BACKGROUND AND IMPORTANCE: In the Czech Republic, paramedics are required to consult a physician before administering intravenous opioids, which may delay effective prehospital pain management. As paramedic competencies expand in Europe, it is important to evaluate the safety and efficacy of independent opioid administration in prehospital emergency care settings. OBJECTIVES: To assess the safety and effectiveness of intravenous sufentanil administered independently by trained paramedics compared to administration following remote physician consultation in adult trauma patients. DESIGN: Prospective, single-center, observational cohort study. SETTINGS AND PARTICIPANTS: Conducted at the Emergency Medical Services of the Karlovy Vary Region between January 1 and December 31, 2024. The study included 462 adult trauma patients who were hemodynamically stable and conscious. Patients were divided into two groups: the Consultation group (physician consultation required) and the Competency group (paramedics administering independently). INTERVENTION OR EXPOSURE: Intravenous administration of sufentanil, with or without physician phone consultation. OUTCOME MEASURES AND ANALYSIS: Primary outcomes included reduction in pain (measured using the Numeric Rating Scale, NRS) and incidence of adverse events (e.g., respiratory depression, oxygen desaturation, hypotension, and antiemetic use). Statistical significance was set at p < 0.05. MAIN RESULTS: Both groups achieved similar pain reduction. The Competency group received a higher mean dose of sufentanil (9.7 ± 3.0 µg vs. 8.9 ± 2.8 µg; p = 0.006) and more frequently used non-opioid adjuvant analgesics (54% vs. 41%). Documentation of pain scores was significantly better in the Competency group (87% vs. 43%; p < 0.01). Adverse events were rare, non-serious, and comparable between groups. Antiemetics were more frequently administered in the Competency group (11% vs. 6%; p = 0.037). A minor, clinically insignificant reduction in diastolic blood pressure was observed in the Competency group. CONCLUSION: Intravenous sufentanil administered independently by trained paramedics in adult patients with lower severity trauma demonstrated safety and effectiveness comparable to administration following remote physician consultation, along with improved documentation and increased use of multimodal analgesia. Although this was a monocentric study, these observations may contribute to ongoing discussions about expanding paramedic competencies in opioid analgesia within the Czech prehospital emergency system.

Department of Anesthesia and Intensive Care 3rd Faculty of Medicine Charles University and FNKV University Hospital Prague Czech Republic

Emergency Medical Services of Karlovy Vary Region Zavodni 390 98C Karlovy Vary 36006 Czech Republic

Medical College Prague Czech Republic

Zobrazit více v PubMed

Colding-Jørgensen JT, Brandstrup GMG, Nielsen VML, Gradman J, Thybo LAB, Hansen PM, Wittrock D, Blomberg SNF, Christensen HC, Mikkelsen S. The use of strong analgesics for prehospital pain management in children in the region of Southern denmark: a register-based study. Scand J Trauma Resusc Emerg Med. 2025;33(1):23. PubMed PMC

Kiavialaitis GE, Müller S, Braun J, Rössler J, Spahn DR, Stein P, Kaserer A. Clinical practice of pre-hospital analgesia: an observational study of 20,978 missions in Switzerland. Am J Emerg Med. 2020;38(11):2318–23. PubMed

Scharonow M, Alberding T, Oltmanns W, Weilbach C. Project for the introduction of prehospital analgesia with Fentanyl and morphine administered by specially trained paramedics in a rural service area in Germany. J Pain Res. 2017;10:2595–9. PubMed PMC

Renza M, Sykora R, Peran D, Hricova K, Brizgalova N, Bakurova P, Kukacka M. Pilot implementation of the competence of Czech paramedics to administer sufentanil for the treatment of pain in acute trauma without consulting a physician: observational study. BMC Emerg Med. 2022;22(1):63. PubMed PMC

Vilcane S, Scharonow O, Weilbach C, Scharonow M. Application of analgesics in emergency services in germany: a survey of the medical directors. BMC Emerg Med. 2023;23(1):104. PubMed PMC

Hachimi-Idrissi S, Dobias V, Hautz WE, Leach R, Sauter TC, Sforzi I, et al. Approaching acute pain in emergency settings; European society for emergency medicine (EUSEM) guidelines-part 2: management and recommendations. Intern Emerg Med. 2020;15(7):1141–55. PubMed

Vilcane S, Scharonow O, Weilbach C, Scharonow M. Application of analgesics in emergency services in Germany: a survey of the medical directors. BMC Emerg Med. 2023;23(1):104. Erratum in: BMC Emerg Med. 2025;25(1):71. European Society for Emergency Medicine. Guidelines for the management of acute pain in emergency situations. March 2020. Accessed April 28, 2025. https://www.eusem.org/images/EUSEM_EPI_GUIDELINES_MARCH_2020.pdf

European Society for Emergency Medicine. Guidelines for the management of acute pain in emergency situations. 2020. Accessed April 28, 2025. https://www.eusem.org/images/EUSEM_EPI_GUIDELINES_MARCH_2020.pdf

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344–9. PubMed

Ministry of Health of the Czech Republic. Decree no. 55/2011 coll. On the activities of medical staff and other professionals. Collection of Laws of the Czech Republic; 2011.

Friesgaard KD, Vist GE, Hyldmo PK, Raatiniemi L, Kurola J, Larsen R, et al. Opioids for treatment of pre-hospital acute pain: a systematic review. Pain Ther. 2022;11(1):17–36. PubMed PMC

Dalton MK, Semco RS, Ordoobadi AJ, Goralnick E, Chovanes J, Salim A, et al. Opioid administration in the prehospital setting for patients sustaining traumatic injuries: an evaluation of National emergency medical services data. Injury. 2022;53(9):2923–9. PubMed PMC

Deslandes M, Deicke M, Grannemann JJ, Hinkelbein J, Hoyer A, Kalmbach M, et al. Effectiveness and safety of prehospital analgesia with Nalbuphine and Paracetamol versus morphine by paramedics: an observational study. Scand J Trauma Resusc Emerg Med. 2024;32(1):41. PubMed PMC

Friesgaard KD, Kirkegaard H, Rasmussen CH, Giebner M, Christensen EF, Nikolajsen L. Prehospital intravenous Fentanyl administered by ambulance personnel: a cluster-randomised comparison of two treatment protocols. Scand J Trauma Resusc Emerg Med. 2019;27(1):11. PubMed PMC

Le Cornec C, Le Pottier M, Broch H, Marguinaud Tixier A, Rousseau E, Laribi S, et al. Ketamine compared with morphine for out-of-hospital analgesia for patients with traumatic pain: a randomized clinical trial. JAMA Netw Open. 2024;7(1):e2352844. PubMed PMC

Sandberg M, Hyldmo PK, Kongstad P, Dahl Friesgaard K, Raatiniemi L, Larsen R, Magnusson V, et al. Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm. BMJ Open. 2020;10(11):e038134. PubMed PMC