Ambulance clinician perspectives of disparity in prehospital child pain management: A mixed methods study

When children suffer pain through medical illness or traumatic injury, they are often assessed, treated, and transported to hospital by ambulance. Prehospital pain management in children is considered poor. Within the United Kingdom (UK), a recent study showed that only 39% of children suffering acute pain achieved effective pain management (abolition or reduction of pain ≥2 out of 10). In Australia, a study showed that 55% of children suffering severe pain received no analgesics. This is despite pain management being considered an essential human right.

The consequences of inadequate pain management in children suffering acute pain include posttraumatic stress disorder and altered pain perception. Prehospital pain management in children is extremely complex; difficulty assessing pain and administering analgesics have been identified as key barriers to effective management. Recent efforts to improve pain management include the introduction of intranasal analgesics. Although a promising solution, there are likely to be many unrecognized barriers to prehospital pain relief in children. These require a mixed methods approach to better clarify and delineate the problems associated with effective management.

We have previously identified a number of predictors of effective pain management in children within a UK ambulance service. Children, who were younger (0‐5 years) compared to older (12‐17 years), administered analgesics, attended by a paramedic, or living in an area of medium (index of multiple deprivation [IMD] 4‐7) or low (IMD 8‐10) deprivation compared to those living in an area of high (IMD 1‐3) deprivation were more likely to achieve effective pain management. We aimed to explain these four predictors, along with two other previously identified predictors; child sex (male) and type of pain (traumatic), using the perspectives of ambulance clinicians within a mixed methods approach.

University of Lincoln, College of Social Science Research

Gregory Whitley, University of Lincoln, Community and Health Research Unit
Pippa Hemingway, University of Nottingham, Faculty of Medicine and Health Sciences
Graham Law, University of Lincoln, Community and Health Research Unit
 Niro Siriwardena, University of Lincoln, Community and Health Research Unit