As the ski season peaks in February, learn how intranasal fentanyl as analgesia is becoming the go-to solution for ski patrols, ensuring rapid pain relief for injured skiers right on the hill in this months PTM Journal Club Review.
Background and Objectives:
Pain control in the out of hospital environment remains challenging as little options are available for providers under the ACP level. This is particularly true in wilderness medicine, as paramedics are not routinely involved in search and rescue missions. Canada’s large territory and wilderness is often giving place to long and complex extrication missions of injured patients. Intranasal fentanyl offers a rapid relief of pain, without the need to uncover a potentially hypothermic patient, and without putting providers at risk of needlestick injury.
Methods:
The study took place at Tao Ski Valley, NM where ski patrollers are EMT-B (225h of training). An EMS special skills protocol with a three hours training module was put in place to allow administration of Fentanyl after a call to control physician.
Retrospective records review of patients with traumatic pain >7/10 that are alert and oriented.
They were given a weight adjusted dose of 50-100mcg of Fentanyl IN. Pain score was documented at 0, 5, 10, 15 minutes as well as any adverse events.
There was no control group. The goal was to assess the safety and efficacy of their protocol.
Authors’ Conclusions:
IN fentanyl administration by EMT-B certified providers is effective in reducing traumatic pain in austere settings. It also is safe with no adverse event reported in the study.
Limitations:
The retrospective nature of the study with the absence of a control group.
Missing datas (2013-2015 seasons) as some records were lost during the moving to a new clinic.
Use of 1,8 pain reduction as beeing significant.
Bottom Line:
Intranasal Fentanyl is an interesting option for pain management in an auster setting. Significant pain reduction was noted at 5, 10 and 15 minutes.
It appears safe as no adverse events were reported despite providers having minimal level of training.
There is a need for analgesia in such settings, as 40% of patients reported an initial pain level of 10/10 and 15% had a level at 9/10.
More robust studies are needed, and there are still many barriers to non paramedic to provide controlled substances.
References:
Lynch TV, Callas PW, Peterson TD, Schlein SM. Intranasal Fentanyl for On-the-Hill Analgesia by Ski Patrol. Wilderness & Environmental Medicine. 2022;33(3):296-303. doi:10.1016/j.wem.2022.05.003
