Paramedic PapersTopic
Pain & sedation research
12 recent papers on pain & sedation in paramedic and prehospital care, newest first. Each has a plain-English summary, the study design, the main finding and caveat, and what it means for Australian practice.
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Prehospital pain assessment happens too rarely
Systematic review of eight prehospital observational studies found pain was assessed and documented in only 22.5% to 46.7% of patients, well below recommended standards.
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Two paramedic attitudes to paediatric pain
Cross-sectional survey of 129 paramedics in a standardised Turkish EMS system used latent class analysis to identify two paediatric analgesia attitudinal profiles — proactive/system-oriented (57.4%) and conservative/low-engagement (42.6%) — unrelated to age, sex or experience.
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Methoxyflurane feasibility confirmed in Canada
Canadian feasibility study of patient-controlled inhaled methoxyflurane in 97 adult trauma patients found 95% protocol compliance, median pain falling from 8/10 to 5/10, mostly mild side effects in 23%, and no serious drug-related adverse events.
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Trauma analgesia rarely given prehospital
A Turkish review of 506 trauma patients found prehospital analgesia was given to only 1%, with 77.5% of surveyed paramedics saying they withheld it for fear of interfering with the hospital doctor's examination.
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Low analgesia rates in sickle cell EMS pain
US nationwide cross-section of 10,023 9-1-1 ALS encounters for sickle cell disease complications in 2023 — pain scores documented in 73% but only 13.5% received any analgesia (11.7% opioids), and among patients scoring ≥7/10, contact times ≥20 min were associated with roughly five-fold more IV access and ten-fold more analgesia/opioid administration.
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IV magnesium adds little for ED headache
RCT of 1,028 ED patients with acute nontraumatic headache found IV magnesium sulfate plus paracetamol achieved more frequent treatment success (78.9% vs 65.1%) but pain score differences were below clinical importance thresholds, with less rescue analgesia needed but more mild side effects.
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Procedural sedation consensus: clinical practice
Multidisciplinary Delphi consensus guidelines covering clinical practice for unscheduled procedural sedation.
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Procedural sedation consensus: oversight & quality
Multidisciplinary Delphi consensus guidelines covering principles, oversight, and quality monitoring for unscheduled procedural sedation.
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Intranasal equals subcutaneous ketamine for pain
RCT testing whether intranasal ketamine is non-inferior to subcutaneous for acute traumatic pain — both routes provided equivalent analgesia with minimal clinically important differences, though minor adverse events were more common with subcutaneous administration.
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Early non-IV analgesia in prehospital trauma
Study on: Early non-intravenous analgesia in prehospital trauma care: time to act. No abstract available for detailed assessment.
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Droperidol for nausea: low adverse event rate
This study evaluated adverse events associated with prehospital droperidol use for nausea or vomiting — the incidence of clinically significant adverse events was low, suggesting droperidol may be safe for prehospital use.
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No benefit from prophylaxis for opioid nausea
Prospective study of 205 HEMS patients comparing ondansetron prophylaxis, aromatherapy, and no prophylaxis for opioid-induced nausea — neither intervention showed benefit compared to no prophylaxis in unselected patients.