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Improving ambulance care for children suffering acute pain: a qualitative interview study
Gregory Adam Whitley1,2, Pippa Hemingway3, Graham Richard Law4
1Community and Health Research Unit, Sarah Swift Building, School of Health and Social Care, University of Lincoln, Brayford Wharf East, Lincoln, England, LN5 7AT, UK. gwhitley@lincoln.ac.uk.
Insights
Pre-hospital pain management for children is suboptimal. Improving analgesic administration and reducing fear in children and clinicians can enhance pediatric emergency care.
Area of Science:
- Emergency Medicine
- Pediatric Care
- Pain Management
Background:
- Pre-hospital acute pain management in children is frequently suboptimal, affecting 61% of pediatric patients.
- Inadequate pain management can lead to long-term consequences, including post-traumatic stress disorder and altered pain perception.
- Understanding clinician perspectives on barriers and facilitators is crucial for improving pediatric pre-hospital care.
Purpose of the Study:
- To identify barriers and facilitators to effective pre-hospital acute pain management in children.
- To explore potential improvements from the perspective of ambulance clinicians.
- To inform strategies for enhancing pediatric pain care in emergency medical services.
Main Methods:
- Qualitative study utilizing semi-structured interviews with 12 UK ambulance clinicians (paramedics and emergency medical technicians).
- Thematic analysis of transcribed interviews to identify key themes related to pain management.
- Data synthesis with existing evidence to develop a driver diagram for improvement.
Main Results:
- Clinicians identified numerous barriers and facilitators across physical, emotional, social, organizational, environmental, management, knowledge, and experience domains.
- Key improvement themes focused on enhancing management, organization, and education.
- A driver diagram proposed three primary drivers: increasing analgesic administration, reducing child anxiety, and reducing clinician anxiety through training and optimized crew mix.
Conclusions:
- Improving pediatric acute pain management in ambulances requires increasing analgesic administration rates.
- Reducing fear and anxiety in both children and clinicians is essential for better outcomes.
- Future research should involve children and parents to guide intervention development and outcome measure selection.
Background:
Pain is a highly complex sensory and emotional experience. When a child suffers acute pain through illness or injury, they are often transported to hospital by ambulance. Pre-hospital pain management in children is poor, with 61% of children receiving suboptimal pain management. Consequences of poor pain management include the risk of developing post-traumatic stress disorder and altered pain perception. We aimed to identify clinicians' perceptions of barriers, facilitators and potential improvements for the management of pre-hospital acute pain in children.
Methods:
Qualitative face to face semi-structured recorded interviews were performed in one large UK ambulance service. Audio files were transcribed verbatim with thematic analysis used to generate themes. NVivo 12 was used to support data analysis. Findings were combined with existing evidence to generate a driver diagram.
Results:
Twelve ambulance clinicians participated, including 9 registered paramedics and 3 emergency medical technicians. Median (IQR) age was 43.50 (41.50, 45.75) years, 58% were male, median (IQR) experience was 12 (4.25, 15.50) years and 58% were parents. Several themes relating to barriers and facilitators were identified, including physical, emotional, social, organisational, environmental, management, knowledge and experience. Improvement themes were identified relating to management, organisation and education. These data were combined to create a driver diagram; the three primary drivers were 1) explore methods to increase rates of analgesic administration, including utilising intranasal or inhaled routes; 2) reduce fear and anxiety in children, by using child friendly uniform, additional non-pharmacological techniques and more public interaction and 3) reduce fear and anxiety in clinicians, by enhancing training and optimising crew mix.
Conclusions:
The quality of care that children receive for acute pain in the ambulance service may be improved by increasing rates of analgesic administration and reducing the fear and anxiety experienced by children and clinicians. Future research involving children and parents would be useful to determine the most important outcome measures and facilitate intervention development.
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