Whitley Gregory Adam, Hemingway Pippa, Law Graham Richard, Siriwardena Aloysius Niroshan
Community and Health Research Unit, School of Health and Social Care University of Lincoln Lincoln UK.
Faculty of Medicine and Health Sciences University of Nottingham Nottingham UK.
Health Sci Rep. 2021 Apr 9;4(2):e261. doi: 10.1002/hsr2.261. eCollection 2021 Jun.
When children suffer acute pain, the ambulance service is often involved to provide initial assessment, treatment, and transport. Several predictors of effective pain management have been identified, including children who are younger (0-5 years), administered analgesics, and living in homes from more affluent areas.
To explain previously identified predictors of effective prehospital pain management in children.
Mixed methods sequential explanatory study.
East Midlands Ambulance Service National Health Service Trust paramedics and emergency medical technicians (EMTs) participated in face-to-face semi-structured interviews. These were audio recorded, transcribed verbatim, and coded using thematic analysis. Meta-inferences were generated and illustrated within a joint display.
Twelve clinicians (9 paramedics and 3 EMTs) were interviewed. Median (interquartile range) age was 43.5 years (41.5, 45.75), 58% were male (n = 7) and 58% were parents (n = 7). Possible explanations were provided for all predictors. Younger children were perceived to express more emotion, were easier to distract, and lived more in the moment than their older counterparts, which explained why younger children were more likely to achieve effective pain management. Analgesics were perceived to have a psychosocial benefit in addition to the pharmacological action. Ambulance clinicians felt that children living in more affluent areas were more likely to achieve effective pain management because the kempt environment facilitated assessment and management and clinicians spent more time on scene; this allowed more time for analgesics to take effect. Participants perceived paramedics to be more confident, and it was found that paramedics were older, more experienced, had a greater scope of practice, and spent more time on scene than EMTs.
Prehospital pain management in children could be improved by facilitating and prioritizing analgesic administration and by ambulance services ensuring a paramedic, or highly trained clinician, is present on each vehicle, necessitating long-term commitment to staff development.
儿童遭受急性疼痛时，救护服务通常会参与提供初步评估、治疗和转运。已确定了有效疼痛管理的几个预测因素，包括年龄较小（0至5岁）、接受镇痛药治疗以及居住在较富裕地区家庭的儿童。
解释先前确定的儿童院前有效疼痛管理的预测因素。
混合方法序列解释性研究。
东米德兰兹救护服务国民保健服务信托机构的护理人员和急救医疗技术员（EMT）参与了面对面的半结构化访谈。访谈进行了录音，逐字转录，并使用主题分析进行编码。在联合展示中生成并说明了元推断。
采访了12名临床医生（9名护理人员和3名急救医疗技术员）。年龄中位数（四分位间距）为43.5岁（41.5，45.75），58%为男性（n = 7），58%为父母（n = 7）。对所有预测因素都提供了可能的解释。较年幼儿童被认为比年龄较大儿童表达更多情感、更容易分散注意力且更活在当下，这解释了为什么年幼儿童更有可能实现有效的疼痛管理。除了药理作用外，镇痛药还被认为具有心理社会益处。救护临床医生认为，生活在较富裕地区的儿童更有可能实现有效的疼痛管理，因为整洁的环境便于评估和管理，且临床医生在现场花费更多时间；这使得有更多时间让镇痛药发挥作用。参与者认为护理人员更有信心，并且发现护理人员比急救医疗技术员年龄更大、经验更丰富、执业范围更广且在现场花费更多时间。
通过促进和优先给予镇痛药以及救护服务确保每辆车都有一名护理人员或训练有素的临床医生在场，可改善儿童院前疼痛管理，这需要对人员发展做出长期承诺。
