Paramedic Student Treatment of Intrapartum Pain

Introduction—There is a dearth of literature concerning out-of-hospital management of intrapartum pain by paramedics, and EMS drug therapy protocols offer little advice to guide administration. Although obstetric cases might often be uncomplicated, when complications do occur they can pose significant risk to the mother and baby if not properly managed. Safe management of childbirth by paramedics requires appropriate curriculum design and training opportunities. A lack of time spent on obstetrics within the curriculum has contributed to a lack of confidence among paramedics while managing obstetric cases (Dawson et al., 2003).

Data from the National EMS Information System (NEMSIS) in 2015 shows 136,370 (0.45% overall responses) obstetric cases attended by paramedics, with 65.4% reporting pain as the primary complaint. Risks of administering systemic analgesics during labor include maternal sedation and respiratory depression, loss of protective airway reflexes, and neonatal depression (Anderson, 2011). The aim of this study was to determine the frequency of obstetric in-field calls attended by student paramedics; to determine the proportion of patients receiving pharmacological pain relief; and to report the type of analgesia administered.

Methods—A retrospective review of data from Fisdap, an online database for EMS and healthcare education, between 1999 and 2016. Inclusion criteria included calls related to obstetrics, including labor or childbirth with pain relief. Descriptive analysis and chi square tests and phi correlations were used to test associations between variables.

Results—Data from Fisdap had 27,778 obstetric cases attended by student paramedics, with 577 (2.08%) receiving a narcotic analgesic [fentanyl (n=314), morphine (n=207), hydromorphine (n=53), meperidine n=3)]. For non-opioid administration, 82 (0.30%) received a “non-opioid” analgesic [ketamine (n=1), ketorolac (n=16), aspirin (n=56), acetaminophen (n=4), ibuprofen (n=2), nitrous (n=3)].

Conclusion—The number of obstetric-related responses indicates that these calls represent a small proportion of the case load. This study found that administration of analgesics is low, but there was no significant correlation between analgesic administration and pain. The data used in this study do not indicate how many patients requested pain relief but were refused, and we are unable to explain the low rate of analgesia administration. These questions require further investigation.