Pain Management in Nurse-Led Emergency Services: Results of a National Survey

INTRODUCTION Acute pain effective management in a pre-hospital setting enables better care for patients in emergency situations. In Italy decision-making algorithms and operating protocols have been issued by the relevant authorities, such as 118 Emergency Medical Dispatch Centers (EMDC) and department or regional bodies. These tools regulate pain management procedures, even when carried out independently by emergency nurses. This study aimed to describe drugs used to treat acute pain in patients managed by nurse-led emergency services in Italy. A further objective was to determine the extent to which nurses can autonomously assess and treat acute pain during patient management. METHODS In April and May 2025, a questionnaire was sent to each Italian region's 118 EMDC. The questionnaire consisted of approximately ten closed and open-ended questions. The questionnaire investigated nursing algorithms for assessing and managing pain in adults and children. The questionnaire was completed online using Google Forms. RESULTS Out of a total of 21 118 EMDC to which the questionnaire was sent, 90.5% (n=19) responded. 89% (n=17) have decision-making algorithms in place for nurse-led emergency vehicles. In 12 of these centres, nurses can independently administer drugs in specific cases defined by the algorithms during emergency management. Of the 17 operational centres, 13 (76.4%) have specific nursing algorithms for managing pain in adults, and 12 (70.5%) have algorithms for managing pain in children. Twelve operational centres (70.5%) use nursing algorithms that include validated pain measurement scales such as the NRS (Numerical Rating Scale), VAS (Visual Analogue Scale), PAINAD (Pain Assessment in Advanced Dementia) and FACES. Nurses can independently administer the following drugs without authorisation from the 118 EMDC: paracetamol in eight cases, NSAIDs in three cases, morphine in four cases, fentanyl in four cases, ketamine in one case, and tramadol in one case. However other emergency response centres report that nurses can only administer these drugs after obtaining EMDC physician authorization. CONCLUSIONS The results highlighted inconsistencies in the management of acute pain in the out-of-hospital setting by nursing teams in Italy. Nevertheless, most emergency response centres have protocols for pain management in ambulances led by nurses. The use of appropriate tools for pain assessment and the ability to manage patients' pain independently or with prior authorisation from the emergency response centre, including the use of stronger analgesics, was also identified.