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Paramedic care for back pain: A review of Australian and New Zealand clinical practice guidelines

  • Simon P. Vella
    Correspondence
    Correspondence to: Level 10N, King George V Building, Royal Prince Alfred Hospital (C39), PO Box M179, Missenden Road, NSW 2050, Australia.
    Affiliations
    Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia

    Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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  • Qiuzhe Chen
    Affiliations
    Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia

    Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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  • Chris G. Maher
    Affiliations
    Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia

    Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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  • Paul Simpson
    Affiliations
    School of Health Sciences, Western Sydney University, Sydney, NSW, Australia

    New South Wales Ambulance Service, Australia
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  • Michael S. Swain
    Affiliations
    Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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  • Gustavo C. Machado
    Affiliations
    Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia

    Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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      Abstract

      Background

      Back pain is one of the most common reasons for a person to call an ambulance service, yet how ambulance services manage back pain has not been described.

      Methods

      Australian-state and New Zealand ambulance service jurisdiction websites were searched between 25th January to 3rd February 2022. Pain management guidelines were included where no specific back pain guideline was found. Identified guidelines were screened, appraised using AGREE II tool and recommendations on pharmacological and non-pharmacological management of back pain, ambulance transport and alerting features were extracted, summarised, and compared to two primary care guidelines.

      Results

      Nine guidelines were identified including four back pain and 5 pain management guidelines. All four back pain guidelines recommend paracetamol or ibuprofen as analgesic options to manage back pain. These guidelines recommend transport to the emergency department when there are alerting features for serious disease, lack of pain control or where the patient is unable to ambulate. 2 out of 9 ambulance guidelines were recommended for use in their existing format following quality appraisal using AGREE II tool. Ambulance guidelines scored significantly lower than primary care guidelines for back pain.

      Conclusion

      Ambulance service guidelines for back pain recommend advice, reassurance, paracetamol and referral to primary care.

      Key words

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