IntroductionPre-hospital analgesia is administered at a suboptimal rate. We aimed to identify barriers to pre-hospital oral analgesia administration to adult patients, as perceived by paramedics, using qualitative methods.MethodsParamedics from a county emergency medical service were invited to participate in semi-structured interviews. The interviews consisted of two questions regarding barriers to pre-hospital administration of oral analgesia using a previously established medical directive. The same investigator completed all interviews, which were audio recorded and transcribed verbatim. Barriers to analgesia administration to adult patients were identified from the interview transcripts using open coding of the data. Two investigators completed the coding process independently and discrepancies were then resolved by consensus. Code frequencies were tabulated and thematic analysis was used to organise the data into broad domains and themes.ResultsIn total, 44 paramedics of a possible 46 (95.7%) completed a semi-structured interview. The final sample size was 43 after exclusion criteria were applied. The median paramedic age and practice experience was 39 and 9.5 years respectively, 58% of the participants were male. Barriers to oral analgesia administration emerged in the domains of patient, medical directive, and paramedic factors.ConclusionParamedic perceived barriers to pre-hospital oral analgesia administration were identified and include those related to patient, medical directive, and paramedic factors. Minimising these barriers should be undertaken to reduce rates of pre-hospital under-treatment of pain and improve pre-hospital pain management.