doi.org/10.3109/10903127.2012.695436

Wilkinson D, Heinz P. G27 (P)paediatric emergency ambulance transport: who calls 999 and why. Arch Dis Childhood. 2014; 99:A12-A13

research
education

Barriers and facilitators to out-of-hospital pain management for children

02 April 2022
Other
02 April 2022
Volume 14 · Issue 4

Abstract

Pain is one of the most common symptoms presented by patients of all ages to ambulance services. While children in pain make up a relatively small proportion of the patients attended by prehospital care services, medical intervention is needed in only 40% of cases. This might go some way to explaining why management of paediatric pain is perceived as poor. Aim: To establish and explore published barriers and facilitators to out-of-hospital pain management for children aged <18 years. Methods: Key search terms were used to search the three databases (CINAHL, MEDLINE and PSYCHInfo) individually and simultaneously. Inclusion and exclusion criteria were applied and 15 papers were identified as meeting the criteria and were subject to data extraction. Results: Three broad themes were identified; organisational factors, patient factors and clinician factors. Conclusion: From considering international systems and aspects of care, it can generally be accepted that the assessment and management of paediatric pain is below what would be expected, and compared with with that for adults, it is sub-optimal. Multiple demographic influences are evident and appear to influence clinician decisions.

After completing this module, the paramedic will be able to:

Pain is one of the most common symptoms presented by patients of all ages to ambulance services (Brown et al, 2017; 2019). The estimated incidence of 126.4 per 10 000 population of children sustaining an intentional or unintentional injury (Critchley and Quigg, 2019) indicates the importance of care for these patients. There is also a need for prehospital clinicians to be aware that symptoms need to be managed adequately.

Established national guidance omits explicit mention of the management of acute pain in those aged under 16 years; furthermore, there are no standard guidelines in the UK on choosing an analgesic for paediatric patients (National Institute for Health and Care Excellence (NICE), 2013; 2015).

While paediatric patients in pain are a relatively small proportion of those attended by prehospital care services, the common reason for aid being requested is a belief that medical intervention is required (Pilbery et al, 2019). However, only in 40% of cases this was necessary (i.e. oxygen, bronchodilators and antipyretics) (Wilkinson and Heinz, 2014).

Subscribe to get full access to the Journal of Paramedic Practice

Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

What's included

  • CPD Focus

  • Develop your career

  • Stay informed

Register
Or continue by

Signing in with your registered email address

pain