Australian and New Zealand journal of medicine, 1993
The role of intravenous aminophylline in acute asthma is unclear despite meta-analysis of many st... more The role of intravenous aminophylline in acute asthma is unclear despite meta-analysis of many studies comparing aminophylline with other bronchodilator therapies. The aim of this study is to determine whether continuous aminophylline infusion confers any benefit in acute severe asthmatics treated with intravenous steroids and inhaled bronchodilators. The study was randomised, double-blind and placebo-controlled. All patients received nebulised salbutamol (1 mL of 0.5%) and ipratropium bromide (1 mL of 0.025%) with glycol diluent (1 mL) at 0, two, four, six, eight and 12 hours, and six-hourly thereafter. In addition all patients were given intravenous hydrocortisone 250 mg six-hourly and oxygen to maintain normoxia. Aminophylline infusions were adjusted to maintain therapeutic levels. Peak expiratory flow rate (PEFR) was measured before and after nebulised bronchodilator on a two-hourly basis in the Emergency Department (ED) and six-hourly on the inpatient wards. Thirty-one patients...
Objective To assess the time taken to complete a Synthesised Geriatric Assessment (SGA) in an Eme... more Objective To assess the time taken to complete a Synthesised Geriatric Assessment (SGA) in an Emergency Department (ED) and to determine what secondary patient characteristics affect results. Methods A convenience sample of 25 patients aged over 65 from an Australian single-centre ED was used for this pilot study. Primary outcome measures included the overall time taken as well as the times for individual screening instruments. Data regarding patient characteristics were taken as secondary outcome measures to assess impact on times. For each of the screening instruments, the mean, median, interquartile range and the 90th percentile for the test duration was calculated. Linear regression was used to evaluate univariate associations between times and patient characteristics. P-values < 0.05 were considered as statistically significant. Results Time required for completion of the SGA by 90% of the study population was 20 min and 40 s. This represents approximately 8.6% of new 4-h ED...
Clinical features have a sensitivity of 90% for identifying SARS. ! Chest radiography supplemente... more Clinical features have a sensitivity of 90% for identifying SARS. ! Chest radiography supplemented with high resolution computerized tomography achieves a sensitivity of 99% for detecting SARS.
Background: Serious sequelae have been associated with injured patients who are hypothermic (<35 ... more Background: Serious sequelae have been associated with injured patients who are hypothermic (<35 • C) including coagulopathy, acidosis, decreased myocardial contractility and risk of mortality. Aim: Establish the incidence of accidental hypothermia in major trauma patients and identify causative factors. Method: Prospective identification and subsequent review of 732 medical records of major trauma patients presenting to an Adult Major Trauma Centre was undertaken between January and December 2008. Multivariate analysis was performed using logistic regression. Significant and clinically relevant variables from univariate analysis were entered into multivariate models to evaluate determinants for hypothermia and for death. Goodness of fit was determined with the use of the Hosmer-Lemeshow statistic. Main results: Overall mortality was 9.15%. The incidence of hypothermia was 13.25%. The mortality of patients with hypothermia was 29.9% with a threefold independent risk of death: OR (CI 95%) 3.44 (1.48-7.99), P = 0.04. Independent determinants for hypothermia were pre-hospital intubation: OR (CI 95%) 5.18 (2.77-9.71), P < 0.001, Injury Severity Score (ISS): 1.04 (1.01-1.06), P = 0.01, Arrival Systolic Blood Pressure (ASBP) < 100 mm Hg: 3.04 (1.24-7.44), P = 0.02, and wintertime: 1.84 (1.06-3.21), P = 0.03. Of the 87 hypothermic patients who had repeat temperatures recorded in the Emergency Department, 77 (88.51%) patients had a temperature greater than the recorded arrival temperature. There was no change in recorded temperature for four (4.60%) patients, whereas six (6.90%) patients were colder at Emergency Department discharge. Conclusion: Seriously injured patients with accidental hypothermia have a higher mortality independent of measured risk factors. For patients with multiple injuries a coordinated effort by paramedics, nurses and doctors is required to focus efforts toward early resolution of hypothermia aiming to achieve a temperature >35 • C.
Synchronized Direct Current Cardioversion (SDC) is an established therapy for the termination of ... more Synchronized Direct Current Cardioversion (SDC) is an established therapy for the termination of supraventricular tachycardia (SVT – either atrio-ventricular nodal reentry tachycardia (AVNRT) or atrio-ventricular reentrant tachycardia (AVRT)) with poor perfusion. The evidence is extremely limited with regard to the safety and effectiveness of this therapy. In Australia, half of the eight ambulance services include SDC within their clinical practice guidelines for the management of poorly perfused SVT; however the degree of variation in the application of SDC across these guidelines suggests a need to quantify the practice. This case provides a previously unreported example of the safety and effectiveness of prehospital SDC for SVT (with poor perfusion precipitated by a Valsalva Maneuver) by Victorian paramedics, and discusses the available literature regarding the effectiveness and safety of this practice.SmithG,TaylorD,MorgansA,CameronP.Prehospital synchronized electrical cardiover...
There is a range of pharmacological interventions available to reduce blood loss and minimize or ... more There is a range of pharmacological interventions available to reduce blood loss and minimize or avoid the use of allogeneic blood transfusions [1]. These agents include the protease inhibitor aprotinin (Trasylol® Aprotinin Bayer AG, Bayerwerk, Leverkusen, Germany), lysine analogue antifibrinolytics [tranexamic acid (Cyclokapron® Tranexamic Acid Pfizer Inc., New York, NY, USA) and epsilon aminocaproic acid (Amicar® Xanodyne Pharmaceuticals, Inc., New York, KY, USA)], DDAVP (Desmopressin® Raybiotech, Inc., Narcross, GA, USA) and recombinant factor VIIa (rFVIIa; NovoSeven® Novo Nordisk A/S, Bagsvaerd, Germany). This article will focus on the current role for rVIIa in controlling haemorrhage in the non-haemophiliac setting. rFVIIa is being widely used off-label and there is considerable controversy as to its benefits and risks. Recombinant activated factor VII is effective for the prevention or treatment of bleeding in patients with inhibitors to factor VIII (FVII) and factor IX. rFVIIa is licenced in many countries for this indication and is also licenced in some markets for Glanzmann's thrombasthenia and congenital FVII deficiency. It has been extensively used among haemophiliacs and enhances clotting at the site of bleeding through the formation of a thrombin burst and a stable fibrin clot. Recent insights into haemostatic mechanisms have resulted in a better understanding of the central role of FVII/FVIIa in the localizing and initiating of haemostasis. Consequently, this has led to the wider use of rFVIIa as a haemostatic agent. There is an increasing number of case reports and series reporting on the use of rFVIIa in critical life-threatening haemorrhage [2]. In many cases, control of critical bleeding is possible with surgical haemostasis and the replacement of blood products to support an underlying coagulopathy. In a small number of cases bleeding continues despite these measures. Patients with uncontrolled critical bleeding and coagulopathy, despite large transfusions and surgical
Background: There has been increasing off-label use of recombinant activated factor VII (rFVIIa/N... more Background: There has been increasing off-label use of recombinant activated factor VII (rFVIIa/NovoSeven; Novo Nordisk, Bagsvaerd, Denmark) for patients with critical bleeding. Given the lack of high-level evidence, the clinical indications, observed response and adverse events are important to capture. Methods: The Haemostasis Registry collects retrospective and contemporaneous data on all use of rFVIIa at participating institutions for non-haemophiliac patients with critical bleeding (i.e. off-label use). Results: As of October 2006, 694 cases had been reported into the register from 37 hospitals across Australia and New Zealand. These comprise an array of therapeutic categories, including salvage use in: perioperative cardiothoracic surgery (44%), trauma (16%), medical bleeding (9%), obstetric bleeding (4%) and other types of critical bleeding (28%). Patients received a median (interquartile range) dose of 91 lg/kg (75-103) and 83% of patients received a single dose of rFVIIa. The documented response rate to a single dose of rFVIIa was 69%. The 28-day survival was 68%, but varied with clinical category. The rate of adverse events probably or possibly linked to the use of rFVIIa was 6%, with most of the thromboembolic adverse events occurring in the cardiac surgery group. Conclusion: The Haemostasis Registry cannot replace well-designed prospective randomized controlled trials, but in their absence this registry provides a basis for understanding current clinical experience of rFVIIa. Registries continue to be vital in monitoring off-label uses of medications.
Population ageing is projected to impact on health services utilisation including Emergency Depar... more Population ageing is projected to impact on health services utilisation including Emergency Departments (ED), with older patients reportedly having a high rate of return visits. We describe and compare patterns in ED utilisation between older and younger adults, and quantify the proportion and rate of return visits. Population-based retrospective analysis of metropolitan Melbourne public hospital ED data, 1999/2000 to 2008/2009. Numbers of patients, presentations, re-presentations and rates per 1000 population were calculated, with comparison of older (aged ≥ 70 years) and younger (15-69 years) attendances. Population growth in each age group was similar over the study period, yet ED presentations rose by 72% for older adults compared with a 59% increase for younger adults. Rates per 1000 population rose with increasing age. Of the population aged ≥ 70 years, 39% presented to ED compared with 17% of the population aged 15-69 years in 2008/2009. Twenty-seven per cent of the increase in older adult presentations was driven by a cohort who attended ≥ 4 times in 2008/2009. The number of older patients presenting ≥ 4 times doubled over the decade, contributing to 23% of all older presentations in 2008/2009. ED length of stay rose with increasing age; 69% of older adults remained in ED for ≥ 4 h compared with 39% of younger adults in 2008/2009. The number of older adult ED hospital admissions doubled over the decade. Older patients are disproportionately represented among ED attendances. They also have an increasing propensity to re-present to ED, indicating a need to identify the clinical, social and health system-related risk factors for re-attendance by specific patients.
Pharmaceuticals) to monitor the use of rFVIIa throughout Australia and New Zealand. More than 80 ... more Pharmaceuticals) to monitor the use of rFVIIa throughout Australia and New Zealand. More than 80 hospitals are contributing data to the Registry including all major users of rFVIIa in Australia and New Zealand. Results: Over 2000 cases of rFVIIa use have been reported to the Register including almost 300 trauma cases ($15%). The recently curtailed CONTROL trial aimed to clarify the role of rFVIIa in trauma; however, the majority of trauma cases in the Haemostasis Registry would not have qualified for this trial. Data from the Registry, however, will be shown to provide insight into the use of rFVIIa in trauma, particularly in relation to pH, temperature and the appropriate use of blood component therapy. Conclusions: This is the largest dataset of rFVIIa cases published to date and can now provide greater insight into the actual rather than theoretical use of rFVIIa in Australia and New Zealand. In the absence of sound clinical trial evidence, consensus regarding appropriate use has not been achieved. In these circumstances, data from the Haemostasis Registry continues to be important in elucidating the safety and efficacy of rFVIIa and providing important feedback to doctors and hospitals.
All emergency departments (EDs) have an obligation to deliver care that is demonstrably safe and ... more All emergency departments (EDs) have an obligation to deliver care that is demonstrably safe and of the highest possible quality. Emergency medicine is a unique and rapidly developing specialty, which forms the hub of the emergency care system and strives to provide a consistent and effective service 24 h a day, 7 days a week. The International Federation of Emergency Medicine, representing more than 70 countries, has prepared a document to define a framework for quality and safety in the ED. Following a consensus conference and with subsequent development, a series of quality indicators have been proposed. These are tabulated in the form of measures designed to answer nine quality questions presented according to the domains of structure, process and outcome. There is an urgent need to improve the evidence base to determine which quality indicators have the potential to successfully improve clinical outcomes, staff and patient experience in a cost-efficient manner--with lessons for implementation.
This retrospective, electronic patient care record review examined a consecutive sample of patien... more This retrospective, electronic patient care record review examined a consecutive sample of patients presenting with pain to the metropolitan region of Ambulance Victoria over a period of 12&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;emsp14;months in 2008. The majority of patients did not achieve clinically significant pain reduction, but did achieve some pain relief while in ambulance care. Those with the most severe pain had pain reduction that was clinically significant. Further research is needed to provide optimal pain relief in the prehospital setting.
Australian and New Zealand journal of medicine, 1993
The role of intravenous aminophylline in acute asthma is unclear despite meta-analysis of many st... more The role of intravenous aminophylline in acute asthma is unclear despite meta-analysis of many studies comparing aminophylline with other bronchodilator therapies. The aim of this study is to determine whether continuous aminophylline infusion confers any benefit in acute severe asthmatics treated with intravenous steroids and inhaled bronchodilators. The study was randomised, double-blind and placebo-controlled. All patients received nebulised salbutamol (1 mL of 0.5%) and ipratropium bromide (1 mL of 0.025%) with glycol diluent (1 mL) at 0, two, four, six, eight and 12 hours, and six-hourly thereafter. In addition all patients were given intravenous hydrocortisone 250 mg six-hourly and oxygen to maintain normoxia. Aminophylline infusions were adjusted to maintain therapeutic levels. Peak expiratory flow rate (PEFR) was measured before and after nebulised bronchodilator on a two-hourly basis in the Emergency Department (ED) and six-hourly on the inpatient wards. Thirty-one patients...
Objective To assess the time taken to complete a Synthesised Geriatric Assessment (SGA) in an Eme... more Objective To assess the time taken to complete a Synthesised Geriatric Assessment (SGA) in an Emergency Department (ED) and to determine what secondary patient characteristics affect results. Methods A convenience sample of 25 patients aged over 65 from an Australian single-centre ED was used for this pilot study. Primary outcome measures included the overall time taken as well as the times for individual screening instruments. Data regarding patient characteristics were taken as secondary outcome measures to assess impact on times. For each of the screening instruments, the mean, median, interquartile range and the 90th percentile for the test duration was calculated. Linear regression was used to evaluate univariate associations between times and patient characteristics. P-values < 0.05 were considered as statistically significant. Results Time required for completion of the SGA by 90% of the study population was 20 min and 40 s. This represents approximately 8.6% of new 4-h ED...
Clinical features have a sensitivity of 90% for identifying SARS. ! Chest radiography supplemente... more Clinical features have a sensitivity of 90% for identifying SARS. ! Chest radiography supplemented with high resolution computerized tomography achieves a sensitivity of 99% for detecting SARS.
Background: Serious sequelae have been associated with injured patients who are hypothermic (<35 ... more Background: Serious sequelae have been associated with injured patients who are hypothermic (<35 • C) including coagulopathy, acidosis, decreased myocardial contractility and risk of mortality. Aim: Establish the incidence of accidental hypothermia in major trauma patients and identify causative factors. Method: Prospective identification and subsequent review of 732 medical records of major trauma patients presenting to an Adult Major Trauma Centre was undertaken between January and December 2008. Multivariate analysis was performed using logistic regression. Significant and clinically relevant variables from univariate analysis were entered into multivariate models to evaluate determinants for hypothermia and for death. Goodness of fit was determined with the use of the Hosmer-Lemeshow statistic. Main results: Overall mortality was 9.15%. The incidence of hypothermia was 13.25%. The mortality of patients with hypothermia was 29.9% with a threefold independent risk of death: OR (CI 95%) 3.44 (1.48-7.99), P = 0.04. Independent determinants for hypothermia were pre-hospital intubation: OR (CI 95%) 5.18 (2.77-9.71), P < 0.001, Injury Severity Score (ISS): 1.04 (1.01-1.06), P = 0.01, Arrival Systolic Blood Pressure (ASBP) < 100 mm Hg: 3.04 (1.24-7.44), P = 0.02, and wintertime: 1.84 (1.06-3.21), P = 0.03. Of the 87 hypothermic patients who had repeat temperatures recorded in the Emergency Department, 77 (88.51%) patients had a temperature greater than the recorded arrival temperature. There was no change in recorded temperature for four (4.60%) patients, whereas six (6.90%) patients were colder at Emergency Department discharge. Conclusion: Seriously injured patients with accidental hypothermia have a higher mortality independent of measured risk factors. For patients with multiple injuries a coordinated effort by paramedics, nurses and doctors is required to focus efforts toward early resolution of hypothermia aiming to achieve a temperature >35 • C.
Synchronized Direct Current Cardioversion (SDC) is an established therapy for the termination of ... more Synchronized Direct Current Cardioversion (SDC) is an established therapy for the termination of supraventricular tachycardia (SVT – either atrio-ventricular nodal reentry tachycardia (AVNRT) or atrio-ventricular reentrant tachycardia (AVRT)) with poor perfusion. The evidence is extremely limited with regard to the safety and effectiveness of this therapy. In Australia, half of the eight ambulance services include SDC within their clinical practice guidelines for the management of poorly perfused SVT; however the degree of variation in the application of SDC across these guidelines suggests a need to quantify the practice. This case provides a previously unreported example of the safety and effectiveness of prehospital SDC for SVT (with poor perfusion precipitated by a Valsalva Maneuver) by Victorian paramedics, and discusses the available literature regarding the effectiveness and safety of this practice.SmithG,TaylorD,MorgansA,CameronP.Prehospital synchronized electrical cardiover...
There is a range of pharmacological interventions available to reduce blood loss and minimize or ... more There is a range of pharmacological interventions available to reduce blood loss and minimize or avoid the use of allogeneic blood transfusions [1]. These agents include the protease inhibitor aprotinin (Trasylol® Aprotinin Bayer AG, Bayerwerk, Leverkusen, Germany), lysine analogue antifibrinolytics [tranexamic acid (Cyclokapron® Tranexamic Acid Pfizer Inc., New York, NY, USA) and epsilon aminocaproic acid (Amicar® Xanodyne Pharmaceuticals, Inc., New York, KY, USA)], DDAVP (Desmopressin® Raybiotech, Inc., Narcross, GA, USA) and recombinant factor VIIa (rFVIIa; NovoSeven® Novo Nordisk A/S, Bagsvaerd, Germany). This article will focus on the current role for rVIIa in controlling haemorrhage in the non-haemophiliac setting. rFVIIa is being widely used off-label and there is considerable controversy as to its benefits and risks. Recombinant activated factor VII is effective for the prevention or treatment of bleeding in patients with inhibitors to factor VIII (FVII) and factor IX. rFVIIa is licenced in many countries for this indication and is also licenced in some markets for Glanzmann's thrombasthenia and congenital FVII deficiency. It has been extensively used among haemophiliacs and enhances clotting at the site of bleeding through the formation of a thrombin burst and a stable fibrin clot. Recent insights into haemostatic mechanisms have resulted in a better understanding of the central role of FVII/FVIIa in the localizing and initiating of haemostasis. Consequently, this has led to the wider use of rFVIIa as a haemostatic agent. There is an increasing number of case reports and series reporting on the use of rFVIIa in critical life-threatening haemorrhage [2]. In many cases, control of critical bleeding is possible with surgical haemostasis and the replacement of blood products to support an underlying coagulopathy. In a small number of cases bleeding continues despite these measures. Patients with uncontrolled critical bleeding and coagulopathy, despite large transfusions and surgical
Background: There has been increasing off-label use of recombinant activated factor VII (rFVIIa/N... more Background: There has been increasing off-label use of recombinant activated factor VII (rFVIIa/NovoSeven; Novo Nordisk, Bagsvaerd, Denmark) for patients with critical bleeding. Given the lack of high-level evidence, the clinical indications, observed response and adverse events are important to capture. Methods: The Haemostasis Registry collects retrospective and contemporaneous data on all use of rFVIIa at participating institutions for non-haemophiliac patients with critical bleeding (i.e. off-label use). Results: As of October 2006, 694 cases had been reported into the register from 37 hospitals across Australia and New Zealand. These comprise an array of therapeutic categories, including salvage use in: perioperative cardiothoracic surgery (44%), trauma (16%), medical bleeding (9%), obstetric bleeding (4%) and other types of critical bleeding (28%). Patients received a median (interquartile range) dose of 91 lg/kg (75-103) and 83% of patients received a single dose of rFVIIa. The documented response rate to a single dose of rFVIIa was 69%. The 28-day survival was 68%, but varied with clinical category. The rate of adverse events probably or possibly linked to the use of rFVIIa was 6%, with most of the thromboembolic adverse events occurring in the cardiac surgery group. Conclusion: The Haemostasis Registry cannot replace well-designed prospective randomized controlled trials, but in their absence this registry provides a basis for understanding current clinical experience of rFVIIa. Registries continue to be vital in monitoring off-label uses of medications.
Population ageing is projected to impact on health services utilisation including Emergency Depar... more Population ageing is projected to impact on health services utilisation including Emergency Departments (ED), with older patients reportedly having a high rate of return visits. We describe and compare patterns in ED utilisation between older and younger adults, and quantify the proportion and rate of return visits. Population-based retrospective analysis of metropolitan Melbourne public hospital ED data, 1999/2000 to 2008/2009. Numbers of patients, presentations, re-presentations and rates per 1000 population were calculated, with comparison of older (aged ≥ 70 years) and younger (15-69 years) attendances. Population growth in each age group was similar over the study period, yet ED presentations rose by 72% for older adults compared with a 59% increase for younger adults. Rates per 1000 population rose with increasing age. Of the population aged ≥ 70 years, 39% presented to ED compared with 17% of the population aged 15-69 years in 2008/2009. Twenty-seven per cent of the increase in older adult presentations was driven by a cohort who attended ≥ 4 times in 2008/2009. The number of older patients presenting ≥ 4 times doubled over the decade, contributing to 23% of all older presentations in 2008/2009. ED length of stay rose with increasing age; 69% of older adults remained in ED for ≥ 4 h compared with 39% of younger adults in 2008/2009. The number of older adult ED hospital admissions doubled over the decade. Older patients are disproportionately represented among ED attendances. They also have an increasing propensity to re-present to ED, indicating a need to identify the clinical, social and health system-related risk factors for re-attendance by specific patients.
Pharmaceuticals) to monitor the use of rFVIIa throughout Australia and New Zealand. More than 80 ... more Pharmaceuticals) to monitor the use of rFVIIa throughout Australia and New Zealand. More than 80 hospitals are contributing data to the Registry including all major users of rFVIIa in Australia and New Zealand. Results: Over 2000 cases of rFVIIa use have been reported to the Register including almost 300 trauma cases ($15%). The recently curtailed CONTROL trial aimed to clarify the role of rFVIIa in trauma; however, the majority of trauma cases in the Haemostasis Registry would not have qualified for this trial. Data from the Registry, however, will be shown to provide insight into the use of rFVIIa in trauma, particularly in relation to pH, temperature and the appropriate use of blood component therapy. Conclusions: This is the largest dataset of rFVIIa cases published to date and can now provide greater insight into the actual rather than theoretical use of rFVIIa in Australia and New Zealand. In the absence of sound clinical trial evidence, consensus regarding appropriate use has not been achieved. In these circumstances, data from the Haemostasis Registry continues to be important in elucidating the safety and efficacy of rFVIIa and providing important feedback to doctors and hospitals.
All emergency departments (EDs) have an obligation to deliver care that is demonstrably safe and ... more All emergency departments (EDs) have an obligation to deliver care that is demonstrably safe and of the highest possible quality. Emergency medicine is a unique and rapidly developing specialty, which forms the hub of the emergency care system and strives to provide a consistent and effective service 24 h a day, 7 days a week. The International Federation of Emergency Medicine, representing more than 70 countries, has prepared a document to define a framework for quality and safety in the ED. Following a consensus conference and with subsequent development, a series of quality indicators have been proposed. These are tabulated in the form of measures designed to answer nine quality questions presented according to the domains of structure, process and outcome. There is an urgent need to improve the evidence base to determine which quality indicators have the potential to successfully improve clinical outcomes, staff and patient experience in a cost-efficient manner--with lessons for implementation.
This retrospective, electronic patient care record review examined a consecutive sample of patien... more This retrospective, electronic patient care record review examined a consecutive sample of patients presenting with pain to the metropolitan region of Ambulance Victoria over a period of 12&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;emsp14;months in 2008. The majority of patients did not achieve clinically significant pain reduction, but did achieve some pain relief while in ambulance care. Those with the most severe pain had pain reduction that was clinically significant. Further research is needed to provide optimal pain relief in the prehospital setting.
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Papers by P. Cameron