Use of morphine sulphate by South African paramedics for prehospital pain management

Background: Evidence in the literature highlights the fact that acute pain in the prehospital setting remains poorly managed. Morphine remains the most commonly used analgesic agent in the South African prehospital emergency care setting. Although guidelines and protocols relating to the dosage and administration of morphine exist, little data are available describing its use by South African paramedics. Objectives: To document and describe the way in which morphine is administered by a sample of South African paramedics for the management of acute pain in the prehospital setting. Methods: An Internet-based survey was conducted. Sixty South African paramedics responded by completing the online questionnaire documenting and describing their use of morphine for management of acute pain. Results: Results revealed that participants appeared to be overly cautious of potential adverse effects associated with administration of morphine. Although the majority of participants calculated the dose of morphine to be administered correctly according to the patient's weight, the majority do not appear to be administering this as a bolus; rather, they administer the calculated loading dose in a titrated manner over time. This method may result in a delay and or failure to adequately achieve therapeutic serum levels. Conclusion: Failure to administer an appropriate bolus or 'loading dose' when administering morphine intravenously may result in ineffective and delayed pain management. The authors recommend more clearly defined protocols be developed to guide the use of morphine sulphate by paramedics in the local emergency medical services environment.