Prehospital pain management in mass casualty scenarios: a scoping review

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dc.contributor.advisorHodkinson, Peter
dc.contributor.authorMorris, Christopher
dc.date.accessioned2026-01-09T11:30:50Z
dc.date.available2026-01-09T11:30:50Z
dc.date.issued2025
dc.date.updated2026-01-09T07:16:19Z
dc.description.abstractBackground: Effective pain management in mass casualty scenarios (MCS) is critical due to the high prevalence of severe pain and its association with increased morbidity. MCS, defined as incidents where patient care needs exceed available resources, pose unique challenges for prehospital care providers. This scoping review aims to synthesize existing evidence on prehospital pain management strategies, identify gaps, and inform future research and policy development. Methods: Following PRISMA-ScR guidelines, a comprehensive literature search was conducted across major medical databases (PubMed/MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science) and grey literature repositories, covering studies published from 2005 to 2024. Inclusion criteria encompassed English-language studies addressing prehospital pain management in MCS, reporting on pain assessment, pharmacological/non-pharmacological interventions, or resource limitations. Excluded were hospital-based studies and non-evidence-based publications. Data were charted and synthesized into thematic categories. Results: The review included 22 studies, highlighting significant gaps in standardised pain management protocols and documentation. Key findings revealed underutilisation of analgesics, with only 3.2% of MCS cases receiving pain medication. Ketamine and regional anaesthesia emerged as viable options, particularly in resource-limited settings, while novel delivery systems like autoinjectors showed promise. Major barriers included resource shortages, provider training gaps, and limited integration of pain management in triage systems. Conclusion: Prehospital pain management in MCS requires scalable, evidence-based protocols emphasising early analgesic administration, particularly ketamine and multimodal strategies. Systemic barriers, including inadequate training and documentation, hinder effective implementation. Addressing these gaps through improved training, simplified protocols, and better resource planning can enhance patient outcomes and disaster response capabilities. Future research should prioritise paediatric care and standardised outcome measures to further refine pain management in diverse MCS contexts.
dc.identifier.apacitationMorris, C. (2025). <i>Prehospital pain management in mass casualty scenarios: a scoping review</i>. (). University of Cape Town ,Faculty of Health Sciences ,Division of Emergency Medicine. Retrieved from http://hdl.handle.net/11427/42515en_ZA
dc.identifier.chicagocitationMorris, Christopher. <i>"Prehospital pain management in mass casualty scenarios: a scoping review."</i> ., University of Cape Town ,Faculty of Health Sciences ,Division of Emergency Medicine, 2025. http://hdl.handle.net/11427/42515en_ZA
dc.identifier.citationMorris, C. 2025. Prehospital pain management in mass casualty scenarios: a scoping review. . University of Cape Town ,Faculty of Health Sciences ,Division of Emergency Medicine. http://hdl.handle.net/11427/42515en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Morris, Christopher AB - Background: Effective pain management in mass casualty scenarios (MCS) is critical due to the high prevalence of severe pain and its association with increased morbidity. MCS, defined as incidents where patient care needs exceed available resources, pose unique challenges for prehospital care providers. This scoping review aims to synthesize existing evidence on prehospital pain management strategies, identify gaps, and inform future research and policy development. Methods: Following PRISMA-ScR guidelines, a comprehensive literature search was conducted across major medical databases (PubMed/MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science) and grey literature repositories, covering studies published from 2005 to 2024. Inclusion criteria encompassed English-language studies addressing prehospital pain management in MCS, reporting on pain assessment, pharmacological/non-pharmacological interventions, or resource limitations. Excluded were hospital-based studies and non-evidence-based publications. Data were charted and synthesized into thematic categories. Results: The review included 22 studies, highlighting significant gaps in standardised pain management protocols and documentation. Key findings revealed underutilisation of analgesics, with only 3.2% of MCS cases receiving pain medication. Ketamine and regional anaesthesia emerged as viable options, particularly in resource-limited settings, while novel delivery systems like autoinjectors showed promise. Major barriers included resource shortages, provider training gaps, and limited integration of pain management in triage systems. Conclusion: Prehospital pain management in MCS requires scalable, evidence-based protocols emphasising early analgesic administration, particularly ketamine and multimodal strategies. Systemic barriers, including inadequate training and documentation, hinder effective implementation. Addressing these gaps through improved training, simplified protocols, and better resource planning can enhance patient outcomes and disaster response capabilities. Future research should prioritise paediatric care and standardised outcome measures to further refine pain management in diverse MCS contexts. DA - 2025 DB - OpenUCT DP - University of Cape Town KW - mass casualty scenarios KW - pain KW - scoping review LK - https://open.uct.ac.za PB - University of Cape Town PY - 2025 T1 - Prehospital pain management in mass casualty scenarios: a scoping review TI - Prehospital pain management in mass casualty scenarios: a scoping review UR - http://hdl.handle.net/11427/42515 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/42515
dc.identifier.vancouvercitationMorris C. Prehospital pain management in mass casualty scenarios: a scoping review. []. University of Cape Town ,Faculty of Health Sciences ,Division of Emergency Medicine, 2025 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/42515en_ZA
dc.language.rfc3066eng
dc.publisher.departmentDivision of Emergency Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.publisher.institutionUniversity of Cape Town
dc.subjectmass casualty scenarios
dc.subjectpain
dc.subjectscoping review
dc.titlePrehospital pain management in mass casualty scenarios: a scoping review
dc.typeThesis / Dissertation
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMasters
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