David A. Miramontes, MD, FACEP, assistant chief of Fire and EMS and EMS Medical Director for the District of Columbia Fire and EMS, presented a lecture on current practices in pain management at the EMS Today Conference and Exposition in Washington, D.C., today.
Dr. Miramontes gave the attendees a brief summary of his department’s demographics and EMS response volume:
- The Washington. D.C.. service area is 61 square miles
- Nighttime population served = 582,000; but 1.2 million daily (M-F)
- D.C. Fire and EMS answers 162,000 calls for service annually, 130,000 are EMS runs (80% of all runs)
- There are 98,000 transports (72% BLS)
- Average transport time = 12 minutes
- Average drop time = 37 minutes
Miramontes told the audience that before you can treat pain properly, you have to understand what pain is. He presented a definition of pain from the International Association for the Study of Pain: “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage…”
He explained that pain really does have several purposes:
- It tells us something is wrong with our body that we can’t see otherwise. Example: Abdominal pain--gas, constipation, infection
- It helps us avoid dangerous things. Example: We touch a hot fire, we feel pain, we pull away with spinal reflex immediately.
- It helps us protect damaged body parts. Example: We shield injuries from physical contact and limit use of injured muscle/skin to promote healing.
Miramontes also explained the classifications of pain, an aspect that he feels all providers need to be keenly aware of when performing patient assessments:
- Acute – sudden in onset, subsides with treatment
- Chronic – persistent or recurrent, hard to treat
- Referred – pain “felt” somewhere other than its origin. Examples: heart attack felt in left arm, spleen rupture felt in left shoulder, gall bladder felt in right shoulder blade.
Miramontes noted that there are also a few other types of pain:
- Neuropathic – caused by damage or disease to the nervous system--tingling, burning, electrical “zapping”; "pins and needles”; bumping the “funny bone”
- Psychogenic – caused by mental, emotional, or behavioral factors. This type of pain is o less hurtful than pain from other sources; it's not “all in their head.”
He advised attendees that the Wong-Baker Pain Rating Scale is popular in all assessment circles for gauging patient pain levels (see image).
Other key areas Miramontes discussed included:
• Pathophysiology of Acute and Chronic Pain
• Non-Pharmacology Pain Management
• Opiates in Pain Management
• Intranasal Medication Therapy
• Pharmacokinetics of Intranasal Route
• Ketamine in Pain Management
• Other pain medications
EMS Today conference sessions will continue through Saturday. The conference will return to D.C. next year, February 4-8, 2014. For details, go to www.EMSToday.com.