Abbey J, Piller N, De Bellis A The abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia. Int J Palliat Nurs. 2004; 10:(1)6-13

Al Jazairi AF, Alinier G. Access to emergency health care. In: Agrawal A (ed). London: Intechopen; 2021

Alinier G, Newton A. A model to embed clinical simulation training during ambulance shift work. Int Para Pract. 2013; 3:(2)35-40

Ambuel B, Hamlett KW, Marx CM, Blumer JL. Assessing distress in pediatric intensive care environments: the COMFORT scale. J Pediatr Psychol. 1992; 17:(1)95-109

Alshamari S. The Qatar health system: challenges and opportunities. Network Int Stud. 2017; 5:(9)47-56

Armour R, Murphy-Jone B. Appropriate pain assessment tools for use in patients with dementia in the out-of-hospital environment. J Para Pract. 2016; 8:(11)533-541

Campbell CM, Edwards RR. Ethnic differences in pain and pain management. Pain Manag. 2012; 2:(3)219-230

Fahy J. Out of sight, out of mind: managing religious diversity in Qatar. Br J Middle Eastern Stud. 2019; 46:(4)640-662

Gangaram P, Menacho AM, Alinier G. Crisis resource management in relation to empowering people to speak up in emergency medical service clinical practice settings. J Para Pract. 2017; 9:(2)60-65

Gangaram P, Dippenaar E, Alinier G. Paramedic adult pain assessment: pilot study. J Para Pract. 2021; 13:(12)507-513

Garra G, Singer AJ, Taira BR Validation of the wong-baker faces pain rating scale in pediatric emergency department patients. Acad Emerg Med. 2010; 17:(1)50-54

Harvey C. Is there scope for an observational pain scoring tool in paramedic practice?. J Para Pract. 2014; 6:(2)84-88

Hewes HA, Dai M, Mann NC, Baca T, Taillac P. Prehospital pain management: disparity by age and race. Prehosp Emerg Care. 2018; 22:(2)189-197

Hjermstad MJ, Fayers PM, Haugen DF Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manag. 2011; 41:(6)1073-1093

Clinical practice guidelines. In: Service A (ed). Doha: HMCAS; 2017

Hodkinson M. Where is the paramedic profession going with pain management?. J Para Pract. 2016; 8:(3)118-120

Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceed Nat Acad Sci. 2016; 113:4296-4301

Howland IR, Howard IL, Pillay Y, Ludick BD, Castle NR. Prehospital analgesia for femur fractures: an improvement study. Qatar Med J. 2019; 2019:(2)

Hutton D, Alinier G. Ambulance service operational improvement. Int Para Pract. 2013; 3:(3)61-63

Lord B, Bendall J, Reinten T. The influence of paramedic and patient gender on the administration of analgesics in the out-of-hospital setting. Prehosp Emerg Care. 2014; 18:(2)195-200

Lynde J, Zorab O. Pre-hospital pain assessment and management: a quality improvement (qi) approach. Emerg Med J. 2015; 32

Mazara L, Zareei MA, Gharib A, Aljazzazi HS. A study to assess the compliance rate with pain assessment and reassessment by nurses in ed, hgh - a quality improvement initiative. J Emerg Med Trauma Acute Care. 2016;

Parker M, Rodgers A. Management of pain in prehospital settings. Emerg Nurs. 2015; 23:(3)16-23

Schyve PM. Language differences as a barrier to quality and safety in health care: the joint commission perspective. J Gen Intern Med. 2007; 22:360-361

Shah Y, Alinier G, Pillay Y. Clinical handover between paramedics and emergency department staff: sbar and imist-ambo acronyms. Int Para Pract. 2016; 6:(2)37-44

Siriwardena AN, Asghar Z, Lord B Patient and clinician factors associated with prehospital pain treatment and outcomes: cross sectional study. Am J Emerg Med. 2019; 37:(2)266-271

Whitley GA, Hemingway P, Law GR, Siriwardena AN. The complexity of pain management in children. J Para Pract. 2019; 11:(11)466-468

Wilson P, Alinier G, Reimann T, Morris B. Influential factors on urban and rural response times for emergency ambulances in qatar. Mediterran J Emerg Med. 2017; 26:8-13

Considerations on out-of-hospital pain assessment of a diverse population

02 December 2021
Volume 11 · Issue 4


Nearly all medical emergency calls are related to someone experiencing some form of discomfort—either due to trauma or pain. Initial pain assessment may be undertaken over the telephone by an emergency medical dispatcher, without seeing the patient; however, the next key moment in pain assessment is completed patient-side by the paramedic. This inquiry is detailed and guides the paramedic in the formation of a differential diagnosis and provision of appropriate pain management. The research team recently conducted and published a study on pain assessment which raised concerns on the subjectivity of pain scoring. The work presented was in the context of a very multicultural environment. The aim of this commentary article is to further explore this topic and encourage health professionals to reflect on this aspect of patient assessment.

Pain is often the trigger that makes people call for an ambulance (Armour and Murphy-Jones, 2016) and alleviating pain and suffering is one of the first goals of a paramedic upon meeting a patient. However, as easy as it sounds, many factors affect pain perception and reporting on the part of patients, and how the paramedic will deal with the situation (Lord et al, 2014; Siriwardena et al, 2019). Pain assessment is not only a difficult aspect of patient care in the prehospital setting (Lynde and Zorab, 2015), as it is also reported as a challenge to consistently perform and document in emergency departments (Mazara et al, 2016). Although pain is a very subjective parameter, it is important that the paramedic appropriately assesses pain and documents it accordingly. This is the first step in appropriate pain management and alleviation. Other factors to consider include the paramedic's scope of practice and legal aspects associated with the use of analgesic and pain medication. Controlled medication may be potentially lethal if inappropriately administered (Hodkinson, 2016). These elements may further influence or impede the decision-making process of paramedics in determining what pain relief option to adopt.

Subscribe to get full access to International Paramedic Practice

Thank you for visiting International Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

What's included

  • CPD Focus

  • Develop your career

  • Stay informed