Nurse-Administered Analgesic Treatment in Italian Emergency Medical Services: A Nationwide Survey

Figures & data

Table 1 Distribution of the Survey’s Participating Provinces and EMDCs

	Italy
	Total	Geographical Subdivision
	n (%)	North n (%)	Centre n (%)	South and Islands n (%)
Provinces	107 (100.0)	47 (43.9)	22 (20.6)	38 (35.5)
Participating provinces ^a	100 (93.5)	45 (95.7)	21 (95.5)	34 (89.5)
EMDCs	74 (100.0)	29 (39.2)	17 (23.0)	28 (37.8)
Participating EMDCs ^b	70 (94.6)	28 (96.5)	16 (94.1)	26 (92.8)

Notes: ^aReported percentages are out of the provinces and geographical subdivisions’ totals (previous line). ^bReported percentages are out of the EMDCs’ totals (previous line).

Abbreviation: EMDCs, emergency medical dispatch centres.

Table 2 Percentage of Nurse-Administered Analgesia Protocols

Items	Italy
	Total	Geographical Subdivision
	n (%)	North n (%)	Centre n (%)	South and Islands n (%)
Participating provinces ^a	100 (100.0)	45 (45.0)	21 (21.0)	34 (34.0)
Nurses-equipped ambulances ^b	94 (94.0)	43 (95.6)	19 (90.5)	32 (94.1)
Analgesia protocols availability ^b	46 (46.0)	30 (66.7)	9 (42.8)	7 (20.6)
Differentiated analgesia protocols for trauma and medical patients ^b	22 (22.0)	15 (33.3)	4 (19.0)	3 (8.8)

Notes: ^aReported percentages are out of the participating provinces’ total. ^bReported percentages are out of the provinces and each geographical subdivisions’ totals (first line).

Table 3 Rates of Drugs Included in Nurse-Administered Analgesia Protocols

Drug	Italy
	Total (n 46)		Geographical Subdivision
			North (n 30)		Centre (n 9)		South and Islands (n 7)
	Medical n (%) ^a	Trauma n (%) ^a	Medical n (%) ^b	Trauma n (%) ^b	Medical n (%) ^b	Trauma n (%) ^b	Medical n (%) ^b	Trauma n (%) ^b
Morphine	35 (76.1)	44 (95.7)	25 (83.3)	30 (100.0)	6 (66.7)	8 (88.9)	4 (57.1)	6 (85.7)
Fentanyl	18 (39.1)	29 (63.0)	14 (46.7)	19 (63.3)	1 (11.1)	1 (11.1)	3 (42.9)	6 (85.7)
Paracetamol	41 (89.1)	41 (89.1)	27 (90.0)	26 (86.7)	9 (100.0)	9 (100.0)	5 (71.4)	6 (85.7)
NSAIDs	30 (65.2)	20 (43.5)	21 (70.0)	17 (56.7)	3 (33.3)	2 (22.2)	6 (85.7)	1 (14.3)
Other	1 (2.2)	1 (2.2)	1 (3.3)	1 (3.3)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)

Notes: ^aPercentage of analgesia drugs in all Italian protocols. ^bPercentage of analgesia drugs within protocols of a given geographical subdivision (Totals: North, n=30; Centre, n=9; South and Islands, n=7). Other, ketamine, lidocaine 2%, tramadol

Abbreviation: NSAIDs, Non-steroidal anti-inflammatory drugs.

Table 4 Rates of Drugs Available in Nurse-Administered Analgesia Protocols

# Optional Drugs	Italy
	Total		Geographical Subdivision
			North		Centre		South and Islands
	Medical n (%) ^a	Trauma n (%) ^a	Medical n (%) ^b	Trauma n (%) ^b	Medical n (%) ^b	Trauma n (%) ^b	Medical n (%) ^b	Trauma n (%) ^b
1	16 (23.5)	7 (10.8)	6 (15.8)	2 (5.7)	5 (38.5)	2 (14.3)	5 (29.4)	3 (18.8)
2	18 (26.5)	25 (38.5)	5 (13.2)	11 (31.4)	7 (53.9)	6 (42.9)	6 (35.3)	8 (50.0)
3	13 (19.1)	16 (24.6)	13 (34.2)	8 (22.9)	0 (0.0)	4 (28.6)	0 (0.0)	4 (25.0)
4	20 (29.4)	16 (24.6)	13 (34.2)	13 (37.1)	1 (7.7)	2 (14.3)	6 (35.3)	1 (6.2)
5	1 (1.5)	1 (1.5)	1 (2.6)	1 (2.9)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
Total	68 (100.0)	65 (100.0)	38 (100.0)	35 (100.0)	13 (100.0)	14 (100.0)	17 (100.0)	16 (100.0)

Notes: ^aPercentage of the optional number of analgesia drugs in all Italian protocols. ^bPercentage of the optional number of analgesia drugs within protocols of a given geographical subdivision.

Table 5 Association Analyses Between Geographical Areas and Independent Variables

Variable	χ^2	P Value	Post Hoc Cell Contribution ^a
			Italian Geographical Areas
			North	Center	South and Islands
Nurses-equipped ambulances	0.896	0.639
Analgesia protocols availability	17.972	0.000	0.00014 (yes)		0.00006 (no)
Differentiated analgesia protocols ^b	2.856	0.428
n° optional drugs for Medical patients	21.015	0.007	0.00137 (3 drugs)
n° optional drugs for Trauma patients	9.034	0.378
Morphine (Trauma)	9.445	0.009			0.00193 (low)
Paracetamol (Trauma)	15.8601	0.000	0.00031 (high)		0.00021 (low)
NSAIDs (Trauma)	7.465	0.024			0.00693 (low)
Fentanyl (Trauma)	5.278	0.071
Morphine (Medical)	13.906	0.001	0.00031 (high)		0.00193 (low)
Paracetamol (Medical)	15.050	0.001	0.00047 (high)		0.00032 (low)
NSAIDs (Medical)	2.317	0.314
Fentanyl (Medical)	10.435	0.005	0.00037 (high)

Notes: ^aχ² – post hoc analysis results (calculated p-values – Bonferroni method - of the adjusted residuals) are reported as cell contribution for the reported association (the most influent two, when appropriate); in parenthesis, the associations’ source: (high), high proportions of the drug availability; (low), low proportions of the drug availability. ^bDifferentiated analgesia protocols for trauma and medical patients.

Table 6 Correlation Analyses Between Area Classes and Drug Items

Patients	Patients	Area	Morphine		Paracetamol		NSAIDs		Fentanyl
			Medical	Trauma	Medical	Trauma	Medical	Trauma	Medical	Trauma
Area	Medical	1.000	0.24 ^a		0.09 ^a		0.07 ^a		0.17 ^a
	Trauma	1.000		0.01 ^a		0.08 ^a		0.45 ^c		0.05 ^a
Morphine	Medical	0.24 ^a	1.000		0.03 ^a		0.13 ^a		0.35 ^b
	Trauma	0.01 ^a		1.000		0.28 ^a		0.06 ^a		0.18 ^a
Paracetamol	Medical	0.09 ^a	0.03 ^a		1.000		0.19 ^a		0.28 ^a
	Trauma	0.08 ^a		0.28 ^a		1.000		0.15 ^a		0.12 ^a
NSAIDs	Medical	0.07 ^a	0.13 ^a		0.19 ^a		1.000		0.49 ^c
	Trauma	0.45 ^c		0.06 ^a		0.15 ^a		1.000		0.56 ^c
Fentanyl	Medical	0.17 ^a	0.35 ^b		0.28 ^a		0.49 ^c		1.000
	Trauma	0.05 ^a		0.18 ^a		0.12 ^a		0.56 ^c		1.000

Notes: Numbers in the table show absolute Rho values. ^ap>0.05. ^bp<0.05. ^cp<0.01.