• Is it time to change? The use of intranasal fentanyl for severe pain in the pre-hospital setting

      Parkinson, Martin (2014-11)
      Abstract published with permission. The treatment of pain is a commonplace issue for today’s paramedics, where the need for new analgesics to overcome cannulation barriers is gathering momentum. Intranasal fentanyl has proven itself to be a very safe and effective form of analgesia that overcomes those barriers and can help paramedics provide a higher standard of care. Although research into its use in the prehospital environment is still limited, evidence of its effectiveness in the accident and emergency department has highlighted its potential for helping paramedics treat severe pain where venous access is compromised. Studies have shown that intranasal fentanyl compares with the analgesic standard set by intravenous morphine and is rapidly becoming the drug of choice in the paediatric accident and emergency department.
    • Pain: highlighting the law and ethics of pain relief in end-of-life patients

      Parkinson, Martin (2015-07)
      Abstract published with permission. As the world of palliative medicine is rapidly becoming a fixture in the pre-hospital field of practice, this article looks to explore the ethical and legal issues surrounding pain relief for end-of-life patients by paramedics. Particular attention is focused on the moral and ethical principles of care as proposed by Beauchamp and Childress (2008), as well as the legal aspects of care as set out by the European Court of Human Rights. Through the use of law cases, this article looks to demonstrate precedence for practice, as well as the implications that arise thereof. This article concludes that, although many aspects are still a grey area for paramedics, the depth of law cases, alongside the moral arguments, show that providing paramedics act with the best interests of the patient at heart and work within a multi-disciplinary team, the administration of analgesia to prevent suffering can be legally and ethically proven.
    • Pain: understanding the biopsychosocial model and the paramedic’s role within the multi-disciplinary team

      Parkinson, Martin (2015-05)
      Abstract published with permission. Pain, and its consequent management, is a major factor in today’s ambulance service, with up to 50% of patients reporting pain among their symptoms when contacting the emergency service. This article explores the role of the paramedic within the multi-disciplinary team and asks the question: ‘What is the appropriate treatment?’ A study of the biopsychosocial model shows that modern clinicians who focus solely on the biomedical model are under-treating the patient’s pain by ignoring the psychological and sociological aspects. All this belies a culture of pain management where recognition and treatments of painful conditions bias heavily on some diseases while ignoring or dismissing others. This can, in the eyes of patients, make the individuals complicit with the neglect of painful and life-altering conditions that may permanently change the patients focus and aspirations for the future, and disconnect the patient from the people that are there to help them.