Nurse-Administered Analgesic Treatment in Italian Emergency Medical Services: A Nationwide Survey

Guglielmo Imbriaco; Riccardo Rondelli; Federica Maroni; Selene Mazzolani; Silvia Sasso; Stefano Sebastiani; Boaz Gedaliahu Samolsky Dekel

doi:10.2147/JPR.S303998

Nurse-Administered Analgesic Treatment in Italian Emergency Medical Services: A Nationwide Survey

J Pain Res. 2021 Jun 16:14:1827-1835. doi: 10.2147/JPR.S303998. eCollection 2021.

Authors

Guglielmo Imbriaco^{1

2}, Riccardo Rondelli³, Federica Maroni^{2

4}, Selene Mazzolani^{2

5}, Silvia Sasso^{2

6}, Stefano Sebastiani^{2

7}, Boaz Gedaliahu Samolsky Dekel^{2

7

8}

Affiliations

¹ Centrale Operativa 118 Emilia Est, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy.
² Critical Care Nursing Master Course, University of Bologna, Bologna, Italy.
³ Intensive Care Unit, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy.
⁴ Emergency Department, Bufalini Hospital, Cesena, Italy.
⁵ Intensive Care Unit, Infermi Hospital, Faenza, Italy.
⁶ Surgical Unit, State Hospital, San Marino, San Marino Republic.
⁷ IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
⁸ Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.

Abstract

Background: Acute pain is common among patients requiring assistance from prehospital emergency medical services (EMS). Nonetheless, the undertreatment of pain in this context remains a frequent phenomenon. Timely and effective analgesia is a crucial feature in emergency medicine. To ensure analgesia provision, prehospital paramedics and nurses can administer analgesics via standard operating protocols or under a physician's remote supervision. Information about such protocols in Italian EMS is lacking.

Objective: Evaluation of the availability of nurse's standard analgesia protocols in Italy's prehospital EMS settings.

Methods: A cross-sectional online survey involved all 74 Italian emergency medical dispatch centres (EMDCs). Aside from descriptive statistics, we used χ ²-analysis and Spearman-rank correlation to look for associations between geographical areas' dependence upon independent variable categories and their correlations.

Results: Of all the 74 Italian EMDCs, 70 (94.6%) completed the survey, covering 100 provinces out of a total of 107 (93.5%). Operating nurses' prehospital analgesia protocols are available in 46 provinces (46.0%). The availability of prehospital analgesia protocols is more extended in northern Italy EMDCs (n=30, 66.7%) than in central Italy (n=9, 42.8%) and southern Italy and islands (n=7, 20.6%). Morphine (76.1% for medical patients and 95.7% for trauma) and paracetamol (89.1% for both) are the most common drugs included in the prehospital analgesia protocols.

Conclusion: Despite international consensus on the necessity, efficacy, and safety of nurses' prehospital analgesia provision, nurse-administered analgesia protocols are available in less than half of Italian provinces, with substantial differences between northern, central, and southern areas. These results indirectly indicate potential undertreatment of prehospital pain in Italy and yield practice improvements.

Keywords: analgesia; emergency medical services; nurses; pain management; pain relief; prehospital emergency care.

Grants and funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.