Ambulance clinician perspectives of disparity in pre-hospital child pain management: A mixed methods study

Background: When children suffer acute pain, the ambulance service is often involved to provide initial assessment, treatment and transport. Several predictors of effective pain management have been identified, including children who are younger (0-5 years), administered analgesics and living in homes from more affluent areas. Objective: To explain previously identified predictors of effective pre-hospital pain management in children. Design: Mixed methods sequential explanatory study. Setting and participants: East Midlands Ambulance Service National Health Service Trust paramedics and emergency medical technicians (EMTs) participated in face-to-face semi-structured interviews. These were audio recorded, transcribed verbatim and coded using thematic analysis. Meta-inferences were generated and illustrated within a joint display. Results: 12 clinicians (9 paramedics and 3 EMTs) were interviewed. Median (interquartile range) age was 43.5 years (41.5, 45.75), 58% were male (n=7) and 58% were parents (n=7). Possible explanations were provided for all predictors. Younger children were perceived to express more emotion, were easier to distract and lived more in the moment than their older counterparts, which explained why younger children were more likely to achieve effective pain management. Analgesics were perceived to have a psychosocial benefit in addition to the pharmacological action. Ambulance clinicians felt that children living in more affluent areas were more likely to achieve effective pain management because the kempt environment facilitated assessment and management and clinicians spent more time on scene; this allowed more time for analgesics to take effect. Participants perceived paramedics to be more confident, and it was found that paramedics were older, more experienced, had a greater scope of practice and spent more time on scene than EMTs. Conclusion: Pre-hospital pain management in children could be improved by facilitating and prioritising analgesic administration and by ambulance services ensuring a paramedic, or highly training clinician, is present on each vehicle, necessitating long-term commitment to staff development.