Albuterol sulfate administration by EMT-basics: results of a demonstration project

1) To evaluate the ability to train emergency medical technicians-basic (EMT-Bs) to accurately identify bronchospasm and, based on a treatment protocol, administer albuterol sulfate via nebulization as a standing order. 2) To measure the improvement in patient condition after treatment.

Following approval by the Commissioner of Health and Institutional Review Board, EMS agencies were enrolled to participate in the study and EMT-Bs were trained using a four-hour curriculum. For each patient, a prehospital data collection form was completed including identifying data for the EMT-B, patient assessment, and history information; and pre- and posttreatment assessments and a hospital data collection form were completed including the emergency department physician's diagnosis, assessment of bronchospasm, number of albuterol treatments received in the emergency department, and final disposition of the patient.

During a one-year study period, EMT-Bs treated 190 patients as part of the project. Across all values patients showed a clinical improvement as a result of the therapy. Concurrence in the assessment of bronchospasm by the EMT-B with an emergency department physician was found in 87.4% of the cases. When including allergic reaction, anaphylaxis, bronchiolitis, and chronic obstructive pulmonary disease in the diagnosis list of bronchospasm, the accuracy rate increased to more than 94%.

This study indicated EMT-Bs were highly successful in their evaluation of bronchospasm. Based on this level of accuracy, the authors suggest that it is safe for emergency medical service systems and medical directors to develop protocols that allow EMT-Bs to administer albuterol via nebulizer for bronchospasm based on their assessment.