Paramedic Student Treatment of Intrapartum Pain
Authors: Belinda Flanagan, PhD(c); Janet Morris, BS; Jenny Koops, BS; Jesse N. Davis, MEd, NRP; Rebecca Valentine, B.S., Paramedic, I/C, NCEE; Jose Palma, BS; Ron Lawler, BUS, NRP
Introduction: There is a dearth of literature concerning out-of- hospital management of intrapartum pain by paramedics; EMS drug therapy protocols offer little advice to guide administration. Although obstetric cases may appear uncomplicated, when complications do occur they can pose significant risk to the mother and baby if not properly managed. Safe management of childbirth by paramedics requires appropriate curriculum design and training opportunities. A lack of time spent on obstetrics within curriculum has contributed to a lack of confidence among paramedics while managing obstetric cases (Dawson et al., 2003). NEMSIS data in 2015 reports 136,370 (0.45% overall responses) obstetric cases attended by paramedics, with 65.4% reporting pain as the primary complaint (NEMSIS,2016). Risks of administering systemic analgesics in labor include maternal sedation and respiratory depression, loss of protective airway reflexes, and the risk of neonatal depression (Anderson, 2011). The aim of this study was to determine the frequency of obstetric in-field calls attended by student paramedics; determine the proportion of patients receiving pharmacological pain relief; and to report the type of analgesia administered.
Methods: A retrospective review of FISDAP data from between 1999 and 2016. Inclusion criteria included calls related to obstetrics, including labor OR childbirth AND pain relief. Descriptive analysis and x 2 tests were used to test associations between variables. Results: 27,778 obstetric cases were attended by student paramedics, with 577 (2.08%) receiving a narcotic analgesic [fentanyl (n=314), morphine (n=207), hydromorphine (n=53), meperidine n=3)]. For 'non-opioid' administration, 82 (0.30%) received a 'non-opioid' analgesic [ketamine (n=1), ketorolac (n=16), aspirin (n=56), acetaminophen n=4), ibuprofen (n=2), nitrous (n=3)].

Conclusions: The number of obstetric related responses indicates that these represent a small proportion of the caseload. This study found that administration of analgesics is low, but was unable to correlate analgesic administration with pain severity due to missing data. Results do not indicate how many patients requested pain relief but were refused and we are unable to explain the low rate of analgesia administration. These questions will require further investigation.