Introduction. Pain is a universal human experience tied to an individual’s health but difficult to understand. It is especially important in health emergencies. We performed a two-step quality improvement project to assess pain management by the SAMU ambulance service in Kigali, Rwanda, examining how pain is assessed and treated by ambulance staff to facilitate development of standardized guidelines of pain management in the prehospital setting, which did not exist at the time of the study. Materials and Methods. Deidentified ambulance service records from December 2012 to May 2016 were analyzed descriptively for patient demographics, emergency conditions, pain assessment, and medications given. Then, anonymized, semistructured interviews of ambulance staff were conducted until thematic saturation was achieved. Data were analyzed using a grounded theory approach. Results. SAMU managed 11,161 patients over the study period, of which 6,168 (55%) were documented as reporting pain and 5,010 (45%) received pain medications. Men had greater odds of receiving pain medications compared to women (OR = 3.8, 95% CI (3.5, 4.1),  < 0.01). Twenty interviews were conducted with SAMU staff. They indicated that patients communicate pain in different ways. They reported using informal ways to measure pain or a standardized granular numeric scale. The SAMU team reviewed these results and developed plans to modify practices. Conclusions. We reviewed the existing quality of pain management in the prehospital setting in Kigali, Rwanda, assessed the SAMU staff’s perceptions of pain, and facilitated standardization of prehospital pain management through context-specific guidelines.

中文翻译：

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卢旺达院前环境的痛苦：混合方法质量改善项目的结果

引言。疼痛是一种与人的健康息息相关的普遍人类经历，但难以理解。这在紧急情况下尤为重要。我们执行了一个分为两步的质量改进项目，以评估卢旺达基加利的SAMU救护车服务部门对疼痛的管理，检查救护人员如何评估和治疗疼痛，以促进制定院前环境中的疼痛管理标准指南，而这并未在研究时存在。材料和方法。对2012年12月至2016年5月不明身份的救护车服务记录进行描述性分析，以了解患者的人口统计信息，紧急情况，疼痛评估和所用药物。然后，对救护人员进行匿名，半结构化访谈，直到主题达到饱和为止。使用扎根理论方法分析数据。结果。在研究期间，SAMU管理了11,161名患者，其中6,168（55％）名患者报告疼痛报告，5,010名（45％）患者接受了止痛药治疗。与女性相比，男性接受止痛药的几率更高（OR = 3.8，95％CI（3.5，4.1）， <0.01）。与SAMU员工进行了20次访谈。他们表示患者以不同的方式传达疼痛。他们报告说使用非正式的方式来测量疼痛或标准化的粒度数字量表。SAMU团队审查了这些结果，并制定了修改实践的计划。结论。我们回顾了卢旺达基加利医院院前环境中疼痛管理的现有质量，评估了SAMU工作人员对疼痛的看法，并通过针对具体环境的指南促进了院前疼痛管理的标准化。