References

Ancker K, Halldin M, Gothe CJ Nitrous-oxide analgesia during ambulance transportation. Airborne levels of nitrous oxide. Acta Anaesthesiol Scand. 1980; 24:(6)497-500

Bridgwater: Class Professional Publishing; 2013

Australian New Zealand Clinical Trials Registry. Paramedic performed fascia iliaca compartment block for patients with suspected femoral fractures: A randomised controlled trial., Trial No. ACTRN12610000504011. 2010. http//www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=335607 (accessed 23 July 2014)

Ball C, Westhorpe RN Methoxyflurane: then and now. Anaesth Intensive Care. 2007; 35:(2)

Baskett PJ The use of entonox in the ambulance service. Proc R Soc Med. 1972; 65:(1)7-8

Baskett PJ, Withnell A Use of Entonox in the ambulance service. BMJ. 1970; 2:(700)41-3

Bendall JC, Simpson PM, Middleton PM Effectiveness of prehospital morphine, fentanyl, and methoxyflurane in pediatric patients. Prehosp Emerg Care. 2011; 15:(2)158-65

Assessment of pain in older adults with dementia—there's an app for that.London: BGS; 2013

British Red Cross. The history of emergency transportation British Red Cross, London. 2013. http//www.redcross.org.uk/About-us/Who-we-are/Museum-and-archives/Historical-factsheets/Emergency-Transport (Accessed 16 November 2013)

Buntine P, Thom O, Babl F, Bailey M, Bernard S Prehospital analgesia in adults using inhaled methoxyflurane. Emerg Med Australas. 2007; 19:(6)509-14

Caradoc-Davies T Opiate toxicity in elderly patients. BMJ. 1981; 283:(6296)

Carney C Prehospital Care—a UK perspective. Brit Med Bull. 1999; 55:(4)757-66

Caton DNew Haven, Conn: Yale University Press; 1999

Chambers JA, Guly HR The need for better pre-hospital analgesia. Arch Emerg Med. 1993; 10:(3)187-92

Chambers JA, Guly HR Prehospital intravenous nalbuphine administered by paramedics. Resuscitation. 1994; 27:(2)153-8

Charlton JESeattle: IASP Press; 2005

Cousins MJ, Lynch ME The Declaration Montreal: access to pain management is a fundamental human right. Pain. 2011; 152:(12)2673-74

Cousins MJ, Mazze RI, Kosek JC, Hitt BA, Love FV The etiology of methoxyflurane nephrotoxicity. J Pharmacol Exp Ther. 1974; 190:(3)530-4

Craig KD The social communication model of pain. Can Psychol. 2009; 50:(1)22-32

Derry CJ, Derry S, Moore RA Sumatriptan (intranasal route of administration) for acute migraine attacks in adults. Cochrane Database Syst Rev. 2012; 2

News. Anaesthesia. 1972; 27:(2)242-6

Fleischman RJ, Frazer DG, Daya M, Jui J, Newgard CD Effectiveness and safety of fentanyl compared with morphine for out-of-hospital analgesia. Prehosp Emerg Care. 2010; 14:(2)167-75

Gray A, Johnson G, Goodacre S Paramedic use of nalbuphine in major injury. Eur J Emerg Med. 1997; 4:(3)136-9

Group Authority (NHS Ambulance Trusts and Paramedics Employed).London: Home Office; 2008

Houlihan KP, Mitchell RG, Flapan AD, Steedman DJ Excessive morphine requirements after pre-hospital nalbuphine analgesia. J Accid Emerg Med. 1999; 16:(1)29-31

Hyland-McGuire P, Guly HR Effects on patient care of introducing prehospital intravenous nalbuphine hydrochloride. J Accid Emerg Med. 1998; 15:(2)99-101

Jennings PA, Cameron P, Bernard S Ketamine as an analgesic in the pre-hospital setting: a systematic review. Acta Anaesth Scand. 2011; 55:(6)638-43

Jennings PA, Cameron P, Bernard S Morphine and ketamine is superior to morphine alone for out-of-hospital trauma analgesia: a randomized controlled trial. Ann Emerg Med. 2012; 59:(6)497-503

Urgent notice Re: Withdrawal of nalbuphine (Nubain).London: JRCALC; 2004

Kober A, Scheck T, Greher M Prehospital analgesia with acupressure in victims of minor trauma: a prospective, randomized, double-blinded trial. Anesth Analg. 2002; 95:(3)723-7

Komesaroff D Pre-hospital pain relief: Penthrane or Entonox?. Aust J Emergency Care. 1995; 2:(2)28-9

Lang T, Hager H, Funovits V Prehospital analgesia with acupressure at the Baihui and Hegu points in patients with radial fractures: a prospective, randomized, double-blind trial. Am J Emerg Med. 2007; 25:(8)887-93

Macintyre PE, Schug SA, Scott DA, Visser EJ, Walker SM Acute pain management: scientific evidence.Melbourne: Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine; 2010

London: The Stationery Office;

Melzack R, Wall PD Pain mechanisms: a new theory. Science. 1965; 150:(3699)971-9

Middleton PM, Simpson PM, Sinclair G, Dobbins TA, Math B, Bendall JC Effectiveness of morphine, fentanyl, and methoxyflurane in the prehospital setting. Prehosp Emerg Care. 2010; 14:(4)439-47

London: The Stationery Office;

London: The Stationery Office;

Use of nitrous oxide:oxygen mixtures in prehospital emergency care. National Association of Emergency Medical Services Physicians. Prehosp Disaster Med. 1990; 5:(3)273-4

Amersham UK: HMSO; 1981

Nicholls T, Hawkes-Frost LBridgwater: Class Professional Publishing; 2012

Workplace exposure standards for airborne contaminants: Nitrous oxide.Canberra: Safe Work Australia; 2013

Simpson PM, Fouche PF, Thomas RE, Bendall JC Transcutaneous electrical nerve stimulation for relieving acute pain in the prehospital setting: a systematic review and meta-analysis of randomized-controlled trials. Eur J Emerg Med. 2013; 21:(1)10-17

Stewart RD, Paris PM, Stoy WA, Cannon GB Patient-controlled inhalational analgesia in prehospital care: A study of side-effects and feasibility. Crit Care Med. 1983; 11:(11)851-5

Turner J, Coster J, Wilson R, Phung V, Siriwardena AN What outcome measures should be developed for pre-hospital care?: results of a consensus event. Prehosp Disaster Med. 2013; 28

Waters EM, Gerstner HB, Huff JE Trichloroethylene: an overview. J Toxicol Environ Health. 1977; 2:(3)671-707

Woollard M, Jones T, Pitt K, Vetter N Hitting them where it hurts? Low dose nalbuphine therapy. Emerg Med J. 2002; 19:(6)565-70

Wright CJ, McDowall DG, Wilson J, Hain WR, Furness R, Daykin JH Pre-mixed nitrous oxide-oxygen analgesia in the ambulance service. Anaesthesia. 1972; 27:(4)459-60

A brief history of analgesia in paramedic practice

02 August 2014
Volume 6 · Issue 8

Abstract

Paramedics and ambulance clinicians have an important role in alleviating pain. However, clinician-initiated analgesia has a relatively short history when compared with the field of medicine. Several barriers to the introduction of pharmacological options for the management of pain appear to have delayed the introduction of options for managing severe pain. These include legislative restrictions as well as concerns about the adverse effects of analgesics.

This report describes the history of analgesia in paramedic or ambulance practice in the United Kingdom (UK) and Australia in order to add to the knowledge base for this profession, and to inform the development of strategies to advance pain management practice.

Relief from pain is a basic human right that compels healthcare professionals to apply the principles of beneficence and non-maleficence to the management of pain in a way that would be expected of a reasonably careful and competent healthcare professional in their field of practice (Cousins and Lynch, 2011). Pain management is now a recognised specialisation in medical and allied health disciplines, and a substantial body of research has informed the development of evidence-based guidelines for the care of individuals experiencing pain.

Significant advances in the understanding of pain have occurred since Melzack and Wall (1965) first proposed a new theory of pain. This work led to a greater understanding of the complex nature of pain, and this subsequently generated a substantial investment in research into pain and methods of managing pain, which has recognised the important social, biophysical and psychological dimensions of pain (Craig, 2009).

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