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The following is a summary of “Analgesic Therapy with the Opioids Fentanyl and Morphine by Ambulance Personnel in Rural Areas: An Observational Study Over 7 Years,” published in the January 2024 issue of Pain by Scharonow et al.
Researchers started a retrospective study to assess the effectiveness of an initiative empowering ambulance personnel to independently administer pain relief in rural areas with longer emergency doctor arrival times.
They conducted a 7-year observational study, recording and statistically analyzing mission protocols. Data included attendance and transport times, vital signs, pain levels, symptom groups (body region), and disease or accident mechanism classification. Treatment details for opioids (fentanyl and morphine) and combinations (morphine to fentanyl, additional esketamine, metamizole, or butylscopolamine) were documented, including dosages.
The results showed 659 patients and ambulance staff used opioids (fentanyl and morphine) in 596 cases for evaluation. When an emergency physician was requested, the average on-scene presence time was 34.8 +- 11.7 min, and in cases of unavailability, it was 29.0 +- 9.8 min (P<0.0001). Analgesic therapy reduced pain from NRS 8.4 (+-1.3) to NRS 3.5 +- 1.8 (P<0.0001). Pain intensity after treatment by emergency paramedics versus emergency physicians showed no significant difference, with NRS 3.5 +- 1.7 versus NRS 3.6 +- 1.9 (P=0.788). Fentanyl was administered at a mean dose of 0.18mg +- 0.11, and morphine at a mean dose of 4.4mg +- 3.6mg. No significant oxygen saturation or respiratory rate changes were observed, and naloxone was unnecessary in all cases.
They concluded that rural study confirms the safety and efficacy of trained EMTs administering morphine/fentanyl for pain management.
