Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, St. Josefs-Hospital Cloppenburg, Academic Teaching Hospital of the Hannover Medical School (MHH), Krankenhausstrasse, 13, 49661, Cloppenburg, Germany.
Department of Internal Medicine, St. Josefs-Hospital Cloppenburg, Academic Teaching Hospital of the Hannover Medical School (MHH), Cloppenburg, Germany.
BMC Emerg Med. 2023 Sep 14;23(1):104. doi: 10.1186/s12873-023-00878-8.
BACKGROUND: Treatment of acute pain is an essential element of pre-hospital care for injured and critically ill patients. Clinical studies indicate the need for improvement in the prehospital analgesia.
The aim of this study is to assess the current situation in out of hospital pain management in Germany regarding the substances, indications, dosage and the delegation of the use of analgesics to emergency medical service (EMS) staff.
A standardized survey of the medical directors of the emergency services (MDES) in Germany was carried out using an online questionnaire. The anonymous results were evaluated using the statistical software SPSS (Chi-squared test, Mann-Whitney-U test).
Seventy-seven MDES responsible for 989 rescue stations and 397 EMS- physician bases in 15 federal states took part in this survey. Morphine (98.7%), Fentanyl (85.7%), Piritramide (61%), Sufentanil (18.2%) and Nalbuphine (14,3%) are provided as opioid analgesics. The non-opioid analgesics (NOA) including Ketamine/Esketamine (98,7%), Metamizole (88.3%), Paracetamol (66,2%), Ibuprofen (24,7%) and COX-2-inhibitors (7,8%) are most commonly available. The antispasmodic Butylscopolamine is available (81,8%) to most rescue stations. Fentanyl is the most commonly provided opioid analgesic for treatment of a traumatic pain (70.1%) and back pain (46.8%), Morphine for visceral colic-like (33.8%) and non-colic pain (53.2%). In cases of acute coronary syndrome is Morphine (85.7%) the leading analgesic substance. Among the non-opioid analgesics is Ketamine/Esketamine (90.9%) most frequently provided to treat traumatic pain, Metamizole for visceral colic-like (70.1%) and non-colic (68.6%) as well as back pain (41.6%). Butylscopolamine is the second most frequently provided medication after Metamizole for "visceral colic-like pain" (55.8%). EMS staff (with or without a request for presence of the EMS physician on site) are permitted to use the following: Morphine (16.9%), Piritramide (13.0%) and Nalbuphine (10.4%), and of NOAs for (Es)Ketamine (74.1%), Paracetamol (53.3%) and Metamizole (35.1%). The dosages of the most important and commonly provided analgesic substances permitted to independent treatment by the paramedics are often below the recommended range for adults (RDE). The majority of medical directors (78.4%) of the emergency services consider the independent application of analgesics by paramedics sensible. The reason for the relatively rare authorization of opioids for use by paramedics is mainly due to legal (in)certainty (53.2%).
Effective analgesics are available for EMS staff in Germany, the approach to improvement lies in the area of application. For this purpose, the adaptations of the legal framework as well as the creation of a guideline for prehospital analgesia are useful.
背景：急性疼痛的治疗是受伤和危重病患者院前护理的重要组成部分。临床研究表明需要改进院前镇痛。
本研究旨在评估德国院外疼痛管理中在物质、适应症、剂量以及将镇痛药的使用委托给急救医疗服务（EMS）人员方面的现状。
使用在线问卷对德国急救服务的医疗主任（MDES）进行了标准化调查。匿名结果使用统计软件 SPSS（卡方检验，Mann-Whitney-U 检验）进行评估。
来自 15 个联邦州的 989 个救援站和 397 个 EMS-医师基地的 77 名 MDES 负责人参与了这项调查。吗啡（98.7%）、芬太尼（85.7%）、哌替啶（61%）、舒芬太尼（18.2%）和纳布啡（14.3%）被用作阿片类镇痛药。非阿片类镇痛药（NOA）包括氯胺酮/ Esketamine（98.7%）、甲灭酸（88.3%）、扑热息痛（66.2%）、布洛芬（24.7%）和 COX-2 抑制剂（7.8%）最常用。大多数救援站都有解痉药丁溴东莨菪碱（81.8%）。芬太尼是治疗创伤性疼痛（70.1%）和背痛（46.8%）最常用的阿片类镇痛药，吗啡用于内脏绞痛样（33.8%）和非绞痛性疼痛（53.2%）。在急性冠状动脉综合征的情况下，吗啡（85.7%）是主要的镇痛物质。非阿片类镇痛药中，氯胺酮/ Esketamine（90.9%）最常用于治疗创伤性疼痛，甲灭酸用于内脏绞痛样（70.1%）和非绞痛性（68.6%）以及背痛（41.6%）。丁溴东莨菪碱是继甲灭酸之后第二常用的治疗“内脏绞痛样疼痛”药物（55.8%）。允许 EMS 工作人员（无论是否要求 EMS 医生在场）使用以下药物：吗啡（16.9%）、哌替啶（13.0%）和纳布啡（10.4%），以及（ES）氯胺酮（74.1%）、扑热息痛（53.3%）和甲灭酸（35.1%）等 NOA。允许护理人员独立治疗的最常用和最重要的镇痛药物的剂量通常低于成人推荐剂量范围（RDE）。大多数急救服务的医疗主任（78.4%）认为急救人员独立使用镇痛药是合理的。急救人员使用阿片类药物的授权相对较少的原因主要是法律上的（不确定）（53.2%）。
德国的急救人员有有效的镇痛药，改进的方法在于应用。为此，适应法律框架以及创建院前镇痛指南是有用的。
