TY - JOUR
T1 - Evidence-Based Guidelines for Prehospital Pain Management
T2 - Literature and Methods
AU - On behalf of the Technical Expert Panel
AU - Powell, Jonathan R.
AU - Browne, Lorin R.
AU - Guild, Kyle
AU - Shah, Manish I.
AU - Crowe, Remle P.
AU - Lindbeck, George
AU - Braithwaite, Sabina
AU - Lang, Eddy S.
AU - Panchal, Ashish R.
N1 - Funding Information:
The authors would like to thank National Highway Traffic Safety Administration (NHTSA), Office of Emergency Medical Services (OEMS), and the Health Resources and Services Administration (HRSA), and Maternal and Child Health Bureau’s EMS for Children (EMSC) Program for their support of this work. Of note, the contents of these documents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by the U.S. Government. For more information, please visit EMS.gov and HRSA.gov.
Funding Information:
The presentation of pain in the prehospital setting is documented and treated inconsistently in the United States, necessitating development of up-to-date and evidence-based clinical guidelines (). Pain can be due to a myriad of conditions, including traumatic injuries or underlying illness (), but a core clinical priority in these cases is the management of the patient’s symptoms (). Previous research suggests that in many settings, and for diverse conditions, the management of pain in the prehospital setting is less than optimal, and evidence-based guidelines (EBG) may assist EMS clinicians in choosing the most appropriate pharmacologic intervention to manage pain (, ). One of the first prehospital EBGs published using the National Prehospital EBG Model Process focused on analgesia in trauma (, ). Emerging evidence related to analgesics in prehospital and in-hospital settings, the need for clinical guidance related to pain management for non-traumatic conditions, and the significant controversy over the use of opioids due to the public health impact of the recent opioid epidemic highlight the need for an updated prehospital pain EBG (). With this in mind, the development of a new EBG for prehospital pain managment was supported in part by the National Highway Traffic Safety Administration (NHTSA), Office of Emergency Medical Services (OEMS), and the Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau’s EMS for Children (EMSC) Program leveraging a strong collaboration between the National Association of EMS Physicians (NAEMSP), the American College of Emergency Physicians (ACEP), and the National Association of State Emergency Medical Services Officials (NASEMSO).
Publisher Copyright:
© 2022 The Author(s). Published with license by Taylor & Francis Group, LLC.
PY - 2023
Y1 - 2023
N2 - Introduction: Emergency Medical Services (EMS) clinicians commonly encounter patients with acute pain. A new set of evidence-based guidelines (EBG) was developed to assist in the prehospital management of pain. Our objective was to describe the methods used to develop these evidence-based guidelines for prehospital pain management. Methods: The EBG development process was supported by a previous systematic review conducted by the Agency for Healthcare Research and Quality (AHRQ) covering nine different population, intervention, comparison, and outcome (PICO) questions. A technical expert panel (TEP) was formed and added an additional pediatric-specific PICO question. Identified evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework and tabulated into Summary of Findings tables. The TEP then utilized a rigorous systematic method, including the PanelVoice function, for recommendation development which was applied to generate Evidence to Decision Tables (EtD). This process involved review of the Summary of Findings tables, asynchronous member judging, and facilitated panel discussion to generate final consensus-based recommendations. Results: The work product described above was completed by the TEP panel from September 2020 to April 2021. For these recommendations, the overall certainty of evidence was very low or low, data for decisions on cost effectiveness and equity were lacking, and feasibility was rated well across all categories. Based on the evidence, one strong and seven conditional recommendations were made, with two PICO questions lacking sufficient evidence to generate a recommendation. Conclusion: We describe a protocol that leveraged established EBG development techniques, the GRADE framework in conjunction with a previous AHRQ systematic review to develop treatment recommendations for prehospital pain management. This process allowed for mitigation of many confounders due to the use of virtual and electronic communication. Our approach may inform future guideline development and increase transparency in the prehospital recommendations development processes.
AB - Introduction: Emergency Medical Services (EMS) clinicians commonly encounter patients with acute pain. A new set of evidence-based guidelines (EBG) was developed to assist in the prehospital management of pain. Our objective was to describe the methods used to develop these evidence-based guidelines for prehospital pain management. Methods: The EBG development process was supported by a previous systematic review conducted by the Agency for Healthcare Research and Quality (AHRQ) covering nine different population, intervention, comparison, and outcome (PICO) questions. A technical expert panel (TEP) was formed and added an additional pediatric-specific PICO question. Identified evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework and tabulated into Summary of Findings tables. The TEP then utilized a rigorous systematic method, including the PanelVoice function, for recommendation development which was applied to generate Evidence to Decision Tables (EtD). This process involved review of the Summary of Findings tables, asynchronous member judging, and facilitated panel discussion to generate final consensus-based recommendations. Results: The work product described above was completed by the TEP panel from September 2020 to April 2021. For these recommendations, the overall certainty of evidence was very low or low, data for decisions on cost effectiveness and equity were lacking, and feasibility was rated well across all categories. Based on the evidence, one strong and seven conditional recommendations were made, with two PICO questions lacking sufficient evidence to generate a recommendation. Conclusion: We describe a protocol that leveraged established EBG development techniques, the GRADE framework in conjunction with a previous AHRQ systematic review to develop treatment recommendations for prehospital pain management. This process allowed for mitigation of many confounders due to the use of virtual and electronic communication. Our approach may inform future guideline development and increase transparency in the prehospital recommendations development processes.
UR - http://www.scopus.com/inward/record.url?scp=85123483020&partnerID=8YFLogxK
U2 - 10.1080/10903127.2021.2018074
DO - 10.1080/10903127.2021.2018074
M3 - Article
C2 - 34928783
AN - SCOPUS:85123483020
SN - 1090-3127
VL - 27
SP - 154
EP - 161
JO - Prehospital Emergency Care
JF - Prehospital Emergency Care
IS - 2
ER -