The use of intravenous nalbuphine in pre-hospital settings by paramedics has been demonstrated to be safe and effective. We assessed the effect of this additional intervention by comparing the time spent on-scene by ambulance crews treating patients with fractures of the tibia and fibula who received intravenous nalbuphine with those who had placement of an intravenous cannula alone and those who had neither cannula nor nalbuphine. The mean on-scene times were 17.1 min without cannulation, 29.9 min for cannulation without nalbuphine and 37.5 min for cannulation and administration of nalbuphine. The benefits of effective pre-hospital analgesia thus have a cost in terms of time. Continued audit of interventions and on-scene times is important to prevent inappropriate delays in pre-hospital care which may cause clinical and operational problems.
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