{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:42:17Z","timestamp":1786977737688,"version":"build-2736575974"},"reference-count":25,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2016,2,23]],"date-time":"2016-02-23T00:00:00Z","timestamp":1456185600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Ministry of Innovation, Science and Research of North Rhine Westphalia, Germany","award":["PtJ-Az. 0909im002b"],"award-info":[{"award-number":["PtJ-Az. 0909im002b"]}]},{"name":"Ministry of Innovation, Science and Research of North Rhine Westphalia, Germany","award":["005-1003-0034"],"award-info":[{"award-number":["005-1003-0034"]}]},{"name":"Philips Healthcare (Hamburg, Germany)"},{"name":"P3 communications (Aachen, Germany)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2016,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      In German emergency medical services (\n                      <jats:styled-content style=\"fixed-case\">EMS<\/jats:styled-content>\n                      ), the analgesia is restricted to physicians. In this prospective, interventional, multicentre trial, complications with and quality of telemedically delegated analgesia were evaluated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      If prehospital analgesia was necessary, five telemedically equipped paramedic ambulances from four different districts could consult a telemedicine centre. Analgesics were delegated based on a predefined algorithm. Telemedically assisted cases were compared with local historical regular\n                      <jats:styled-content style=\"fixed-case\">EMS<\/jats:styled-content>\n                      missions using matched pairs. The primary outcome was the frequency of therapeutic complications (respiratory\/circulatory insufficiency, allergic reactions). Secondary outcomes were quality of analgesia (11\u2010point numerical rating scale,\n                      <jats:styled-content style=\"fixed-case\">NRS<\/jats:styled-content>\n                      ) and the frequency of nausea\/vomiting.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Analgesia was necessary in 106 telemedically assisted missions. In 23 cases, the telemedical procedure was used until an\n                      <jats:styled-content style=\"fixed-case\">EMS<\/jats:styled-content>\n                      physician arrived. Of the remaining 83 cases, 80 could be matched to comparable controls. Complications did not occur in either the study group or the control group (0 vs. 0;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0N\/A). Complete\n                      <jats:styled-content style=\"fixed-case\">NRS<\/jats:styled-content>\n                      documentation was noted in 65\/80 (study group) and 32\/80 (control group) cases (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001). Adequate initial pain reduction (quality indicator: reduction of\n                      <jats:styled-content style=\"fixed-case\">NRS<\/jats:styled-content>\n                      \u00a0\u2265\u00a02 points or\n                      <jats:styled-content style=\"fixed-case\">NRS<\/jats:styled-content>\n                      \u00a0&lt;\u00a05 at end of mission) occurred in 61\/65 versus 31\/32 cases (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a01.0);\n                      <jats:styled-content style=\"fixed-case\">NRS<\/jats:styled-content>\n                      reduction during mission was 3.78\u00a0\u00b1\u00a02.0 versus 4.38\u00a0\u00b1\u00a02.2 points (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.0159). Nausea and vomiting occurred with equal frequency in both groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Telemedical delegation of analgesics to paramedics was safe and led to a pain reduction superior to the published minimum standard in both groups. The documentation quality was better in the telemedicine group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>What does this study add?<\/jats:title>\n                    <jats:p>\n                      Little is known about the safety and quality of prehospital analgesia carried out by emergency medical services (\n                      <jats:styled-content style=\"fixed-case\">EMS<\/jats:styled-content>\n                      ). Beside potential quality problems, in some countries meaningful pain reduction is limited by legal regulations that allow only physicians to administer analgesics.\n                    <\/jats:p>\n                    <jats:p>\n                      This first multicentre prospective trial for telemedically delegated analgesia demonstrates that remote analgesia is possible and safe and retains equivalent analgesic quality compared with that administered by onsite\n                      <jats:styled-content style=\"fixed-case\">EMS<\/jats:styled-content>\n                      physicians.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejp.843","type":"journal-article","created":{"date-parts":[[2016,2,25]],"date-time":"2016-02-25T21:21:04Z","timestamp":1456435264000},"page":"1176-1184","source":"Crossref","is-referenced-by-count":55,"title":["Analgesia by telemedically supported paramedics compared with physician\u2010administered analgesia: A prospective, interventional, multicentre trial"],"prefix":"10.1002","volume":"20","author":[{"given":"J.C.","family":"Brokmann","sequence":"first","affiliation":[{"name":"Emergency Department University Hospital RWTH Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Rossaint","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology University Hospital RWTH Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Hirsch","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology University Hospital RWTH Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.K.","family":"Beckers","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology University Hospital RWTH Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Czaplik","sequence":"additional","affiliation":[{"name":"Department 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