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Analysis of the paramedic administration of fentanyl

Jocelyn Freeman Garrick, MD, FACEP, Senai Kidane, MD, EMS Fellow, James E. Pointer, MD, William Sugiyama, MA, RN, NREMT-P, Christopher Van Luen, EMT-P, Rebecca Clark, EMT-B


Introduction: Pain is a common complaint among emergency medical services patients. When compared with the most commonly used morphine, fentanyl has a shorter onset of action, shorter duration, and far fewer side effects making it an appealing candidate for prehospital pain management. This study’s intent is to prospectively assess the feasibility and safety of fentanyl for pain in prehospital patients in comparison with morphine.
Methods: Observational trial to evaluate select characteristics of fentanyl administration. The primary outcome measure was the reduction of pain from time of initial patient assessment to transfer of care (TOC) to emergency department (ED) staff. Secondary outcome measures included the development of adverse outcomes and side effects related to fentanyl administration. Additionally, data obtained were compared with morphine retrospectively from an identical prior time period, ie, 1 year earlier.
Results: About 16.6 percent of the patients who received fentanyl reported subjective pain relief in less than 1 minute, 47 percent in 1-2 minutes, 19.9 percent in 2-3 minutes, and 16.6 percent at greater than 3 minutes. The reduction of pain after fentanyl administration, on a scale of 1-10, was 3.82 points in TOC at the ED. No significant adverse clinical outcomes or incidents of diversion were reported during the trial period.
Conclusions: Fentanyl can be used safely and effectively for pain control in the prehospital setting.


fentanyl, prehospital, EMS, morphine, pain, analgesic

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