To the Editor:French et al should be congratulated for reporting their study of the
effects of an educational intervention on prehospital care
management of pain.1 Following the educational intervention
paramedics certainly improved their management of pain– but
there remain some unanswered questions on the intervention and
the outcome.First of all the intervention was quite substantial and multifaceted.
However it is interesting to ask what facet of the intervention
caused the positive outcomes. Could a shorter (1 or 2 hour)
intervention resulted in a similar outcome? Could the same
outcome have been achieved as a result of an e-learning
intervention or print-based learning materials? Is it possible
that the surveys themselves had an effect on the changed
management? These questions cannot be answered from the current
results as all learners received the same intervention. Perhaps
a further follow up study might be conducted where different
groups of learners receive different interventions. In this way
more effective and more efficient interventions might be
uncovered.Secondly the educational intervention was not costed; nor indeed was any
cost utility assigned to the outcomes. Low cost educational
interventions that result in more efficient care and as a result
lower cost care are obviously the interventions most sought
after by educators and educational providers alike. However this
is only possible when interventions and their outcomes are
properly and thoroughly costed.We would like to thank Dr. Walsh for highlighting two
additional aspects of education which concern many
of us. We incorporated this investigational study
into our already established monthly 3 hour
continuing education (CE) session provided for
paramedics in our emergency medical services system;
therefore, this study added no additional costs to
the program. It would, however, be helpful to learn
if a shorter session on pain assessment and
management would be just as effective. This would
allow us to add additional topics to the 3 hour CE
session thus making the time more efficient.
Dividing the paramedics into subgroups to apply
different types of educational tools would be quite
simple with our model. We could separate them on the
basis of the 3 different shifts they work within a
station or according to the different station
locations within each suburban village.Cost is all too important when it comes to delivering CE. We
educate paramedics from fire services during their
regularly scheduled shifts so no additional pay for
personnel time is required. Our private ambulance
providers are required to attend CE during their
off-shift time; however, other private providers
throughout Illinois and throughout the country are
compensated for attending CE. Identifying more
efficient methods to provide CE would make better
use of the paramedics’ time and save costs for those
ambulance/fire services which pay for time spent in
attendance at CE sessions. We have also looked at
providing CE which is either videotaped for later
playback or conferenced live video in order to
decrease the number of CE sessions that the paid
infield nurse educators have to provide and to
include additional paramedics at other
locations.Thanks again to Dr. Walsh for identifying additional
questions to the education intervention that we hope
to address in future studies.