Clinical guideline for Non- pharmacological pain management of trauma patients in pre hospital setting

Pain management is the core of care in traumatic injuries, which unfortunately is not properly managed in the pre-hospital stages. The use of pharmacological pain management by emergency medical technicians in the Iran is also subject to widespread restrictions and prohibited, so focusing on nonpharmacological pain management techniques can help improve pain management and quality of care for the injured. The aim of this study was to develop and localize a clinical guideline for the management of nonpharmacological pain in a pre-hospital emergency.

This study was carried out through a multi-stage evolutionary study. . In the first phase, systematic review of articles, books and clinical guides of pre-hospital acute pain management was performed and then  38 clinical guides and 150 related articles were found in the study databases.The research team identified 4 more comprehensive, up-to-date and most relevant clinical guides. Then, the experts, the 3 clinical guides that were most relevant to the topic were selected by examining their quality with the AGREE tools. Next, the drafted localized clinical guideline was developed based on the highest rated clinical guideline recommendations, Then the Delphi method and the panel of experts were used to finalize the localized clinical guideline recommendations.

A total of 27 recommendations from Delphi participants’ consensus recommendations were taken into consideration and each were localized as a clinical guideline for non-medication pain management patients.

The results of the present study showed that in Iran no clinical practice guideline or written guideline for non-pharmacologic management of pain in pre-hospital settings has been published so far, so that emergency centers can apply it. Usage of these guidelines would improve and supply part of the need for emergency medical technicians in pain management to improve pain management status.