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Effects of an Educational Intervention on Prehospital Pain Management

Introduction. Pain is a common symptom evaluated by emergency medical services (EMS) providers. Hospital pain management programs began in the early 1990s based on a multidisciplinary approach andprinciples of total quality improvement. To date, these programs have had limited exposure in the prehospital setting. Objectives. To evaluate the effects of a pain management educational intervention (EI) for paramedic caregivers. Methods. All ambulance providers from ten urban andsuburban fire departments andtwo private ambulance companies participated in a three-hour EI during a quality improvement project. A survey was performed prior to the EI andrepeated one month after the EI. A two-month collection of EMS runs for pain complaints was performed prior to the EI andrepeated one month after the EI. Data analysis was performed using descriptive statistics andchi-square tests. Results. The authors reviewed 397 surveys and439 EMS runs for pain. Overall, after the EI, paramedics' knowledge of basic pain management principles increased from 57.3% to 74.9% (17.5%; 95% confidence interval (CI): 14.9%–20.2%; p < 0.001). Paramedics' utilization of nonpharmacologic pain therapies improved by 32.2% (95% CI: 25.3%–39.2%; p < 0.001), but there was no significant change in the use of pain medication (20.2% to 24.5%). There were 51.0% (95% CI: 44.1%–57.9%; p < 0.001) improvement in documentation of pain severity, 24% (95% CI: 21.2%–26.8%; p < 0.001) improvement in documentation of pain characteristics, and13% (95% CI: 7.4%–18.7%; p < 0.001) improvement in pain reassessment following intervention. Conclusion. As a result of a three-hour educational intervention, paramedics had an increased understanding of pain principles, were more likely to provide prehospital nonpharmacologic pain therapy, andwere more likely to document the results of their interventions.