Patient Demographics Are Associated with Differences in Prehospital Pain Management among Trauma Patients.

OBJECTIVE: Disparities have been observed in the treatment of pain in emergency department patients. However, few studies have evaluated such disparities in emergency medical services (EMS). We describe pain medication administration for trauma indications in an urban EMS system and how it varies with patient demographics. METHODS: We performed a retrospective review of the electronic medical records of adult patients transported for isolated trauma (without accompanying medical complaint) from 1/1/18 to 6/30/2020 by a third service EMS agency in a major United States metropolitan area. We performed descriptive statistics on epidemiology, type of pain medications administered, and pain scores. Kruskall-Wallis and chi-square or Fisher's exact tests were used to compare continuous and categorical variables, respectively. We constructed a logistic regression model to estimate the odds of nontreatment of pain by age, race, sex, transport interval, pain score, and Glasgow Coma Scale (GCS) score for patients with pain scores of at least four on a one to ten scale, the threshold for pain treatment per the EMS protocol. RESULTS: Of 32,463 EMS patients with traumatic injuries included in the analysis, 40% (12,881/32,463) were African American, 50% (16,284/32,463) were female, the median age was 27 years (IQR 45-64), and the median initial pain score was 5 (IQR 2-8). Fifteen percent (4,989/32,463) received any analgesic. Initial pain scores were significantly higher for African American and female patients. African American patients were less likely to receive analgesia compared to White and Hispanic patients (19% versus 25% and 23%, respectively, p < 0.0001). Adjusting for age, pain score, transport interval, and GCS, African American compared to White, and female compared to male patients were less likely to be treated for pain, OR 1.59 (95% CI 1.47-1.72) and OR 1.20 (95% CI 1.11-1.28), respectively. CONCLUSION: Among patients with isolated traumatic injuries treated in a single, urban EMS system, African American and female patients were less likely to receive analgesia than White or male patients. Analgesics were given to a small percentage of patients who were eligible for treatment by protocol, and intravenous opioids were used in the vast majority patients who received treatment.

Emergency Medical Services Clinicians Have a High Prevalence of Metabolic Syndrome.

BACKGROUND: Metabolic syndrome is a constellation of risk factors associated with the development of cardiovascular disease and increased all-cause mortality. Data examining the prevalence of metabolic syndrome among emergency medical services (EMS) clinicians are limited. METHODS: We conducted a cross-sectional study of EMS clinicians and firefighters from three fire departments with transport-capable EMS divisions. Data were collected from compulsory annual physical exams for 2021 that included age, sex, race, body mass index (BMI), waist circumference, blood pressure, cholesterol levels, and hemoglobin A1c level. These data were used to determine the prevalence of meeting metabolic syndrome criteria. We calculated descriptive statistics of demographics, anthropometrics, and metabolic syndrome criteria for EMS clinicians and firefighters. We used chi-square tests to compare the proportion of EMS clinicians and firefighters meeting criteria for the whole group and among age groups of <40 years old, 40 to 59 years old, and ≥60 years old. We used logistic regression to estimate the odds of meeting criteria in EMS clinicians compared to firefighters, adjusted for age, sex, race, and BMI. RESULTS: We reviewed data for 65 EMS clinicians and 239 firefighters. For the combined cohort, 13.2% (40/304) were female and 95.1% (289/304) were White. The median age for EMS clinicians was 34 years versus 45 years in firefighters (p < 0.0001). Metabolic syndrome criteria were met in 27.3% (83/304) of the entire group. The prevalence of meeting criteria among EMS clinicians and firefighters was 33.9% (22/65) and 25.5% (61/239), respectively (p = 0.18). Of the participants who were younger than age 40, 36.6% (15/41) of EMS clinicians versus 9.1% (7/74) of firefighters met criteria for metabolic syndrome (p < 0.001). EMS clinicians had significantly higher odds of meeting criteria [OR 4.62 (p = 0.001)] compared to firefighters when adjusted for age, sex, race, and BMI. CONCLUSION: EMS clinicians had a high prevalence of metabolic syndrome at an early age, and had a higher adjusted odds of having metabolic syndrome compared to firefighters.

Functional movement screen did not predict musculoskeletal injury among emergency medical services professionals.

BACKGROUND: Emergency Medical Services (EMS) professionals frequently experience job-related injuries, most commonly overexertion or movement injuries. Data on injury reduction in EMS professionals is limited. The Functional Movement Screen (FMS) is a movement analysis tool suggested to predict musculoskeletal injury, but it has not previously been evaluated for EMS professionals. OBJECTIVE: To evaluate the effectiveness of the FMS to predict musculoskeletal injury among EMS professionals. METHODS: In October 2014, EMS professionals employed in an urban third-service EMS agency volunteered to participate in FMS administered by certified screeners. Age, sex, height and weight were recorded. After screening, participants were instructed on exercises to correct movement deficiencies. We reviewed recorded injuries from 2013 to 2016. We performed descriptive statistics. With logistic regression modeling, we described factors that predicted musculoskeletal injury. We generated a receiver operating curve (ROC) for FMS prediction of musculoskeletal injury. RESULTS: 147 of 240 full-time employees participated in the FMS. Participants' mean age was 33.7 years (SD = 9.6) and the majority (65%) were male. The median initial FMS score was 14 (IQR 11-16). Area under the ROC curve was 0.603 (p = 0.213) for FMS ability to predict any musculoskeletal injury within two years. Female sex was associated higher odds of injury (OR 3.98, 95% CI 1.61-9.80). Increasing age, body mass index (BMI) category, and FMS score≤14 did not predict musculoskeletal injury. CONCLUSION: The FMS did not predict musculoskeletal injury among EMS professionals.