Pain is one of the most common reasons people call EMS, yet it is often undertreated, especially in children and older adults. Good pain care combines a structured assessment, nondrug measures and medicines chosen for the patient and the cause, with reassessment after each dose.
Key symptoms
- Pain described with OPQRST: onset, provocation, quality, region, severity, time
- Crying, guarding or grimacing
- Fast pulse and breathing, sweating
- Anxiety or agitation
- Trouble moving or sleeping
What you find on exam
- Pain score with a numeric, faces or behavioral scale
- Full vital signs before any medicine
- Look for the cause: injury, deformity, abdomen or chest
- Allergies, current medicines, last dose and opioid use
- Level of consciousness and breathing before opioids
Tests
- Repeat pain score after each intervention
- Capnography and oxygen saturation with opioids
- ECG for chest pain
- Imaging or laboratory tests in hospital to find the cause
Treatment basics
- Nondrug measures: splinting, positioning, ice and calm reassurance
- Acetaminophen, ibuprofen or ketorolac for mild to moderate pain
- Fentanyl IV, IM or intranasal, titrated to effect
- Low-dose ketamine as an alternative or addition
- Monitor for sedation and slow breathing; keep naloxone ready
Red flags
- Drowsiness or slow breathing after opioids
- Low blood pressure
- Pain out of proportion, suggesting compartment syndrome or ischemia
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic); National EMS Education Standards (2021). Written by Making Synapses. Making Synapses is not affiliated with these organizations.