Analgesia Provided by Paramedic Students: Evidence of Disparities
Bill Lord, PhD; Monte L. Rober ts, DNP, RN; Linda Spang, JD, MSB, EMT-P
Evidence of disparities in pain management practice have been documented in paramedic practice. The purpose was to evaluate differences in analgesic treatment associated with age, gender, and clinical presentation in patients sustaining injury due to ground level falls.
A retrospective review of paramedic student patient care records extracted from the FISDAP™ internship database for a 5-year period from 2010-2015. Cases included: mechanism of injury when recorded as a fall. Exclusion criteria: head injury, multi-system trauma, Systolic Blood Pressure <100 mmHg, age <18 years,
and Glasgow Coma Scale <14. Patients were classified: (1) Green, non-critical, ambulatory, (2) Yellow, injury, non-life threatening, and (3) Red, critical, life threatening.
A total of 11,269 assessments met inclusion criteria, 22% of patients received analgesic treatment. Sixty-three percent female, and 60% over age 65. Patterns of analgesia administration pre-hospital were examined. Most patients did not receive analgesia pre-hospital. There were differences in analgesia administration according to perceived criticality with 88% classified as green, 70% yellow, and 70% of red.
A separate logistic regression was completed on just geriatric patients (60% of population). Significant predictors of receiving pre-hospital analgesia included being female (OR = 1.418, p = 0.017), and perceived criticality of yellow (OR = 3.01, p < 0.001).
Gender becom es significant when examining just geriatrics, women receiving more analgesia. Most patients (80%) do not receive analgesia. There is a low rate of analgesic administration for all non-complicated ground level falls. There is a need for more education in assessment of analgesia administration in the
pre-hospital setting.