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What a Pain!

When IT hurts, it HURTS. 

It’s been estimated that nearly 33 percent of all 911 medical calls in the United States are pain-related. When your patient is in pain, it can cause many other complications, including raised heart rate and blood pressure, anxiety, and the patient’s ability to transmit correct information to the EMT.

Treating patients for pain is a very individual and subjective process, one which has historically been treated effectively rather poorly according to patient advocate groups. The World Health Organization has called for pain relief to be considered a basic human right. EMS professionals have a legal and ethical obligation to provide the level of care that would be offered by a competent healthcare professional within their scope of practice, and this includes pain relief.

While New York State offers a practitioner at the EMT level few options to help relieve a patient’s pain, usually just hot and cold compresses, there are some things that can be done to help mitigate a patient’s discomfort and pain. Often just listening, and not dismissing, the patient’s complaints, will help as the patient gains confidence in his/her caregivers.

Pain is a different experienced for everyone, especially if they’ve suffered this before. For instance, the person who repeated has twisted their knee, while acknowledging the pain, is actually “used to it” and may only compare it to previous injuries; whereas the individual who breaks a bone, any bone, for the first time, is liable to “feel” more intense pain. Also remember that age may alter the way someone feels or expresses their pain. Young children may simply not be able to articulate exactly what is hurting, or may not understand questions about quality and time; the elderly often have multiple conditions and it may be hard to differentiate between a “normal arthritis attack” for example, and fractured bones.

Evaluating a patient’s pain may give important clues as to their overall medical condition —try to determine the intensity (possibly numbers 1 through 5), the cause of the pain, the quality (burning, sharp, dull, throbbing), and the length of time the patient has had that specific pain. An important consideration is the location of the pain and knowledge of what internal organs might be affected, or even causing the pain. It is also very important to note any changes to the pain or to the patient, especially blood pressure, heart rate, and coherency. Never, ever, question the patient’s truthfulness about their pain.

After and during the evaluation of your patient, you should begin to think of and apply NON-pharmacological interventions. As stated above, hot and cold packs may help. The EMT should also, as permitted, use distraction (discussion, calm music) and for very young children, cradling if possible (and safe) or at least holding a hand or close contact and soft words. Other non-invasive methods include splinting, compression, blankets, oxygen, or even breathing into a paper bag to ward off a panic attack. While accounting for physical injuries that need to be treated, make your patient as comfortable as possible in route to the hospital.

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