Pain management for casualties receiving lifesaving interventions in the prehospital scenario: Raising awareness of our human nature

Factors that influence the administration of tranexamic acid (TXA) to trauma patients in prehospital settings: a systematic review

OBJECTIVE

In the UK there are around 5400 deaths annually from injury. Tranexamic acid (TXA) prevents bleeding and has been shown to reduce trauma mortality. However, only 5% of UK major trauma patients who are at risk of haemorrhage receive prehospital TXA. This review aims to examine the evidence regarding factors influencing the prehospital administration of TXA to trauma patients.

DESIGN

Systematic literature review.

DATA SOURCES

AMED, CENTRAL, CINAHL, Cochrane Database of Systematic Reviews, Conference Proceedings Citation Index-Science, Embase and MEDLINE were searched from January 2010 to 2020; searches were updated in June 2022.

CLINICALTRIALS

gov and OpenGrey were also searched and forward and backwards citation chasing performed.

ELIGIBILITY CRITERIA

All primary research reporting factors influencing TXA administration to trauma patients in the prehospital setting was included.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers performed the selection process, quality assessment and data extraction. Data were tabulated, grouped by setting and influencing factor and synthesised narratively.

RESULTS

Twenty papers (278 249 participants in total) were included in the final synthesis; 13 papers from civilian and 7 from military settings. Thirteen studies were rated as 'moderate' using the Effective Public Health Practice Project Quality Assessment Tool. Several common factors were identified: knowledge and skills; consequences and social influences; injury type (severity, injury site and mechanism); protocols; resources; priorities; patient age; patient sex.

CONCLUSIONS

This review highlights an absence of high-quality research. Preliminary evidence suggests a host of system and individual-level factors that may be important in determining whether TXA is administered to trauma patients in the prehospital setting.

FUNDING AND REGISTRATION

This review was supported by Research Capability Funding from the South Western Ambulance Service NHS Foundation Trust and the National Institute for Health Research Applied Research Collaboration South West Peninsula.

PROSPERO REGISTRATION NUMBER

CRD42020162943.

Paracetamol and amoxicillin adsorptive removal from aqueous solution using phosphoric acid activated-carbon

Charcoal-based materials have attracted much attention for the removal of pharmaceutical agents. The charcoal-based carbon materials have green synthetic routes, high surface area, numerous active site with active functional groups available for physico-chemical interactions with adsorbate for surface-adsorptive removal of toxins. In this study, acid treated activated carbon was developed from the peach seeds using thermal pyrolysis approach. Phosphoric acid activated carbon (PAC) was further modified by HNO3 and employed as an adsorbent for the removal of amoxicillin and paracetamol and process variables were optimized for enhanced removal of amoxicillin and paracetamol. The adsorption of pharmaceutical agents was significantly affected by temperature, pH and reaction time. The amoxicillin and paracetamol sorption process onto PCA followed a pseudo second order kinetics and Langmuir isotherm model with a maximum removal capacity of 51.8 mg/g and 51.1 mg/g, respectively. The results revealed that acid activated carbon has promising efficiency for the removal of amoxicillin and paracetamol from aqueous medium and peach seeds derived PCA could be employed for the removal of these pharmaceutical agents from effluents and PAC is also extendable for the removal of other drugs from pharmaceutical wastewater streams.

The Influence of Gender Bias: Is Pain Management in the Field Affected by Health Care Provider's Gender?

INTRODUCTION

Appropriate pain management indicates the quality of casualty care in trauma. Gender bias in pain management focused so far on the patient. Studies regarding provider gender are scarce and have conflicting results, especially in the military and prehospital settings.

STUDY OBJECTIVE

The purpose of this study is to investigate the effect of health care providers' gender on pain management approaches among prehospital trauma casualties treated by the Israel Defense Forces (IDF) medical teams.

METHODS

This retrospective cohort study included all trauma casualties treated by IDF senior providers from 2015-2020. Casualties with a pain score of zero, age under 18 years, or treated with endotracheal intubation were excluded. Groups were divided according to the senior provider's gender: only females, males, or both female and male. A multivariate analysis was performed to assess the odds ratio of receiving an analgesic, depending on the presence of a female senior provider, adjusting for potential confounders. A subgroup analysis was performed for "delta-pain," defined as the difference in pain score during treatment.

RESULTS

A total of 976 casualties were included, of whom 835 (85.6%) were male. Mean pain scores (SD) for the female only, male only, and both genders providers were 6.4 (SD = 2.9), 6.4 (SD = 3.0), and 6.9 (SD = 2.8), respectively (P = .257). There was no significant difference between females, males, or both female and male groups in analgesic treatment, overall and per specific agent. This remained true also in the multivariate model. Delta-pain difference between groups was also not significant. Less than two-thirds of casualties in this study were treated for pain among all study groups.

CONCLUSION

This study found no association between IDF Medical Corps providers' gender and pain management in prehospital trauma patients. Further studies regarding disparities in acute pain treatment are advised.