Whitley Daniel E, Li Timmy, Jones Courtney M C, Cushman Jeremy T, Williams David M, Shah Manish N
From the *University of Rochester School of Medicine and Dentistry, Departments of †Emergency Medicine, and ‡Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester; §Department of Surgery, New York University School of Medicine, New York; and ║Division of Geriatrics/Aging, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY.
Pediatr Emerg Care. 2017 Jun;33(6):381-387. doi: 10.1097/PEC.0000000000000514.
The aim of this study was to quantitatively assess the prevalence of newly identified barriers and enablers to prehospital narcotic analgesic administration in a sample of paramedics and determine whether these barriers and enablers differ between new and experienced paramedics.
We surveyed a convenience sample of paramedics from urban, suburban, and rural practice settings in an emergency medical services system. Descriptive statistics were calculated to describe responses, and differences between new (≤5 years) and experienced (>5 years) providers were assessed.
There were 127 surveys analyzed; 67% of our sample was experienced and 86% considered treating pain important. Notable barriers for analgesic administration include causing more pain from intravenous catheter insertion, parental influences, difficulty assessing pain, and worry about allergic reactions. Notable enablers include belief that analgesic administration is important, education to administer analgesics, and support from agency leadership. There were statistically significant differences between new and experienced providers in the distribution of responses for survey items regarding how the importance of treating pain in children was learned, overall comfort with pediatric patients, receiving negative responses from superiors about giving pediatric patients analgesics, and usefulness of the Broselow tape for dosing fentanyl for children. Other barriers and enablers were not significantly different between new and experienced providers.
Top barriers to prehospital pediatric analgesic administration are related to skills and knowledge deficits, whereas enablers include support from agency leadership and personal views on analgesics. This information can be used to guide interventions to improve the management of pain in children.
本研究旨在定量评估急救医护人员样本中新发现的院前使用麻醉性镇痛药的障碍和促进因素，并确定这些障碍和促进因素在新老急救医护人员之间是否存在差异。
我们对一个紧急医疗服务系统中来自城市、郊区和农村执业环境的急救医护人员进行了便利抽样调查。计算描述性统计数据以描述调查结果，并评估新入职（≤5年）和经验丰富（>5年）的急救医护人员之间的差异。
共分析了127份调查问卷；我们样本中的67%为经验丰富的急救医护人员，86%的人认为治疗疼痛很重要。使用镇痛药的显著障碍包括静脉置管引起更多疼痛、家长影响、疼痛评估困难以及担心过敏反应。显著的促进因素包括认为使用镇痛药很重要、镇痛药使用教育以及机构领导的支持。在关于如何了解治疗儿童疼痛的重要性、对儿科患者的总体舒适度、上级对给儿科患者使用镇痛药的负面反馈以及布罗泽洛胶带对儿童芬太尼给药的有用性等调查项目的回答分布上，新老急救医护人员之间存在统计学显著差异。新老急救医护人员在其他障碍和促进因素方面没有显著差异。
院前儿科镇痛的主要障碍与技能和知识缺陷有关，而促进因素包括机构领导的支持和对镇痛药的个人看法。这些信息可用于指导干预措施，以改善儿童疼痛管理。
