EFFECTS ON PATIENT-CARE OF INTRODUCING PREHOSPITAL INTRAVENOUS NALBUPHINE HYDROCHLORIDE

Objective-Since March 1992, intravenous nalbuphine hydrochloride has b een used prehospital by paramedics in the Plymouth area. This study as sesses the impact of this intervention. Methods-A prospective study of the parenteral analgesic requirements of 1000 consecutive patients ar riving by ambulance at the accident and emergency (A&E) department of a large district general hospital. Where parenteral analgesia was give n in the A&E department but not by ambulance personnel, a questionnair e was sent to the ambulance crew concerned to ascertain the reasons fo r not having given nalbuphine. Results-Of 1000 consecutive patients ar riving by ambulance, 87 (8.7%) had been given parenteral analgesia eit her prehospital, in A&E, or in both places. Seventy five (7.5%) needed parenteral analgesia in the A&E department, 29 (2.9%) had been given prehospital intravenous analgesia by paramedics, and a further seven ( 0.7%) had been given parenteral analgesia by a general practitioner (G P). Thus 36 (3.6%) received prehospital analgesia. Ten patients who ha d been given analgesia by paramedics required no further analgesia in A&E, whereas 51 patients who had not been given prehospital analgesia required parenteral analgesia in the A&E department. Conclusions-The i ntroduction of nalbuphine for use by paramedics in prehospital care ha s increased prehospital parenteral analgesia from 1% in 1992 (given by GPs only) to 3.6% in the current study group, and 41% of patients req uiring parenteral analgesia received analgesia prehospital. There may be further scope for extending the indications for nalbuphine use by a mbulance personnel.