Lightning Presentation Sydney Spinal Symposium 2025

Paramedic management of back pain in a large Australian ambulance service (#54)

Simon Vella 1 2 , Chathurani Sigera 1 2 , Jason Bendall 3 , Paul Simpson 4 , Christina Abdel Shaheed 1 2 , Michael Swain 5 , Christopher Maher 1 2 , Gustavo Machado 1 2
  1. School of Public Health, University of Sydney, Sydney, NSW, Australia
  2. Institute for Musculoskeletal Health, University of Sydney, Sydney, NSW, Australia
  3. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
  4. School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
  5. Department of Chiropractic, Macquarie University, Sydney, NSW, Australia

Background

Back pain commonly leads people to seek healthcare from paramedics via the national emergency service telephone number, yet the management approaches by providers of ambulance services remain unclear.

Objectives

This study aims to investigate paramedic management of back pain in NSW, Australia, including the call characteristics, provisional diagnoses and the clinical care being delivered by paramedics.

Methods

We performed a retrospective medical record review of NSW Ambulance computer-aided dispatch and electronic medical records from 1st January 2017 to 31st December 2022. We included adults who sought ambulance service for non-traumatic back pain and subsequently received treatment by paramedics. Outcomes included call characteristics, patient profile and paramedic management strategies. Factors associated with ambulance transport, opioid use and use of medication combinations were explored using multivariable logistic regression models and we reported data as odds ratios (ORs).

Results

There were 73,128 calls to NSW Ambulance triaged as non-traumatic back pain. Of these, 54,398 (74.4%) were diagnosed with spinal pain; 52,825 (97.1%) were categorised by the paramedic as back or neck pain, 1,573 (2.9%) as lumbar radicular pain, and 46 (0.1%) as serious spinal pathology. Eight out of 10 patients with spinal pain were transported to emergency departments and 4% were referred to primary care. Opioids were the most administered medication by a paramedic (37.4% of patients with spinal pain). Older patients (OR 1.36, 95% CI 1.30 to 1.44) were more likely to be transported to hospital. Patients with moderate (OR 4.39, 95% CI 4.00 to 4.84) and severe pain (OR 18.90, 95% CI 17.18 to 20.79) were more likely to be administered an opioid.

Conclusion

Back pain complaints to ambulance service are a common presentation, yet education does not reflect this. Current paramedic management of back pain typically results in the administration of an opioid and transport to an emergency department.