Emerg Med J doi:10.1136/emermed-2012-202291
  • Original article

The use of analgesia in mountain rescue casualties with moderate or severe pain

  1. Peter Paal3
  1. 1Birbeck Medical Group, Penrith Health Centre, Penrith, Cumbria, UK
  2. 2Department of Emergency Medicine, West Cumberland Hospital, Whitehaven, Cumbria, UK
  3. 3Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
  1. Correspondence to Dr John Ellerton, Birbeck Medical Group, Penrith Health Centre, Bridge Lane, Penrith, Cumbria CA11 8HW, UK; johnellerton01{at}
  • Received 16 December 2012
  • Revised 16 January 2013
  • Accepted 17 January 2013
  • Published Online First 12 February 2013


Objectives To assess the effectiveness of analgesia used in mountain rescue (MR) in casualties with moderate or severe pain. To determine if a verbal numeric pain score is practical in this environment. To describe the analgesic strategies used by MR.

Design Prospective, descriptive study.

Setting Fifty-one MR teams in England and Wales. The study period was 1 September 2008 to 31 August 2010.

Participants 92 MR casualties with a pain score of 4/10 or greater.

Main outcome 38% of casualties achieved a pain reduction of 50% or greater in their initial score at 15 min and 60.2% had achieved this at handover.

Results The initial pain score was 8 (median), reducing to 5 at 15 min and 3 at handover. The mean pain reduction was 2.5±2.4 at 15 min and 3.9±2.5 at handover. 80 casualties (87%) were treated with an opioid and seven had two different opioids administered. Seven main strategies were identified in which the principal agent was entonox, intramuscular opioid, oral analgesia, fentanyl lozenge, intranasal or intravenous opioid. The choice of strategy varied with the skills of the casualty carer.

Conclusions Pain should be assessed using a pain score. When possible, intravenous opioid is the gold standard to achieve early and continuing pain control in patients with moderate or severe pain. Entonox and oral analgesics, as sole agents, have limited use in moderate or severe pain. Intranasal opioid and fentanyl lozenge are effective, and appropriate in MR. Research priorities include bioavailability in different environmental conditions and patient's satisfaction with their pain management.

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Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

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