The Pain Assessment for Your EMS Department

“Where does it hurt?” It probably is one of the most frequently asked questions during patient assessments. Pain is a critical parameter that we must assess, measure and locate to help to identify the source of the problem, highlight any underlying issues and quantify to alleviate. A mnemonic that EMS providers use to assess pain is OPQRST (onset, provocation/palliation, quality, region/radiation, severity, time). What if I told you that you can use this same tool to assess issues, or pain-points, within your EMS department? The department is the patient and is experiencing some pain/problem, and it’s EMS department leaders’ job to identify the issue accurately so that it can be fixed.

Pain and problem-solving

Pain is both a symptom and a diagnostic tool that EMS providers use in their patient assessments. Pain is the body’s way of signaling an issue or problem, which EMS providers use to identify underlying conditions; guide their decisions in treatment that’s based on the severity or location; track the effectiveness of interventions that’s based on relief; and quantify the severity of patient distress in determining patient priority. EMS providers use the OPQRST tool to give a comprehensive assessment of the patient’s pain. They ask when the pain started (onset), what makes the pain worse or better (provocation/palliation), what is the nature of the pain (quality), where is the pain and does it spread (region/radiation), how much pain on a scale of 1–10 is present (severity), and how long has the pain been evident (time)? In this way, we have a complete description of the patient’s pain.

Problem-solving is a two-part process. First, it involves the accurate identification and assessment of a problem. Second, it involves the development and selection of an appropriate solution that’s tailored particularly to alleviate or solve said problem. When presented with a problem in an EMS department, many times, all of the important facets of the problem aren’t uncovered, and the fix is rushed in an effort to be efficient. In doing that, key elements of that problem can be missed, which, if left unaddressed, can lead to further exacerbations. Here lies the gap that the OPQRST approach can fill.

OPQRST as a business-improvement tool

In many cases, EMS departments, when buildings, land, apparatus, equipment and other assets are included, are multimillion-dollar organizations. Thus, because they are businesses, we must treat them like a business and use business-improvement tools as appropriate.

One innovative and unique way that the problem-solving technique of assessing pain in our patients through the use of the OPQRST tool can translate to this is to use OPQRST to assess pain points in the department. By slightly rescoping the questions, they can be applied when assessing a departmental issue:

• Onset: When did the issue or trend begin? Source the origin of the operational or administrative challenge.
• Provocation/Palliation: What worsens or improves the situation? Evaluate the internal factors (organizational culture, staffing levels, call volume and training) and external factors (weather, economic, including inflation/recession, and regulatory/legal changes) that influence the problem.
• Quality: What is the nature of the issue? Judge the tone, characteristics, vibe or essence of the problem.
• Region/Radiation: Where is the problem occurring and/or spreading? Locate the station/shift/personnel that are affected. Identify whether the issue is affecting other ancillary systems or processes.
• Severity: How serious is the effect? Quantify the effect on patient outcomes, staff morale, reputation, fundraising amounts and costs.
• Time: How is the issue changing over time? Track and trend the issue using charts or qualitative comparisons.

By using this method, issues are addressed in a structured and systematic way. The approach adds both an objective and comprehensive perspective. This helps to remove subjective and biased input and ensures that the entire scope of the problem is addressed. In this way, a true understanding of the problem can be gained.

Problem-solving in practice

This approach can be used to assess any department issue, either operational or administrative in nature. To convert this from theory to practice, below are two scenarios for which the OPQRST technique can add context and clarity.

Scenario 1. The department is experiencing delayed response times.

• Onset: Began three months ago when several key members moved out of the first-due area.
• Provocation/Palliation: The situation is made worse when overlapping events occur and staffing is stretched thin.
• Quality: Recently, when calls are dispatched, a driver never seems to be available to get the ambulance out in a timely manner.
• Region/Radiation: Response times seem to be longer when calls occur overnight.
• Severity: Average response time has risen by an average of four minutes.
• Time: When placed on a line chart, response time is shown to have spiked three months ago and has sustained this higher level since.

Assessment: Several key members moved out of the first-due area, which lengthened their response time as a driver for the ambulance. This is felt acutely during the overnight hours when staffing typically is lower. Solutions might include posting a sign-up for duty hours during the night shift, ramping up recruitment efforts for new drivers who reside in the first-due area and/or posting a stay-back crew when events are hosted.

Scenario 2. The department is experiencing a budget overrun.

• Onset: The department began to overspend on the budget over the past fiscal year.
• Provocation/Palliation: Inflation has had an adverse effect on EMS supplies in particular.
• Quality: The increase was unexpected because of national supply chain issues, which are causing the department to react instead of being proactively ready.
• Region/Radiation: Medications are affected particularly.
• Severity: EMS supplies expenditures increased 15 percent over budget, which caused the overall budget to overrun by 2 percent.
• Time: Supply costs have risen steadily and trended upward when placed on a line chart.

Assessment: Inflation has increased supply prices steadily over the past year, particularly concerning medications. Solutions might include adding an inflation-adjustment buffer to the EMS supplies budget line for next fiscal year, reallocating funds from another noncritical budget area to backfill, initiating a fundraising event that’s designated particularly to the budget overrun and/or exploring partnerships with other local health agencies to form a regional buying group to leverage reduced pricing for bulk purchasing of medications.

Structured approach

The same OPQRST tool that EMS providers use to assess pain in patients can be used to assess pain points in EMS departments. In taking this structured approach, EMS department leaders can improve their organizational problem-solving skills, which ultimately better serve the community.