Lessons from the Introduction of Oral Transmucosal Fentanyl Citrate as Pre-Hospital Analgesia in the Mountain Rescue Service of England and Wales.

IntroductionPain management is important in pre-hospital care but studies demonstrate that it is often inadequate. This study describes the lessons learned from introducing oral transmucosal fentanyl citrate (OTFC) into Mountain Rescue England and Wales (MREW) as an analgesic alternative for rescue teams.MethodsThis was an observational health care improvement project. Data were extracted from the annual controlled drug return and the MREW incident database across three periods of time between 2004 and 2025. The primary outcomes were, OTFC adoption, as a measure of acceptability, changes in opioid use, the initial dose used and safety. Secondary outcomes examined opioid use with injury data and potential implications for mass-casualty incidents. Data were summarised descriptively and reported following the SQUIRE guidelines.ResultsOTFC was administered 685 times, for a variety of conditions and with the report of no significant adverse events. After full implementation (2025), 42 teams (89%) were using the drug. The most common initial dose used was 800 µg. The use of OTFC increased relative to other opioids but there was no evidence of increased overall opioid administration for lower leg injuries.ConclusionOTFC was widely adopted by rescue teams, suggesting it was a suitable drug to use in this environment. There was a change towards a more frequent use of OTFC and away from other opioids. The absence of significant adverse effects, suggests that OTFC can be used safely in selected patients by healthcare professionals and trained non-healthcare personnel. OTFC maybe a suitable drug to use in MCIs.