To determine the factors contributing to the clinical decision-making process made by South African paramedics in their management of patients with acute traumatic pain
Initial: main determinant in decision-making around initiating analgesia was the patient’s expression (verbal) of pain Reassess: participants rely on the patient’s expression of pain relief rather than a numerical score in the decision-making process
Not reported
Morphine or ketamine (preferred when in scope) or alternatively a combination of morphine and ketamine
To assess the community management of paediatric burns prior to admission to a burns centre against the current provincial policy guidelines and to identify areas for improvement
Cape Town, South Africa
August–October 2012 and June–August 2013
paediatric burn patients (aged 1 month to 14 years)
Initial: not performed Reassess: not performed
Cooling with water, ice or cooling agents like Burnshield® Burnshield® applied by EMS in 6.2% () children
Paracetamol, NSAID, tilidine, morphine, and ketamine
To review and update existing protocols for ECPs and create an evidence-based CPG which provides an evidence base for emergency care practice contextualised to the South African setting, is patient-centred, realistic, and enhances continuity of care throughout the emergency system, and is aligned to best practice and provide guidance to current practitioners and those envisioned by the draft NECET policy
South Africa
Searching: October 2015–January 2016
276 CPGs included
Initial: assess pain as part of general patient care Reassess: use age-appropriate pain assessment scale, reassess every 5 minutes Observe for evidence of serious adverse effects
Burns: cool and cover burns Fracture: effectively immobilise fracture No further recommendation specifically related to nonpharmacological pain management
Labour: inhaled nitrous oxide or opioids (IV or IM) Chest pain (dependent on the cause): sublingual or IV nitrates and/or opioids (IV or IM) Burns: paracetamol or NSAIDs, consider opioids for intermittent or procedural pain Trauma: narcotic analgesics (morphine IV or fentanyl IV/IN) for moderate to severe pain Procedural sedation and analgesia: ketamine: IV, if sedation inadequate, incremental IV doses Postresuscitation care: pain and discomfort should be controlled with analgesics and sedatives
Quasi-experimental: interrupted time series analysis
To compared five quality process measures recorded before and after the implementation of the CQI programme and aimed to determine the immediate impact of the CQI programme as well as the impact over time
Kigali, Rwanda
Pre-CQI: January 2013–February 2014 Post-CQI: April 2014–May 2015
trauma patients >15 years
Initial: not reported Reassess: not reported
Splinting of long bone fractures: Pre-CQI: 87.5% () Post-CQI: 92.6% () value: 0.019
Acetaminophen, ibuprofen, diclofenac, morphine, tramadol, fentanyl, pethidine and ketamine. Pain management for long bone fractures: pre-CQI: 85.1% () Post-CQI: 93.6% () value: <0.001
No formal prehospital care-certified programme was available, and thus, ambulances in Rwanda are manned by one driver, one anaesthesia technician, and one nurse. ALS: advanced life support; CPGs: clinical practice guidelines; CQI: continuous quality improvement; ECPs: emergency care providers; EMS: emergency medical services; IM: intramuscular; IN: intranasal; IV: intravenous; NECET: National Emergency Care Education and Training; NRS: numeric rating scale.