A description of pharmacological analgesia administration by public sector advanced life support paramedics in the City of Cape Town

Emergency Medical Services are ideally placed to provide relief of acute pain and discom- fort. The objectives of this study were to describe pre-hospital pain management practices by Emergency Medical Services in the Western Cape, South Africa. Methods: Aretrospective,descriptivesurveywasundertakenofanalgesicdrugadministrationbyadvanced lifesupportparamedics. Patientcare recordsgenerated intheCityofCapeTownduringan11-monthperiod containing administrations of morphine, ketamine, nitrates and 50% nitrous oxide/oxygen were randomly sampled. Variables studied were drug dose, dose frequency, and route of administration, patient age, gender, disorder and call type as well as qualification and experience level of the provider. Results: A total of 530 patient care records were included (n = 530). Morphine was administered in 371 (70%, 95% CI 66–74) cases, nitrates in 197 (37%, 95% CI 33–41) and ketamine in 9 (1.7%, 95% CI 1–3) cases. Atotalof5 mgorlessofmorphine wasadministeredin278(75%,95%CI70–79)cases,withthemediandose being 4 mg (IQR 3–6). Single doses were administered to 268 (72.2%, 95% CI 67–77) morphine administra- tions, five (56%, 95% CI 21–86) ketamine administrations and 161 (82%, 95% CI 76–87) of nitrate adminis- trations. Chest pain was the reason for pain management in 226 (43%) cases. Advanced Life Support Providers had a median experience level of two years (IQR 2–4). Discussion: Pre-hospital acute pain management in the Western Cape does not appear to conform to best practice as Advanced Life Support providers in the Western Cape use low doses of morphine. Chest pain isan important reasonfordrug administrationinacute pre-hospital pain.Multimodalanalgesia isnotafea- ture of care in this pre-hospital service. The development of a Clinical Practice Guideline for and training in pre-hospital pain should be viewed as imperative.