Rahman Amaly, Curtis Sarah, DeBruyne Beth, Sookram Sunil, Thomson Denise, Lutz Shari, Ali Samina
1Department of Pediatrics,University of Alberta,Edmonton,Alberta,Canada.
3Department of Emergency Medicine, Faculty of Medicine and Dentistry,University of Alberta,Edmonton,Alberta,Canada.
Prehosp Disaster Med. 2015 Feb;30(1):66-71. doi: 10.1017/S1049023X14001277. Epub 2014 Dec 8.
The undertreatment of pediatric pain is a significant concern among families, clinicians, and researchers. Although some have examined prehospital pain management, the deterrents to pediatric analgesia administration by Emergency Medical Services (EMS) have not yet been examined in Canada. Problem This study describes EMS pain-management practices and prehospital provider comfort treating pediatric pain. It highlights differences in pain management between adults and children and assesses the potential barriers, misconceptions, difficulties, and needs related to provision of pediatric analgesia.
A study-specific survey tool was created and distributed to all Primary Care Paramedics (PCPs) and Advanced Care Paramedics (ACPs) over four mandatory educational seminars in the city of Edmonton (Alberta, Canada) from September through December 2008.
Ninety-four percent (191/202) of EMS personnel for the city of Edmonton completed the survey. The majority of respondents were male (73%, 139/191), aged 26-35 (42%, 80/191), and had been in practice less than 10 years (53%, 101/191). Seventy-four percent (141/191) of those surveyed were ACPs, while 26% (50/191) were PCPs. Although the majority of respondents reported using both pain scales and clinical judgement to assess pain for adults (85%, 162/191) and adolescents (86%, 165/191), children were six times more likely than adults (31%, 59/191 vs 5%, 10/191) to be assessed by clinical judgement alone. Emergency Medical Services personnel felt more comfortable treating adults than children (P < .001), and they were less likely to treat children even if they were experiencing identical types and intensities of pain as adults (all P values <.05) and adolescents (all P values < .05). Twenty-five percent of providers (37/147) assumed pediatric patients required less analgesia due to immature nervous systems. Three major barriers to treating children's pain included limited clinical experience (34%, 37/110), difficulty in communication (24%, 26/110) and inability to assess children's pain accurately (21%, 23/110).
Emergency Medical Services personnel self-report that children's pain is less rigorously measured and treated than adults' pain. Educational initiatives aimed at increasing clinical exposure to children, as well as further education regarding simple pain measurement tools for use in the field, may help to address identified barriers and discomfort with assessing and treating children.
儿科疼痛治疗不足是家庭、临床医生和研究人员极为关注的问题。尽管有些人已对院前疼痛管理进行了研究，但加拿大尚未对紧急医疗服务（EMS）人员给予儿科镇痛的阻碍因素进行研究。问题 本研究描述了EMS的疼痛管理实践以及院前医护人员治疗儿科疼痛时的舒适度。它突出了成人和儿童在疼痛管理方面的差异，并评估了与提供儿科镇痛相关的潜在障碍、误解、困难和需求。
创建了一项针对本研究的调查工具，并在2008年9月至12月期间于加拿大艾伯塔省埃德蒙顿市举办的四次强制性教育研讨会上分发给所有初级护理急救员（PCP）和高级护理急救员（ACP）。
埃德蒙顿市94%（191/202）的EMS人员完成了调查。大多数受访者为男性（73%，139/191），年龄在26 - 35岁之间（42%，80/191），且从业年限少于10年（53%，101/191）。接受调查的人员中74%（141/191）为ACP，26%（50/191）为PCP。尽管大多数受访者报告在评估成人（85%，162/191）和青少年（86%，165/191）的疼痛时同时使用疼痛量表和临床判断，但儿童仅通过临床判断进行评估的可能性是成人的六倍（31%，59/191对比5%，10/191）。EMS人员在治疗成人疼痛时比治疗儿童疼痛时感觉更自在（P <.001），并且即使儿童与成人经历相同类型和强度的疼痛，他们治疗儿童的可能性也更低（所有P值 <.05），与青少年相比也是如此（所有P值 <.05）。25%的医护人员（37/147）认为儿科患者由于神经系统不成熟而需要较少的镇痛。治疗儿童疼痛的三大障碍包括临床经验有限（34%，37/110）、沟通困难（24%，26/110）以及无法准确评估儿童疼痛（21%，23/110）。
EMS人员自我报告称，儿童疼痛的测量和治疗不如成人疼痛严格。旨在增加临床接触儿童的教育举措，以及针对现场使用的简单疼痛测量工具的进一步教育，可能有助于解决已识别出的评估和治疗儿童时的障碍及不适感。
