One-hundred sixteen patients were given nalbuphine by 10 specifically trained ambulance paramedics over a 9-month period. Forty-seven had suspected myocardial infarction and 69 had sustained trauma or burns. The mean pain score measured by a 10-cm visual analogue scale fell from 8 before analgesia to 3. This was highly significant. There were no serious side effects. We conclude that nalbuphine can be safely administered by trained paramedics to provide effective analgesia to those in pain in a prehospital setting.