Emergency Medical Services of Karlovy Vary Region, Karlovy Vary, Czech Republic.
Department of Anesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Šrobárova 50, 100 34, Prague, Czech Republic.
BMC Emerg Med. 2022 Apr 9;22(1):63. doi: 10.1186/s12873-022-00622-8.
The use of intravenous opioids in the traumatic pain in pre-hospital care in the Czech Republic is based primarily on the indication of a physician. If the paramedic crew arrives at the site earlier or only on their own, analgesia is given after phone-call consultation with the physician or after his arrival at the site. The objective of this study was to evaluate the safety and efficacy of the indication and administration of sufentanil by paramedics in the treatment of pain in acute trauma adult patients without the physician's control.
Paramedics underwent voluntarily the simulation training aimed at administering intravenously sufentanil to treat pain in acute trauma in adults without physician's indication. Subsequently, the adverse events and efficacy were monitored for a six-month period and compared in two groups: administration of sufentanil by paramedics without this competence, who further consulted the administration by telephone with physicians (group Consultation) and those with this competence (group Competence).
A total number of sufentanil administration in group Consultation was 88 and in group Competence 70. There was no respiratory arrest, bradypnea, or need for oxygen therapy reported in any of the study groups. The incidence of nausea was 3% in both groups - Consultation (n = 3) and in Competence (n = 2). Vomiting was not reported in the Consultation group and in 6% in the Competence group (n = 4). Intravenous antiemetic drugs were used in the Consultation group only in 1% (n = 1) and in the Competence group in 7% of patients (n = 5) (p < 0,05). In both groups there was observed a decrease in the pain numeric rating scale (Consultation: M =-3,2; SD = 1,2 points vs. Competence: M =-3,9; SD = 1,8 points).
Intravenous administration of sufentanil by properly trained paramedics without consultation with a physician in acute trauma can be considered safe.
在捷克共和国的院前急救中，静脉使用阿片类药物主要基于医生的指示。如果护理人员先到达现场或只有他们自己在场，在与医生电话咨询或医生到达现场后，会给予镇痛治疗。本研究的目的是评估未经医生控制，由护理人员对急性创伤成年患者疼痛进行指示和给予舒芬太尼治疗的安全性和有效性。
护理人员自愿接受模拟培训，旨在在没有医生指示的情况下对急性创伤成人患者静脉给予舒芬太尼进行疼痛治疗。随后，在六个月的时间内监测不良事件和疗效，并在两组中进行比较：未经该能力的护理人员给予舒芬太尼（咨询组）和有该能力的护理人员（能力组）。
咨询组共给予舒芬太尼 88 次，能力组共给予舒芬太尼 70 次。研究组均未报告呼吸暂停、呼吸过缓或需要氧疗。两组的恶心发生率均为 3%（咨询组：n=3；能力组：n=2）。咨询组无呕吐，能力组有 6%（n=4）呕吐。咨询组仅 1%（n=1）的患者使用静脉止吐药，能力组有 7%（n=5）的患者使用（p<0.05）。两组患者疼痛数字评分量表（咨询组：M=-3.2；SD=1.2 分；能力组：M=-3.9；SD=1.8 分）均有下降。
经过适当培训的护理人员在未经与医生咨询的情况下对急性创伤患者静脉给予舒芬太尼，可以认为是安全的。
