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Updated: Aug 22, 2025

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
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Provision of immobilization or ice by paramedics in Southwestern Ontario

Naveen Poonai1,2, John Teefy3, Kristine Van Aarsen4

  • 1Department of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. naveen.poonai@lhsc.on.ca.

CJEM
|November 8, 2022
PubMed

Insights

Paramedic documentation of non-pharmacologic pain relief, including immobilization and ice, for children with musculoskeletal injuries is suboptimal. Enhanced education is needed to improve the use of these effective pain management strategies.

Area of Science:

  • Emergency Medicine
  • Pediatric Care
  • Pain Management

Background:

  • Pain is a primary reason for prehospital emergency transport.
  • Timely pain management is crucial, especially with increasing emergency department wait times.
  • Prehospital pharmacologic analgesia in children is often suboptimal, with limited data on non-pharmacologic approaches.

Purpose of the Study:

  • To characterize paramedic documentation of non-pharmacologic (immobilization, ice) and pharmacologic pain relief in pediatric patients with musculoskeletal injuries.
  • To identify factors associated with the use of non-pharmacologic pain management techniques.

Main Methods:

  • Retrospective review of ambulance call reports for children (0-17 years) with musculoskeletal injuries from January 2017 to December 2019.
  • Analysis of documented immobilization, ice application, and pharmacologic analgesia.
  • Multivariable analysis exploring associations between non-pharmacologic interventions and covariates like pain severity and visible deformity.

Main Results:

  • Of 4445 eligible reports, immobilization was documented in 36.1% and ice in 8.7%.
  • Pharmacologic analgesia was documented in 13.9% (primary care) and 12.6% (advanced care) paramedics.
  • Moderate/severe pain and visible deformity were associated with increased odds of documented immobilization or ice.

Conclusions:

  • Paramedic documentation of both non-pharmacologic and pharmacologic pain management for pediatric musculoskeletal injuries is suboptimal.
  • There is a significant need for improved education on the benefits and application of non-pharmacologic pain relief strategies for children.
Abstract

Keywords:
PainPediatricsPrehospital

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