[Comparison of the preclinical quality of analgesia of emergency physicians and paramedics based on trauma patients].

Die Anaesthesiologie Pub Date : 2024-09-01 Epub Date: 2024-08-06 DOI:10.1007/s00101-024-01447-9
Julian Thomas, Stefan Kleinschmidt, Philipp Mörsdorf, David Conrad, Ulrich Berwanger, Werner Armbruster
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Abstract

Background: Adequate prehospital pain management is a critical component of emergency medical services. With the introduction of the paramedic profession and the Paramedics Act in Germany, the basis for more extensive competencies of paramedics was established. In many emergency medical service areas it is thus possible for paramedics to perform analgesia and sedation with esketamine/midazolam according to pre-established instructions and/or standard operating procedures. This study assessed the quality of analgesia administered to trauma patients by paramedics compared to emergency medical service physicians.

Material and methods: The study included trauma patients who received prehospital administration of analgesia by either emergency medical service physicians or paramedics and were subsequently admitted to the central emergency department of the Saarland University Hospital. A standardized data collection form was used to collect information from the emergency service protocol and initial emergency department assessment. The evaluation employed descriptive statistical methods and a total of 207 completed records were analyzed.

Results: Both professional groups achieved significant pain reduction and fulfilled the criteria for effective pain management (pain reduction: emergency medical service physicians 5.5 ± 2.0/paramedic 4.4 ± 2.1, p < 0.001). Emergency medical service physicians, however, more frequently attained a higher reduction in numerical rating scale scores and administered oxygen. Notable differences were observed in the range of medications used and the dosages.

Conclusion: This study could show that prehospital analgesia is comparable between emergency medical service physicians and paramedics in terms of effectiveness for trauma patients if the indications are correctly set, while observing pre-existing instructions. With their competencies paramedics are able to perform an effective and safe analgesic treatment within the framework of preformulated procedural instructions, which can be equal to that of an emergency medical service physician.

[基于创伤患者,比较急诊科医生和辅助医务人员的临床前镇痛质量]。
背景:充分的院前疼痛管理是急救医疗服务的重要组成部分。随着辅助医务人员职业和《辅助医务人员法》在德国的实施,为辅助医务人员更广泛的能力奠定了基础。因此,在许多急救医疗服务地区,辅助医务人员可以根据预先制定的说明和/或标准操作程序,使用艾司氯胺酮/咪达唑仑进行镇痛和镇静。本研究评估了辅助医务人员与急救医生为创伤患者实施镇痛的质量:研究对象包括由急诊科医生或辅助医务人员进行院前镇痛并随后入住萨尔州大学医院中心急诊科的外伤患者。研究人员使用标准化数据收集表收集急诊服务协议和急诊科初步评估信息。评估采用了描述性统计方法,共分析了207份完整记录:结果:两组专业人员都取得了明显的止痛效果,达到了有效止痛的标准(止痛效果:急诊科医生为 5.5 ± 2.0,护理人员为 4.4 ± 2.1,P 结论:该研究表明,院前止痛是一种有效的止痛方法:这项研究表明,如果正确设定适应症,同时遵守预先存在的指示,急救医生和护理人员对创伤患者的院前镇痛效果相当。辅助医务人员凭借其能力,能够在预先制定的程序指示框架内进行有效、安全的镇痛治疗,与急诊科医生的能力相当。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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