COMPARISON OF PAIN MANAGEMENT IN PATIENTS CARED FOR BY BASIC VERSUS ADVANCED LIFE SUPPORT (BLS VS. ALS) FIRE ENGINE FIRST RESPONSE CREWS

Abstract

Objective: In 2023, a single large fire-based EMS agency, transitioned from a Basic Life Support (BLS) fire engine and dual paramedic Advanced Life Support (ALS) ambulance system, to an all ALS response model, with a paramedic on both the engine and ambulance transport. The impact of this transition from a dual medic (DM) ambulance to a one and one (1:1) system on patient care is unknown. In this same system, administration of morphine and transport by Basic Life Support (BLS) ambulance is encouraged as a method to improve ALS ambulance resource utilization. The aim of this study is to describe the impact of this system change on pain management. Methods: This study involved a retrospective analysis of quality improvement (QI) data gathered by the fire-based EMS agency on an ongoing basis. QI data referencing pain management was compared from the DM period (June 1, 2022, to May 31, 2023) to the 1:1 period (June 1, 2023, to May 31, 2024). Cases during the implementation of the 1:1 system (April 1, 2023, to May 30, 2024) were excluded. Key outcome measures included rates of ketamine and morphine administration, frequency of IV access and rate of ALS and BLS transports in reference to morphine administration. Statistical analysis was conducted to evaluate the association between system design change and outcomes. Statistical significance was set at p < 0.05. Results: There were 893 patients who received pain management during the DM period and 1054 during the 1:1 period. The median age / percent female was 62 years / 54% and 63 years / 54%. The frequency of ALS transports (Before: 51%, After: 51%; OR = 0.99 95% CI: 1.97, 0.51) did not change. Patients without an IV placed, despite complaints of pain, decreased from 35% to 28% (OR = 0.72, 95% CI: 0.88, 0.60). Patients who received only ketamine increased from 13% to 22% (OR = 1.94 95% CI: 2.48, 1.52), while patients the number of patients who received only morphine (Before: 50%, After: 48%; OR = 0.92, 95% CI: 1.09, 0.78) or morphine and ketamine (Before: 2%, After: 2%; OR = 1.01, 95% CI: 1.97, 0.51) showed no significant change. Among patients who received morphine, frequency of BLS transports increased from 38% to 52% (OR = 1.78 95% CI: 2.30, 1.39). Conclusion: In this single agency, the transition from a DM transport to the 1:1 system was associated with higher rates of IV insertion, increased use of ketamine and increased rates of BLS transport after morphine administration. All suggesting that the presence of a paramedic on every call allows for more aggressive pain management. Further research is necessary to determine if these single systems observations can be applied more broadly.