Prehospital management of pain in trauma patients presenting to the Emergency Medical Services in Gaborone, Botswana.

Abstract

This study aimed to establish a general description of pain management practice in prehospital pain management in trauma patients by an urban public sector EMS system in Botswana. The study sought to determine the different types of traumatic conditions presented to the Emergency Medical Services in Gaborone, Botswana; to establish how pain in trauma patients presenting to the Emergency Medical Services in Gaborone, Botswana is managed and to analyze the factors that influence how pain is managed in traumatic patients presenting to the EMS in Gaborone, Botswana. This research study employed a retrospective descriptive research design targeting trauma patients treated by the Botswana Ministry of Health EMS personnel under Provincial EMS for the period 01 January 2018 to 31 December 2018 in Gaborone. A census of 954 Patient Report Forms (PRFs) medical records was selected based on different types of traumas recorded on the PRF, presenting complaints, provisional diagnosis, and treatment or even drug administered. This research established that 62% of the EMS personnel had a basic EMT qualification followed by 22% with an EMT-A qualification, 12% with an advanced nursing qualification and 4% have an ECP qualification. However, most of the cases (71%) had no records for initial pain scores and 98.9% had no record at all about their second pain assessment after being handled by the EMS personnel. Only Diazepam 5mg, Midazalom, and Panado stat were clearly stated as administered to very few patients (0.3%) with a few others (9.7%) being said to have been given unspecified analgesia including different concentrations of Morphine. In addition, this research established that EMS practitioners rarely if ever administer analgesia to trauma patients. This research established that EMS records do not document the conduct of pain assessment and therefore do not adequately acknowledge the pain in trauma patients. The factors associated with traumatic injuries sustained and the related pain management practices, levels of consciousness, and time taken from the scene to the hospital of admission were assessed. The acceptable standard of care is that pain should be relieved. Inadequate practice may result in partial analgesia or poor handling of injuries resulting in further pain or complications. It is recommended that EMS personnel prioritise and document pain assessment and management including measuring pain, documenting pain quality, and administering analgesia to trauma patients with evaluation. The EMS practitioners should be conscientious of pain assessment and management for medical surveillance. Further research may be conducted to assess the capacity to implement pain management.