A scoping review of qualitative studies on pre-hospital analgesia administration and practice

Seth En Teoh; Caitlin Yuen Ling Loh; Ryan Ian Houe Chong; Clyve Yu Leon Yaow; Yoshio Masuda; Ming Xuan Han; Daryl Jimian Lin; Yu Liang Lim; Justin Choon Hwee Ng; Qin Xiang Ng

doi:10.1016/j.ajem.2022.04.038

A scoping review of qualitative studies on pre-hospital analgesia administration and practice

Am J Emerg Med. 2022 Jul:57:81-90. doi: 10.1016/j.ajem.2022.04.038. Epub 2022 May 1.

Affiliations

¹ Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
² Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia.
³ Emergency Medical Services Department, Singapore Civil Defence Force, Singapore.
⁴ Emergency Medical Services Department, Singapore Civil Defence Force, Singapore. Electronic address: ng.qin.xiang@u.nus.edu.

PMID: 35526405
DOI: 10.1016/j.ajem.2022.04.038

Abstract

Background: Pain is an exceedingly common complaint in the pre-hospital setting. Despite advancements in organizational protocols and guidelines, many emergency medical services (EMS) systems still fail to provide optimal pain management. This scoping review thus aimed to map the body of qualitative literature pertaining to factors influencing pre-hospital analgesia administration and practice in order to clarify concepts and understanding as well as to identify any knowledge gaps.

Methods: The review protocol was guided by the framework outlined by Arksey and O'Malley and ensuing recommendations made by Levac and colleagues. Five databases were searched from inception till October 26, 2021, namely MEDLINE, EMBASE, CINAHL, The Cochrane Library, and Scopus. The search strategy was developed in consultation with a medical information specialist. A total of 5848 records were screened by abstract and title by four independent researchers. 199 records were included for full text review. From these, 15 articles were eligible for thematic analysis based on pre-defined inclusion criteria.

Results: Included studies found that practitioner, patient, and environmental factors influenced the administration and practice of pre-hospital analgesia. Key barriers included the difficulty in assessing pain, poor inter-professional relationship, knowledge deficits, stress and anxiety, and miscellaneous factors, such as concerns over drug-seeking behaviours. Some possible solutions were proposed, and pre-hospital EMS systems and healthcare institutions could consider bridging some of these gaps. There was a notable paucity of Asian studies, and a variety of EMS settings with different protocols and workflows were examined, hence systemic factors including guidelines and legislations cannot and should not be generalized across every healthcare system.

Conclusion: The factors influencing pre-hospital analgesia administration and practice remain incompletely understood. Existing tools and practice guidelines were also inadequate. This scoping review provided an overarching perspective of the extant literature, highlighting some of the significant barriers, enablers, and areas for further research.

Keywords: Analgesia; Emergency medical services; Pain; Paramedic; Pre-hospital.

Publication types

Review

MeSH terms

Analgesia*
Hospitals
Humans
Pain
Pain Management*
Qualitative Research