Vol.:(0123456789) Canadian Journal of Emergency Medicine https://doi.org/10.1007/s43678-022-00394-x Vol.:(0123456789) 1 3 BRIEF ORIGINAL RESEARCH Provision of immobilization or ice by paramedics in Southwestern Ontario Naveen Poonai 1,2  · John Teefy 1  · Kristine Van Aarsen 3  · Branka Vujcic 3  · Charlotte Mace 1  · Karina Burke 1  · John Hamilton 1  · Priti Gupta 1  · Adam Dukelow 3,4  · Matthew Davis 3,4  · Jay Loosely 5  · Samina Ali 6 Received: 22 April 2022 / Accepted: 4 October 2022 © The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU) 2022 Abstract Objectives Pain is the most common reason for prehospital transport. As emergency wait times increase, timely pain management is essential. In children, there is abundant evidence that prehospital pharmacologic analgesia is suboptimal, but little is known about non-pharmacologic therapies. We sought to characterize documentation by paramedics of non-pharmacologic (immobilization and ice) and pharmacologic analgesia in children with musculoskeletal injuries. Methods We reviewed all ambulance call reports for children 0–17 years transported to Southwestern Ontario regional hospitals from January 1, 2017, to December 31, 2019, with a musculoskeletal injury (Ontario Ministry of Health and Long-Term Care problem codes 66 and 67). Primary and secondary outcomes were documented immobilization or ice and pharmacologic analgesia, respectively. In a multivariable analysis, we explored the relationship between immobilization or ice and the following a priori covariates: age, sex, visible deformity, crew type, pain severity, and analgesia. Results Of 40,692 ambulance call reports reviewed, 4445 met inclusion criteria. There were 2584/4441 (58.2%) males, with a median (IQR) age of 14 (10, 16) years. In ambulance call reports with documented pain scores, 2106/3048 (69.1%) ambulance call reports reported “moderate or severe” pain. Immobilization or ice were documented in 1605/4445 (36.1%) and 385/4445 (8.7%) of ambulance call reports. Pharmacologic analgesia was documented in 275/1983 (13.9%) and 125/991 (12.6%) of ambulance call reports for primary care paramedics and advanced care paramedics, respectively. An increased odds of documented immobiliza- tion or ice was associated with moderate or severe pain [OR: 2.4; 95% CI 1.84–3.17; p < 0.01] and visible deformity [OR: 2.5; 95% CI 1.97–3.12; p < 0.01]. Conclusions Documented immobilization and ice and pharmacologic analgesia to children by paramedics is suboptimal. Our fndings underscore an important need for enhanced education surrounding the benefts of non-pharmacologic options for children with musculoskeletal injuries. * Naveen Poonai naveen.poonai@lhsc.on.ca 1 Department of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada 2 Children’s Health Research Institute, Children’s Hospital, London Health Sciences Centre, London, ON, Canada 3 Division of Emergency Medicine, London Health Sciences Centre, London, ON, Canada 4 Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada 5 Superintendent of Education, Middesex-London Paramedic Service, London, ON, Canada 6 Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB, Canada