Paramedic management of back pain: a scoping review

Simon P Vella; Qiuzhe Chen; Chris G Maher; Paul M Simpson; Michael S Swain; Gustavo C Machado

doi:10.1186/s12873-022-00699-1

Paramedic management of back pain: a scoping review

BMC Emerg Med. 2022 Aug 9;22(1):144. doi: 10.1186/s12873-022-00699-1.

Authors

Simon P Vella^{1

2}, Qiuzhe Chen^{3

4}, Chris G Maher^{3

4}, Paul M Simpson^{5

6}, Michael S Swain⁷, Gustavo C Machado^{3

4}

Affiliations

¹ Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia. simon.vella@sydney.edu.au.
² Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. simon.vella@sydney.edu.au.
³ Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia.
⁴ Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
⁵ School of Health Sciences, Western Sydney University, Sydney, NSW, Australia.
⁶ New South Wales Ambulance Service, New South Wales, Australia.
⁷ Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.

Abstract

Background: Research examining paramedic care of back pain is limited.

Objective: To describe ambulance service use and usual paramedic care for back pain, the effectiveness and safety of paramedic care of back pain, and the characteristics of people with back pain who seek care from paramedics.

Methods: We included published peer-reviewed studies of people with back pain who received any type of paramedic care on-scene and/or during transport to hospital. We searched MEDLINE, EMBASE, CINAHL, Web of Science and SciELO from inception to July 2022. Two authors independently screened and selected the studies, performed data extraction, and assessed the methodological quality using the PEDro, AMSTAR 2 and Hawker tools. This review followed the JBI methodological guidance for scoping reviews and PRISMA extension for scoping reviews.

Results: From 1987 articles we included 26 articles (25 unique studies) consisting of 22 observational studies, three randomised controlled trials and one review. Back pain is frequently in the top 3 reasons for calls to an ambulance service with more than two thirds of cases receiving ambulance dispatch. It takes ~ 8 min from time of call to an ambulance being dispatched and 16% of calls for back pain receive transport to hospital. Pharmacological management of back pain includes benzodiazepines, NSAIDs, opioids, nitrous oxide, and paracetamol. Non-pharmacological care is poorly reported and includes referral to alternate health service, counselling and behavioural interventions and self-care advice. Only three trials have evaluated effectiveness of paramedic treatments (TENS, active warming, and administration of opioids) and no studies provided safety or costing data.

Conclusion: Paramedics are frequently responding to people with back pain. Use of pain medicines is common but varies according to the type of back pain and setting, while non-pharmacological care is poorly reported. There is a lack of research evaluating the effectiveness and safety of paramedic care for back pain.

Keywords: Allied health personnel; Ambulances; Back pain; Emergency medical services; Health service.

Publication types

Review
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Allied Health Personnel
Ambulances
Back Pain
Emergency Medical Services*
Emergency Medical Technicians*
Humans
Referral and Consultation