Physician staffed ambulances are better for patient's analgesia on arrival at the emergency department

Objectives. - To find out prehospital factors linked with low pain on arrival into a traumatic emergency unit. Methods. - A 4-month monocentric prospective study, including patients recruited at their arrival into a traumatic emergency unit. Pain (with a numerical rating scale [NRS]), anxiety, prehospital care including the type of transportation (Physician staffed ambulances Smur, emergency medical technicians or firemen ambulances), immobilization and analgesics used were evaluated. These data were collected on arrival at the hospital by the ED orientation nurse. Uni- and multivariate analysis were performed to identify low pain's predictive factors (e.g. with a NRS <= 3). Results. - Three hundred and four patients were recruited, mean age = 51 +/- 25, sex ratio = 1.8, mean pain/10 = 5.8 +/- 2.9, 64% with a moderate or severe pain on arrival (NRS > 3). For one third of patients, immobilizations hadn't been performed during the prehospital phase. Medical management by Smut is a low pain predictive factor (OR = 5.8; CI 95% = 1.4-24.16), anxiety is a pejorative factor (OR = 0.53 CI 95% = 0.38-0.75). Conclusion. - Our study highlights the physician staffed ambulances' effectiveness in prehospital trauma victim's management and raises the question of anxiolysis as an adjuvant for traumatic pain management. (C) 2010 Elsevier Masson SAS. All rights reserved.