Pain is Inevitable, Suffering is Optional: An Analysis of Paramedic Student Treatment of Extremity Traumas

Laurie Hill,  NRP; Catherine Lewis, BA; Jason Hums, MPH; Avis Thomas, MS; Sandi Wewerka, EMT-B, MPH; Benjamin Getsug; Rachel Walberg, BA; Abigail Zagar, BS; Nick Skenderian, BA, EMT-B; Nathan Ross, BS, NRP, MS; Mike Burbank, EMT-B; Mark Malonzo, MA, NRP

Background

Evidence-based standards in pain management indicate all patients should have pain assessed continually utilizing age-appropriate pain scales. Additionally, all patients with moderate or greater pain should be considered candidates for analgesia regardless of transport intervals.

Hypothesis

Paramedic students are not administering narcotic medication for pain management uniformly across age groups.

Methods

A retrospective review of data was collected using Fisdap™, an internship skills tracking system for EMS students.  Inclusion criteria included:  Field data inputted by paramedic students in contexts between 01-01-2009 and 12-31-2013; patients coded as “alert and oriented”; patients with a primary impression of “trauma – extremity”. Age groups were defined as pediatric (0-8 years), adolescent (9-17), adult (18-69) & geriatric (70+). Patient care was analyzed based on administration of narcotic pain management medication (morphine, fentanyl, hydromorphone & meperidine). Data was analyzed using descriptive statistics and P-values were calculated for two-way interactions between categorical variables using Chi Square statistics.  Most differences were statistically significant due to large sample size.

Results

A total of 190,449 patient encounters by 33,997 paramedic students were included for analysis. 62 patients were excluded due to missing age. The final data set included 190,449 patients. (Table 1, 2) We were interested in examining differences between team lead, skills performed and skills observed. Given that the majority of the data included team leads, we did not explore differences in these categories beyond this point (Table 3). In a comparison between age groups, results indicated patients in the pediatric age group received narcotic medication significantly less frequently than patients in other age groups (Chart 1).

Table 1
GenderSample SizePercent of Sample
Female103,02754.10
Male87,42245.90
Table 2
Age Group (years)Sample SizePercent of Sample
0-87,5714%
9-1717,5239%
18-69109,49358%
≥7055,862

29%

 

Table 3
Clinical ExperiencePercent
Lead77.53
Performed17.32
Observed5.15

 

Chart 1

Narcotic use trends over time

Conclusion

In examining the paramedic students’ treatment of extremity trauma between 2009 and 2013, a trend appeared that administration of narcotic medication to pediatric patients was approximately one third the rate given to other age groups.  Future research needs to be done to determine the reasons for this discrepancy.