Acupressure in EMS... does it have a place?

[spenac]

Yes acupressure would be great for discomfort such as OB and others where pain meds are not really needed. But I guess I look at it based on long transport times.

[HellsBells]

I would be inclined to agree that acupressure is best left in the clinic, for those with ongoing, chronic problems.

I think that EMS, in general, has enough deficits concerning education as it is. We really don't need to compound the problem by teaching massage techniques that will have limited effectiveness at best.

[jsadin]

http://nccam.nih.gov/health/acupuncture/

[rock_shoes]

I'm a real "Show me the money" (Jerry Maguire) kind of guy. If hard evidence can be provided that it can be effective in the pre-hospital setting then I'm all for it. Until then I think it should be left to the "alternative medicine" crowd.

[Just Plain Ruff]

I have undergone accupressure for headaches but putting this addtional education on a already burdened educational system for EMS is not a good idea.

When our current ems educational system gets fully functional and consistent throughout the united states and our paramedics and emt's have a full grasp of the education that is considered basic then we can add this type of education to the medic/emt courses but not until then.

Let's get the basics down and wait on adding these alternative treatments.

[mshow00]

Would this become a possible alternative to those pts that are "drug seeking"? I fail to see how this would be implemented in the field. Where I work I'm 15 to 20 mins to two level 1 trauma centers, and no more than 10 to 15 mins from any other general hospital, and we have Arch(helicopter units) that can fly. I am not sure that this would be all that practical here in the pre-hospital setting. Or, am I missing the bigger picture?

[JPINFV]

I don't remember which area it was, but I saw a few weeks ago a protocol page online that included an accupressure section for treating nausea. I do wonder how much of it is placebo and how much of it is true work. Of course I'd rather have a placebo than have nothing.

[Doczilla]

Not no, but Hell no.

It takes 3 years of full time training to be properly schooled in acupuncture/acupressure, despite what some fly-by-night "schools" would have you believe. To say that you can learn the techniques in a short class is nothing but a sham.

I'd rather see the training time go to airway management, critical care decision-making, patient relations, or just about any other skill relevant to EMS before we start adding in this skill which takes extensive training and is not of much benefit to the patient in the prehospital environment.

'zilla

[HellsBells]

Prehospital analgesia with acupressure

When it comes to pain control, the first thing many emergency response personnel reach for is the drug bag. Now after a randomized, double-blind study acupressure may be the first technique used to comfort the patient in the prehospital setting.

Acupressure is a traditional Chinese Medicine technique derived from acupuncture. Many East Asian martial arts also make extensive study and use of acupressure for self-defence and health purposes. The technique is believed to work by release of endogenous opioid analgesics such asenkephalin, endorphin and dynorphins leading to alleviation of pain. Acupressure is considered to be safe form of therapy with side effects being rare.

The study, "Prehospital [sic] Analgesia with Acupressure in Victims of Minor Trauma: A Prospective, Randomized, Double-Blinded Trial," was conducted by researchers at the University of Vienna Department of Anesthesia and Intensive Care, the Vienna Red Cross, and the Research Institute of the Vienna Red Cross.

Sixty people, ages 19 to 99, participated in the study once initial medical intervention, such as bandaging, was complete. They all suffered from similar small injuries, such as simple fractures, small wounds and contusions.

At the site of the accident, a paramedic measured victims' blood pressure and heart rate, and asked them to rate their pain and anxiety on a scale of zero to 100. Subjects were also asked to rate their belief in acupressure as a treatment for pain. They were then assigned to one of three groups: true acupressure, sham acupressure or no acupressure.

Another paramedic performed the acupressure for approximately three minutes, then brought the subject to the ambulance. This paramedic was not aware that one of the acupressure treatments was false, but was instead told that the aim of the study was to compare two acupressure techniques using different points. Data collection was always performed by the other paramedic, in the absence of the one applying acupressure.

Upon arrival at the hospital, subjects were again asked to rate their pain and anxiety; blood pressure and heart rate were measured. Subjects were also asked to rate their overall satisfaction on a scale of zero to 100.

"After treatment the three groups differed in a highly significant way in pain, anxiety, and heart rate," state the studies authors.

In the true acupressure group, 89 percent of the subjects had a significant heart-rate reduction. This group also experienced a significant decrease in pain and anxiety, and had significantly better patient-satisfaction scores.

In the other two groups, measurements of pain and heart rate remained unchanged. Although there was a decrease in anxiety for both groups, it was not statistically significant. Belief in acupressure did not differ among the three groups.

What this research and others like have proven is that this technique is an effective and is an easy to learn treatment for pain. Now EMT’s Medical First Responders and Paramedic in the prehospital setting can use acupuncture safely and effectively to help provide quality care without the risk of pharmaceutical treatments.

I think that perhaps a little more research needs to be done on this subject before the nation of prehospital acupressure is considered a success ( as this article seems to gleefully imply). One test group of sixty people is hardly an adequate number.

First off, I'd like to see these results measured against inhaled analgesics, such as entonox, which I find ( when used PROPERLY) is fairly effective for minor injuries. Secondly, should we really be in the business of providing pain relief for the most minor of abrasions and contusions? Good grief, I think the patient should be able to shoulder the burden of minor aches and sores, and if it gets to the point of unbearable pain, then by all means administer some narcotic relief, and be done with it.

Whats with the whacky pain scale in this study? Rate your pain between 1-100? I guess the 1-10 pain scale wasn't specific enough. I suggest if the researchers desire more accurate results in further studies, they take off the kid gloves and go directly to a 1-10,000 pain scale for really definitive data.

Now EMT’s Medical First Responders and Paramedic in the prehospital setting can use acupuncture safely and effectively to help provide quality care without the risk of pharmaceutical treatments.

This last sentence made me chuckle to myself. It is written as if this study was the culmination of some long, tiresome, scholarly body of research that is finally complete. The last word has been spoken on the subject, and NOW, all ambulance personal are at last free to practice acupuncture without fear or shame.

[Dustdevil]

Not no, but Hell no.

It takes 3 years of full time training to be properly schooled in acupuncture/acupressure, despite what some fly-by-night "schools" would have you believe. To say that you can learn the techniques in a short class is nothing but a sham.

I'd rather see the training time go to airway management, critical care decision-making, patient relations, or just about any other skill relevant to EMS before we start adding in this skill which takes extensive training and is not of much benefit to the patient in the prehospital environment.

Agreed. I'm a believer in acupressure and acupuncture, but they are not merit badge skills like IVs and ET tubes. The licensing boards for those disciplines would probably raise ten kinds of hell if we were to treat them as such.