Frederick B Abbuhl1, David B Reed. 1. Department of Emergency Medicine, Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA. fredabbuhl@aol.com
Abstract
OBJECTIVE: To measure the time to analgesia for patients with painful, isolated extremity injuries brought to the emergency department (ED) by emergency medical services (EMS). METHODS: A retrospective chart review of all patients presenting with isolated, painful extremity injuries during an 18-month period to a Level 1 trauma center. Medical records were reviewed by diagnostic codes for extremity injuries. INCLUSION CRITERIA: patients 18 years or older transported to the ED by EMS; isolated, painful extremity injuries; received parenteral analgesia in the ED or by EMS. Excluded: multiple trauma patients, interfacility transfers, hemodynamically unstable patients, head-injured patients, intoxicated patients, and patients with mental status changes. Data elements: age, sex, EMS arrival time, EMS medication time, hospital triage time, and ED medication time. All "times to analgesia" were calculated from the EMS arrival time on scene. RESULTS: Extremity injuries were identified in 706 patients. Of these, 104 patients with painful, isolated, extremity injuries met all inclusion criteria. Thirteen (12.5%) of 104 received analgesia by EMS during prehospital care. Ninety-one patients (88%) first received parenteral analgesia in the ED. The mean time to analgesia for EMS treated patients was 23 minutes (95% CI 16.7-30.2). Mean time to analgesia for patients treated in the ED was 113 minutes (95% CI 99.2-128.1). Mean time to analgesia after triage in this group was 75 minutes (95% CI 60.8-89.7). CONCLUSION: In this study, patients received analgesia sooner when administered by EMS during prehospital care. There was a significant time delay after triage for patients first medicated in the ED.
OBJECTIVE: To measure the time to analgesia for patients with painful, isolated extremity injuries brought to the emergency department (ED) by emergency medical services (EMS). METHODS: A retrospective chart review of all patients presenting with isolated, painful extremity injuries during an 18-month period to a Level 1 trauma center. Medical records were reviewed by diagnostic codes for extremity injuries. INCLUSION CRITERIA: patients 18 years or older transported to the ED by EMS; isolated, painful extremity injuries; received parenteral analgesia in the ED or by EMS. Excluded: multiple traumapatients, interfacility transfers, hemodynamically unstable patients, head-injured patients, intoxicated patients, and patients with mental status changes. Data elements: age, sex, EMS arrival time, EMS medication time, hospital triage time, and ED medication time. All "times to analgesia" were calculated from the EMS arrival time on scene. RESULTS:Extremity injuries were identified in 706 patients. Of these, 104 patients with painful, isolated, extremity injuries met all inclusion criteria. Thirteen (12.5%) of 104 received analgesia by EMS during prehospital care. Ninety-one patients (88%) first received parenteral analgesia in the ED. The mean time to analgesia for EMS treated patients was 23 minutes (95% CI 16.7-30.2). Mean time to analgesia for patients treated in the ED was 113 minutes (95% CI 99.2-128.1). Mean time to analgesia after triage in this group was 75 minutes (95% CI 60.8-89.7). CONCLUSION: In this study, patients received analgesia sooner when administered by EMS during prehospital care. There was a significant time delay after triage for patients first medicated in the ED.