Date of Award
Medical Doctor (MD)
Medical utilization of opioid analgesia comes with a risk of iatrogenic opioid addiction. It is crucial to scrutinize areas where opioids are used by medicine, including emergency pre-hospital pain care. It is important to investigate if pre-hospital pain management is adequate, and if the benefits of opioid analgesia outweigh the risk of iatrogenic addiction. The objective was to characterize opioid administration and pain complaints in the pre-hospital setting in New Haven, and compare to global trends.
A retrospective qualitative chart review focused on a two-week period of adults transported by emergency medical personnel to Yale New Haven Hospital’s York Street adult emergency department. A literature review was done to understand current trends both regionally and worldwide regarding pre-hospital pain documentation and management and protocols implemented.
There were 1,611 patients brought by ambulance who were included, excluding any age< 18 years, record confidentiality, and obtunded presentations. Ambulance run-sheets were missing in 770 cases. In 301 cases, there were medical pain complaints. Roughly half reported severe pain. EMS administered opioid analgesia in 12 cases. In another 349 cases, patients reported acute injuries. Pain ranged moderate-severe. EMS gave opioids in 10 cases. The patients who received pain medications for medical reasons had a mean age of 57 years and those with acute pain had a mean age of 43.1. Females made up 61.8% medical opioid treatment and 33.7% of acute injury pain treatment. EMS never administered ketamine, NSAIDs, or tylenol. A global trend of oligoanalgesia in acute pre-hospital management was found in literature, along with sex, age, and race disparity.
With half of the ambulance run-sheets missing, it is difficult to assess EMS pain management. Results suggest EMS transport in New Haven follows the trend of oligoanalgesia, pain assessment documentation, and age disparity. There is a question of whether there is sex disparity. Opioids are not given often for medical chief complaints. Future direction should be why opioid alternatives are not used as often as the protocol suggests, and how to improve pain documentation.
Stands-Over-Bull, Goldie Beth, "Characterization And Review Of Pre-Hospital Pain Management Strategies At Yale New Haven Hospital" (2019). Yale Medicine Thesis Digital Library. 3535.