Pediatric Pain Assessment and Management in the Prehospital Setting: The Impact of an Educational Intervention on Pediatric Patient Care

The application of developmentally appropriate pain assessment and pain management techniques in the prehospital emergency setting continues to fall behind other areas of health care. To date only limited research has been conducted to improve these techniques in the prehospital setting. The goals of the current study were two-fold: 1) To assess paramedic knowledge regarding pediatric pain management, and 2) To pilot test an educational intervention designed to a) teach paramedics about pediatric pain physiology, developmental aspects of pediatric pain, and pediatric pain assessment and management strategies, and b) teach paramedics how to use developmentally appropriate self-report and observational pain scales with children of different ages. Paramedics from two counties in Delaware participated in the study. Baseline measures of pain management practices, knowledge about pain management, and comfort and confidence in treating pediatric patients were collected during mandatory continuing education sessions; similar post-study measures were collected 15 months after baseline. Paramedics in the experimental group received the educational intervention while paramedics in the control did not receive the intervention. Paramedics from each group were asked to complete an electronic report after each pediatric ambulance incident specifying any pain assessment or interventions they conducted. Results revealed that paramedics who participated in the educational intervention were over two times more likely to assess pediatric pain compared to the control group. The educational intervention also led to an increased frequency of pain treatment among experimental group paramedics. There were no group differences in paramedic comfort or confidence at both pre- and post-study measurements. Pediatric pain knowledge significantly decreased from baseline to post-study measurement in the control group while experimental group knowledge increased slightly over time. Prehospital pediatric pain assessment and management is an important and understudied aspect of pediatric medical care. This study is an important first step in the investigation of strategies to improve prehospital pediatric pain management. The results of this study indicate that an educational intervention, including appropriate assessment tools, is an effective means to improving paramedic patient care skills related to pain assessment and management. Study findings have important implications for paramedic training and continuing education