Understanding the role of ambulance services in the management of low back pain

Abstract

Back pain is the leading cause of disability worldwide. The management of back pain in primary-care and the emergency department is well established, though there is little knowledge regarding the management of back pain by ambulance services. This thesis aims to describe ambulance service guidelines for the management of back pain, explore paramedic management of back pain and their views toward its management, and evaluate the effectiveness of care delivered by allied health and nurse-practitioners for musculoskeletal conditions in the emergency department. Chapter two provides an overview of Australian and New Zealand guidelines for back pain and found that less than half of ambulance service jurisdictions had specific guidance. Chapter three explores paramedic management of back pain and found that back pain ranks amongst the top 10 conditions to present to ambulance service. Chapter three also highlights variation in pharmacological management and the limited evidence on non-pharmacological care strategies to manage back pain. Chapter four describes the management of back pain by one Australian ambulance service and found that approximately 80% of people with back pain received transport to the emergency department, one-third received opioid medication and less than 1% of people reportedly received education and hot/cold therapy. Chapter five reports Australian paramedics’ personal experiences and challenges in managing people with back pain. The chapter demonstrates the complexity, frustration and reward that is associated with managing people with back pain and recognised patient misconceptions and access to health services to influence paramedic care. Chapter six found limited evidence of the effectiveness of allied health and nurse-practitioner care for the management of musculoskeletal conditions in the emergency department and supports ongoing research investigating health service outcomes such as patient flow.