EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.
Issue link: https://emsworld.epubxp.com/i/672538
EMSWORLD.com | MAY 2016 45 EMERGENCY MEDICAL SCIENCE Paramedic Certifi cation (Hybrid Program) • Fully CAAHEP Accredited • Hybrid Paramedic program offered through LCC Continuing Education Department. Only four on-site visits required for skills training and evaluations. All coursework is done online. Tuition is $360. • Clinicals can be completed in your area. Contact LCC regarding available areas. • Different course options that allow currently credentialed EMTs, AEMTs, or individuals with no certifi cation to train for their Paramedic certifi cation. • Graduates are eligible for the NCOEMS Paramedic exam and the National Registry Paramedic exam. Associate Degree in Emergency Medical Science — Bridging • All degree classes offered 100% online. • Currently credentialed state and national Paramedics earn up to 45 credits toward their degree just for being certifi ed! • Designed for demanding EMS work schedules. Complete the degree at your own pace! Earn Your Degree Online! 231 Hwy. 58 South, Kinston, NC www.lenoircc.edu (252) 527-6223, ext. 115 jgtilghman38@lenoircc.edu For More Information Circle 24 on Reader Service Card S p e c i a l P o p u l a t i o n s The use of a pain scale for self-reports of pain severity demands the cognitive ability to quantify a subjective experience. This requires a degree of abstract reasoning that young children and patients with cognitive impairment may find challenging. This places these populations at risk of unrecognized and untreated pain. Research has identified this as a problem when treating infants and children in paramedic practice settings. 29 When attempting to measure pain severity in children, a numerical rating scale (0–10) should be understood in children 8 years and older. 30 In younger children, such as preverbal infants, it is difficult to differentiate between pain associated with a medical condition and the distress associated with hunger and fatigue. In this instance, a pain scale should be used to rate behavioral cues associated with pain. FLACC Scale: The facial expression, leg movement, activity, cry and consolability (FLACC) scale has been researched in children aged 2 months to 7 years and shown to be a valid and reliable tool, and is one that is currently used and recommended for use in the prehospital setting (see Table 2). 31 Several other pain scales are available for the assessment of pain in infants and children, but few have been trialed in paramedic practice. 32 Wong-Baker FACES Pain Scale: This has been validated in children 4 and older (see Figure 3). 34 EVENDOL Scale: The recently developed and tested Evaluation Child Pain Scale, from an abbreviated form of the French for evaluation child pain, has demonstrated excellent validity for the assessment of pain in children aged less than 7 years in the emergency department. 35 The scale has not yet been validated in the prehospital setting. An evaluation of the strengths and limitations of the various pain scales has been undertaken, and this should be used to inform clinical practice guidelines for the assessment of pain in the prehospital setting. 36 A range of pain severity assessment tools exists for older patients with cognitive impairment. Advanced dementia is a common disease in the elderly and is associated with difficulty in understanding instructions required to rate pain using the VNRS or VAS. This situation may require the use of a tool that rates behavioral cues associated with pain. Abbey Pain Scale: This has been designed to assess pain in older adults with dementia who cannot verbalize their pain experience. Although not commonly used by paramedics, the scale should be in use in aged-care facilities. Paramedics should ask nursing staff whether they use the tool, and if so, if they can use it to assist with the assessment of the patient's pain. 24 Behavioral cues should also be used to assess for evidence of pain in patients with impaired level of consciousness due to injury or disease. Just because a patient cannot verbalize pain does not mean they are not experiencing it. 24,37