Inclusion Criteria:  Patients suffering from severe pain or discomfort.

SPECIAL NOTE: Withholding analgesia from a patient in pain is considered negligence.

Basic Level

  1. Assess and support ABCs.  Offer comfort and reassurance.
  2. Patient positioning:
    1. Initiate SPINAL MOTION RESTRICTION, if indicated.
    2. If no spinal injury is suspected, place the patient in a position of comfort.
    3. If there is evidence of shock, place the patient supine with the feet elevated and closely monitor airway status.  Treat shock according to the SHOCK Guidelines.
  1. Administer oxygen, as needed, to maintain a SpO2 of at least 94%.
  2. Assess and document neurovascular status and perfusion of injured extremities. Splint injured extremities and apply cold packs.  SPECIAL NOTE: Do NOT use a traction splint for patients under 14 years of age.
  3. Once advanced level care arrives on scene, give report and transfer care.

Advanced Level

  1. Consider establishing IV/IO access at a TKO rate or use a saline lock.
    1. For an adult or pediatric patient with sickle cell crisis, administer 10 mL/kg Normal Saline, then maintain TKO rate.
  2. Once drug allergies have been verified, administer pain medication according to the following:



NOTE: Individual agencies may carry none, one, or both of these analgesics. There is no uniform requirement for all agencies to carry these medications.

  1. After analgesia administration, monitor for cardiorespiratory depression or excessive sedation.
  2. For additional patient care considerations not covered under standing orders, consult BioTel