Emerg Med J doi:10.1136/emermed-2012-202166
  • Original article

A qualitative study of the barriers to prehospital management of acute pain in children

  1. Ronan O'Sullivan1,5
  1. 1Department of Paediatric Emergency Medicine, Paediatric Emergency Research Unit, National Children's Research Centre, Our Lady's Children's Hospital, Crumlin Dublin, Ireland
  2. 2Midwifery and Health Systems & Our Lady's Hospice and Care Services, School of Nursing, Health Sciences Centre, University College Dublin, Dublin, Ireland
  3. 3Midwifery and Health Systems, School of Nursing, University College Dublin, Dublin, Ireland
  4. 4Emergency Care Research Unit (ECRU), Division of Population Health Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
  5. 5Department of Emergency Medicine, Cork University Hospital, Ireland
  1. Correspondence to Dr Adrian Murphy, Department of Paediatric Emergency Medicine, Paediatric Emergency Research Unit, National Children's Research Centre, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland; adrianmurphy06{at}
  • Received 13 November 2012
  • Revised 13 February 2013
  • Accepted 26 February 2013
  • Published Online First 21 March 2013


Introduction Effective pain management in the prehospital setting is gaining momentum as a potential key performance indicator by many emergency medical service systems, but historically has been shown to be inadequate, particularly in the paediatric population. This study aimed to identify the barriers, as perceived by a national cohort of advanced paramedics (APs), to achieving optimal prehospital management of acute pain in children.

Methods A qualitative approach was employed to capture data through two focus group interviews. Sixteen APs were invited to participate in this study. Both focus groups were audio recorded, transcribed and analysed using Attride–Stirling's framework for thematic network analysis.

Results The global theme ‘Understanding Barriers to the Prehospital Management of Acute Pain in Children’ emerged from three organising themes as follows: AP education and training; current clinical practice guidelines for paediatric pain management; realities of prehospital practice. Limited exposure to children in the prehospital setting, difficulty assessing pain intensity in small children, and challenges in administering oral or inhaled analgesic agents to distressed and uncooperative children were highlighted by participants. Short transfer times to the emergency department, and a ‘medical’ cause of pain were also implicated as examples of when children are less likely to receive analgesia from practitioners.

Conclusions The pathway to improving care must include an emphasis on improvements in practitioner education and training, offering alternatives to assessing pain in preverbal children, exploring the intranasal route of drug delivery in managing acute severe pain, and robustly developed evidence-based guidelines that are practitioner friendly and patient-focused.

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

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