An Investigation into the use of Emergency Medical Services in the UK by patients experiencing back pain

  • Matthew Capsey

Student thesis: Doctoral Thesis


Introduction: Demand for Emergency Medical Services (EMS) is increasing, but
some cases, like people with back pain, may be more appropriate for primary care
services. Currently, little is known about EMS use by those presenting with back
pain and the care they receive. The overall aim of this thesis was to investigate the
use of EMS in the UK by patients experiencing back pain.
Methods: Four studies were undertaken. A scoping review explored the current
literature. Two quantitative studies investigated EMS use in the UK, in a hospital ED
and an ambulance service. The final study qualitatively explored EMS clinicians’
experiences of treating people with back pain.
Results: There is increasing research interest in the management of back pain in
EMS. Most studies assess the care provided against primary care guidelines.
However, emerging literature suggests a different population present to EMS. The
two quantitative studies demonstrated that patients experiencing back pain were
1%-2% of the total presenting to EMS. They have higher rates of serious and nonspinal
pathology, compared to the primary care literature.
Entonox was the analgesic used most frequently by ambulance clinicians. Whilst it
is not mentioned in any guidelines, many other analgesics used in EMS are contrary
to current guidance. EMS clinicians recognised EMS as a legitimate choice for
patients experiencing distressing symptoms or struggling to access primary care.
EMS clinicians focus on identifying serious pathologies, are confident in their
management of these patients, and often base treatment on their own and others’
Discussion: There is a sizeable minority of the EMS back pain population with
potentially serious, often non-spinal, pathology. Ambulance clinicians often manage
patients experiencing immobilising acute episodes of back pain, commonly using
non-guideline compliant methods. This suggests current, primary care focused,
guidelines, are inadequate and there is a need for EMS specific guidelines.
Date of Award26 Apr 2024
Original languageEnglish
Awarding Institution
  • Teesside University
SupervisorCormac Ryan (Supervisor), Denis Martin (Supervisor) & Jaj Mankelow (Supervisor)

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