TITLE:
Knowledge of Morphine Administration by Ambulance Paramedics: A Comparison of Two Clinical Levels of Paramedics
AUTHORS:
Anthony Weber, Brian Maguire, Trudy Dwyer
KEYWORDS:
Pain Management, Advanced Care Paramedics, Intensive Care Paramedics, Clinical Judgement
JOURNAL NAME:
Open Journal of Emergency Medicine,
Vol.3 No.4,
December
15,
2015
ABSTRACT: Objective: The purpose of this study is to identify any differences in adherence to morphine administration
protocols between two clinical levels of paramedics within one emergency medical
system in Australia. Methods: The participants were made up of 63 Advanced Care Paramedics
(ACPs) who were trained in basic and intermediate life support and 45 Intensive Care Paramedics
(ICPs) who were trained in advanced life support skills; all were operational and practicing paramedics
qualified in morphine administration. Participants were required to complete a survey
designed to assess their knowledge of morphine drug therapy protocol (DTP). The survey involved
two sections: 1) demographics, and 2) questions related to two scenario-based cases. Scenario
one was a cardiac case and scenario two was a pediatric case. Results: In scenario one, more
intensive care paramedics administered the correct dose than the advanced care paramedics
(25.4% vs. 4.4%; df = 101, P = 0.002); scenario two showed no statistically significant difference
between the two groups (35.5% vs. 31.6%; df = 97, P = 0.3). Conclusion: The comparison of the two
levels of paramedics and their adherence to drug protocols identified that ICPs had a higher rate
than ACPs for adherence to morphine administration protocols for patients suffering cardiac related
chest pain. The clinical differences may be based on the length of the opioid-administration
training program, clinical exposure to morphine administration, work experience and length of
qualifications as an ACP or ICP. Our findings suggest that there is a need for structured initial and
ongoing continuing education programs in pain management to maintain knowledge and behavior
in pain management strategies. Further research is also required into paramedic’s behavioral intention
regarding morphine administration to also identify what constructs affect their intent to
administer morphine.