• Aloysius Niroshan Siriwardena, Zahid Asghar, Bill Lord, Helen Pocock, Viet-Hai Phung, Theresa Foster, Julia Williams, and Helen Snooks.
• Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, England, United Kingdom; East Midlands Ambulance Service NHS Trust, Nottingham, England, United Kingdom. Electronic address: nsiriwardena@lincoln.ac.uk.
• Am J Emerg Med. 2019 Feb 1; 37 (2): 266-271.

ObjectiveWe aimed to identify how patient (age, sex, condition) and paramedic factors (sex, role) affected prehospital analgesic administration and pain alleviation.MethodsWe used a cross-sectional design with a 7-day retrospective sample of adults aged 18 years or over requiring primary emergency transport to hospital, excluding patients with Glasgow Coma Scale below 13, in two UK ambulance services. Multivariate multilevel regression using Stata 14 analysed factors independently associated with analgesic administration and a clinically meaningful reduction in pain (≥2 points on 0-10 numerical verbal pain score [NVPS]).ResultsWe included data on 9574 patients. At least two pain scores were recorded in 4773 (49.9%) patients. For all models fitted there was no significant relationship between analgesic administration or pain reduction and sex of the patient or ambulance staff. Reduction in pain (NVPS ≥2) was associated with ambulance crews including at least one paramedic (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.14 to 2.04, p < 0.01), with any recorded pain score and suspected cardiac pain (OR 2.2, 95% CI 1.02 to 4.75). Intravenous morphine administration was also more likely where crews included a paramedic (OR 2.82, 95% CI 1.93 to 4.13, P < 0.01), attending patients aged 51 to 64 years (OR 2.04, 95% CI 1.21 to 3.45, p = 0.01), in moderate to severe (NVPS 4-10) compared with lower levels of pain for any clinical condition group compared with the reference condition.ConclusionThere was no association between patient sex or ambulance staff sex or grade and analgesic administration or pain reduction.Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

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