Charlevoix  County  Medical  Control  Authority
State  Model  Protocol


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Updated 7-2008


Page: G 5.1

Purpose: To provide a method for managing the pain of patients during the delivery of emergency medical care or transport. This procedure is for Paramedic use only.

I. Assessment

A.  Evaluate and maintain the airway, evaluate breathing, adequate perfusion.

1. Monitor vital signs, pulse oximetry and level of consciousness.

I. Indications for Pain Management

A.  Patient with pain due to orthopedic injury

B.  Patient with burns or other severe soft tissue injury

C.  Patient with known diagnosis of kidney stones

D.  For pain induced by procedures, see Patient Sedation Procedure.


III. Contraindications


A.  Potentially hemodynamically unstable patient

B.  Allergies to morphine sulfate, fentanyl or midazolam

IV. Procedure

A.  Utilize universal precautions.

B.  Maintain airway, provide oxygenation and support ventilation as needed.

1.  Airway and ventilation equipment must be prepared because of the potential for respiratory compromise due to medication effects.

C.  Obtain vascular access.

D.  ASK the patient and/or family about allergies

E.  Obtain a pain rating from the patient.*

E.  Standing Order Medications

1.  Titrate administration of medication to a level where pain is reduced or relieved.

a.  Consider morphine sulfate (use only one of the analgesics)

i.   ADULT: 2.0 -10.0 mg slow IVP (2.0 mg increments)

ii.  Pediatrics: 0.1 mg/kg IVP

1.)  If IV cannot obtained, consider morphine IM

 b.  Consider Fentanyl (use only one of the analgesics)

 i.  Adult: 25.0 - 100.0 mcg IVP titrate to effect, max 200.0 mcg

ii.  Pediatrics: 1.0 mcg IVP slowly.  Call after intial dose.

iii. More rapid onset then morphine, duration 30-60 min.  Less histamine release, therefore fewer hemodynamic effects.

iv. 100.0 mcg roughly equivalent to 10.0 mg morphine

v.  May cause chest wall rigidity with rapid administration

c.  Consider Demerol (meperidine) (use only if allergic to morphine  AND use only one of the analgesics)

 i.  Adult- 25.0mg slow IVP

2.  Consider the administration of Zofran concurrently with pain medications

a.  0.1 mg/kg slow IVP adults and pediatric patients diluted to 10cc NaCl (given slow IVP over 2 minutes) max dose 4mg.

F.  Possible orders post radio contact:

1.  Additional morphine sulfate, if MS was the administer medication

2.  Additional fentanyl if fentanyl was the administered medication

3.  Additional demerol it demerol was the administered medication

4.  Administer midazolam 0.05 mg/kg to max of 5.0 mg, titrating to pain. (Adult and peds)

5. Administer ketorolac ( Toradol ) 15.0 - 30.0 mg IV (Adults ONLY)


IV. Special Considerations


A.  Diluting morphine OR fentanyl with saline assists in the ability to titrate slowly

B.  It is wise to have naloxone prepared in syringe for reversal of morphine




Page: G 5.2




This pain assessment tool is intended to help patient care providers assess pain according to individual patient needs.

Explain and use 0-10 Scale for patient self-assessment. Use the faces or behavioral observations to interpret

expressed pain when the patient cannot communicate his/her pain intensity.


               0      1     2     3     4     5      6     7     8     9     10

                    No                                 Mild                          Moderate                   Moderate                       Severe                          Worst

                  Pain                                Pain                            Pain                             Pain                               Pain                               Pain


                    Alert                            No humor                     Furrowed brow                  Wrinkled nose                    Slow blink                      Eyes closed

                  Smiling                            serious                         pursed lips                    raised upper lips                 open mouth                       moaning

                                                           Flat                          breath holding                   rapid breathing                                                           crying

                NADA DE DOLOR                 UNPOQUITO DE DOLOR                     UN DOLOR LEVE                        DOLOR FUERTE                      DOLOR DEMASIADO          UN DOLOR INSOPORTABLE