Participants and interventions

All cases of administered sufentanil were checked from electronical patient documentation („ePaRe “ – part MZD, European Medical Distribution Ltd., Bratislava, Slovak Republic). Subsequently, only events which met eligibility criteria were included in analysis. Eligibility criteria consist of a) administration of sufentanil by paramedics on site without physical presence of physician in acute traumatic pain, b) adult patients (at least 18 years old), c) no impairment of consciousness (defined as Alert and Glasgow Coma Scale = 15), d) who is hemodynamically stable (defined by systolic blood pressure > 100 mmHg and without presence of bradycardia bellow 60 beats per minute). The two study groups were identified from eligible cases of patients with pain in acute trauma, who were given sufentanil 1) by paramedics in a routine way, after telephone consultation with an EMS physician (Consultation) and 2) who were given sufentanil by competent paramedics themselves (Competency). In the Competency group, the paramedics were allowed to administer sufentanil intravenously up to 20 µg. The recommended pain Numeric Rating Scale (NRS) score for consideration of sufentanil administration was above 4 points.

Baseline characteristics of both groups were obtained from electronical patient documentation: age, gender, NACA score (National Advisory Committee for Aeronautics), type of trauma (lower or upper limb, trauma of torso, head injury), dose of sufentanil and if there was fractional dose administration, and proportion of cases where additional non-opioid analgesia (paracetamol) was used.