T IME TO A NALGESIA FOR P ATIENTS WITH P AINFUL E XTREMITY I NJURIES T RANSPORTED TO THE E MERGENCY D EPARTMENT BY A MBULANCE

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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.

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