Exploring factors increasing paramedics’ likelihood of administering analgesia in pre-hospital pain: cross sectional study (ExPLAIN)

Introduction This study aimed to investigate patient and practitioner factors affecting prehospital pain management practice and outcomes including use of analgesics and reduction in pain in adult patients attended by ambulance clinicians. The objective was to explore whether practitioner initiated analgesia or reduction in pain differed according to factors such as the adult patient’s age, sex, ethnicity or causation of pain and clinician factors such as sex or role seniority. Methods We employed a cross sectional design using routine retrospective data for a one-week sample of all 999 ambulance attendances in two large regional UK ambulance services for all patients aged 18 years or over, in people requiring primary transport to hospital. We excluded patients with a Glasgow Coma Scale score below 13. We used a multivariate multilevel (two-level) regression model to determine factors independently associated with use of analgesia and a clinically meaningful reduction in pain of 2 points or more on the numerical (0-10) verbal pain scale (NVPS), taking into account confounders including patient demographic and other variables. Results There were 28.8% non-paramedic staff , 29.5% paramedic and 37.1% mixed crew attending. At least two pain scores were recorded in 49.9% (4,773/9,574) of the sample and in this group, pain was reduced in 23.0% (1,100/4,773), increased in 102/4,773 (2.1) and unchanged in 3,571/4,773 (74.8%). For all models fitted there was no significant relationship between analgesic use or pain reduction and patient sex or sex or grade of ambulance staff member. Reduction in pain (NVPS of 2 points or more) was associated with an ambulance crew attending which included at least one paramedic (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.14 to 2.04, p