Pain management for casualties receiving lifesaving interventions in the prehospital scenario: Raising awareness of our human nature

BACKGROUND Life-saving interventions (LSIs) are the hallmark of medical care in trauma casualties, reducing mortality and morbidity. Analgesia is another essential treatment, which has been shown to improve outcomes and decrease long-term complications. However, oligoanalgesia is common, and information regarding its relation to the performance of LSIs is scarce. The purpose of this study was to assess the relation between the performance of LSIs and analgesia administration in the prehospital environment. METHODS A retrospective database-based study was performed, including all trauma casualties treated by Israeli Defense Forces physicians and paramedics during 2006-2017 and admitted to hospitals participating in the Israeli National Trauma Registry (INTR). Included LSIs were Tourniquet application, administration of Tranexamic acid (TXA) and Freeze-dried plasma (FDP) and chest decompression, Casualties treated with endotracheal intubation or cricothyroidotomy were excluded. RESULTS In the multivariable logistic regression analysis, LSIs were associated with prehospital analgesia administration (OR 3.59, CI 2.56-5.08, P < 0.001). When assessing for the different LSIs, tourniquet application (OR 2.83, CI 1.89-4.27, P < 0.001) and TXA administration (OR 4.307, CI 2.42-8.04, P < 0.001) were associated with prehospital analgesia administration. CONCLUSION A positive association exists between performance of LSIs and administration of analgesia in the prehospital environment. Possible explanations may include cognitive and emotional biases affecting casualty care providers. LEVEL OF EVIDENCE IV.