Prehospital Opioids Significantly Reduced Pain From Traumatic Injury With Few Adverse Events

This study evaluated patterns of prehospital pain management utilized by emergency medical services across the United States.

Patients with traumatic injuries who received opioids from emergency responders in the field were found to have reduced pain with few adverse events. These findings were published in the journal Injury.

Data for this study were sourced from the 2019 National Emergency Medical Services Information System (NEMSIS). Injured patients (N=3,831,768) who encountered emergency medical services (EMS) were evaluated for pain and adverse events on the basis of receiving opioids prehospital.

Patients were aged mean 51.5 (standard deviation [SD], 25.4) years, 51.6% were women or girls, 85.3% received care from an advanced life support team, and median EMS travel time was 16.50 (interquartile range [IQR], 9.05-53.00) minutes.

Opioids were distributed to 7.0% of patients. Among opioid recipients, most (88.2%) received fentanyl followed by morphine (11.0%) and hydromorphone (1.7%). The median opioid dose was 10 morphine milligram equivalents. After receiving opioids, the median pain reduction was 3 (IQR, 1-5) points based on a 10-point vital sign score.

Patients who received opioids from EMS prehospital were more likely to have a blunt injury, to be intubated, to have higher pain scores, and to receive ketamine (all P <.001).

Opioid distribution was more likely among older patients with higher initial pain scores and those in the Western Plains (odds ratio [OR], 2.69; 95% CI, 2.61-2.77; P <.001) and urban areas (OR, 1.32; 95% CI, 1.29-1.35; P <.001).

Few adverse events from prehospital opioids were observed with 0.2% reporting altered mental state and 0.1% respiratory compromise.

This study may have been limited by the differing reporting practices of healthcare entities, in which some regions may have been under- or over-represented.

These data indicated that few patients with severe injury received opioids prehospital despite the efficacy in treating pain and the limited evidence of adverse events.

“Given the demonstrated effectiveness and low incidence of adverse events associated with opioids in this study, 1 potential intervention to improve the prehospital treatment of pain is to reduce barriers to opioid administration,” the study authors stated.

Additional research is needed to determine whether protocols for opioid administration are needed in the field.


Dalton MK, Semco RS, Ordoobadi AJ, et al. Opioid administration in the prehospital setting for patients sustaining traumatic injuries: An evaluation of national emergency medical services data. Injury. 2022;S0020-1383(22)00258-3. doi:10.1016/j.injury.2022.03.068