Analgesia for extremity trauma by rescue paramedics

The German Medical Association recommends the use of selected medications for emergency treatment including prehospital analgesia by paramedics under specific circumstances even before the arrival of the emergency physician. Currently there are no data proving the safety and efficiency of analgesia by German paramedics. Selected paramedics underwent an additional training to administer morphine in patients with isolated extremity trauma using a protocol. During the study period from January 2006 to October 2009 all calls with analgesia by these paramedics were included. Data elements included baseline and endpoint of vital signs, pain score defined by a numeric rating scale (NRS 0-10), the amount of morphine administered and the occurrence of adverse effects. A total of 172 cases were included. No severe morphine-induced complications occurred. The rate of adverse effects was low (5.2%) and the mean dose of morphine administered was 8.5 +/- 3.9 mg. The initial pain score defined by NRS was 8.3 +/- 1.2 which on arrival at the emergency department was reduced to 2.9 +/- 1.5. Analgesia with morphine in isolated prehospital extremity trauma can be safely and effective performed by trained paramedics in the field.