Prehospital and emergency department analgesia for air-transported patients with fractures.

OBJECTIVE To evaluate prehospital and receiving emergency department (ED) analgesia administration in air-transported patients with isolated fractures. METHODS The study was a retrospective descriptive analysis of flight and hospital records. Study patients were consecutive adults (not pharmacologically paralyzed) with fractures undergoing scene or interfacility helicopter transport during 1994-1996. The study aeromedical program uses two helicopters staffed by a nurse/paramedic flight crew providing protocol-guided care. The receiving ED was in an urban academic Level I trauma center (annual census 65,000). Primary data collected were timing and amount of prehospital and ED analgesia. Analysis was mainly descriptive, with chi-square and nonparametric methods used to compare patients who did and did not receive intratransport fentanyl. RESULTS 130 patients with isolated fractures underwent air transport during the study period 1994-1996. Of these, 98 (75.4%) received intratransport fentanyl; 20 of 98 (20.4%) received no analgesia in the receiving ED. Patients who did receive repeat analgesia in the receiving ED (n = 78, 79.6% of those receiving prehospital fentanyl) had a median interval of 42.5 minutes (interquartile range 25-100) between ED arrival and analgesia administration; only 62.8% of these patients received their ED analgesia within 60 minutes of arrival. CONCLUSIONS Some patients receiving intratransport fentanyl received no ED analgesia, and those who did receive ED analgesia often had administration delays surpassing the clinical half-life of intratransport-administered fentanyl. Further study should investigate whether setting-specific analgesia practice differences reflect true differences in analgesia needs, overmedication by prehospital providers, or undermedication by ED staff.