Appropriate morphine administration by paramedics: a review of the literature
Abstract
Objective: This paper focuses on three main areas: pain management practices for paramedics; in service continuing education programs and, possible pain-management differences between two levels of paramedics.
Methods: A literature search was performed using four databases to identify literature reviews and journal articles from 1997 to 2013. The search was focused around three core areas: 1) Pre-hospital pain management 2) barriers to pain management; and 3) pain management education. There was a five stage process to identify the relevant literature based on specific terminology in the abstracts.
Results: The literature search located 1 240 articles, incorporating five stages with each stage having specific terms relevant to the research. Thirty two articles met the inclusion criteria. The breakdown of the articles included stage one – 6 articles, stage 2 – 10 results, stage 3 – 11 results, stage four – 5 articles and stage 5 – 0 articles.
Conclusions: There remains little high-quality published evidence of systemic theoretical approach with which to validate many aspects of pain management in paramedic practice. Future research must identify if concepts taught in the classroom are being transferred to the clinical setting. Potential findings of such a study could be used to improve organisational awareness of factors that contribute to the behaviour and development of paramedics.
Paramedics are a critical component of the health care system, the public health system and the public safety system. As an example the mission statement of the Queensland Ambulance Service (QAS) is to improve the health, safety and well-being of the community (QAS, 2013). One of the duties of paramedics in fulfilling this mission is to relieve pain and suffering. As professional health care providers, paramedics through their business of providing high-quality patient care for the best possible outcomes should adhere to best practice guidelines and evidence based medicine in order to deliver the best possible care to patients. Unfortunately, lack of research, poor or outdated procedures, attitudes, knowledge deficits and poor clinical judgment can all impede best practices. Paramedics have a primary responsibility for assessing pain and for making decisions about pain management based on sound clinical judgment. Paramedics’ judgments may be influenced by many factors including education and their knowledge and attitudes towards pain and pain management; misconceptions about pain and pain management may also result in poor clinical management of a patient's pain. This paper will examine the factors that influence the paramedic's management of pain. We examine challenges to proper pain management and recommend steps to help ensure that all patients will receive appropriate pain management.
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