Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care

Area of Science:

• Emergency Medicine
• Prehospital Care
• Neurology

Background:

• Emergency medical services (EMS) protocols for altered mental status (AMS) exhibit considerable variability across different jurisdictions in the United States.
• This heterogeneity can impact the quality and consistency of prehospital care for patients experiencing an acute change in mental status.

Purpose of the Study:

• To develop evidence-based recommendations for the prehospital evaluation and treatment of patients with AMS.
• To compare these recommendations against existing protocols of 33 EMS agencies in California.

Main Methods:

• A comprehensive literature review was conducted on current evidence for prehospital AMS treatment.
• Guidelines from national and international societies were incorporated to formulate evidence-based recommendations.
• Protocols from 33 California EMS agencies were analyzed for consistency with the developed recommendations, focusing on assessment, testing, oxygen use, scoring, etiology evaluation, and pediatric care.

Main Results:

• Significant variations were observed in the 33 California EMS agency protocols for AMS.
• While all protocols include blood glucose checks, only 64% specify treatment thresholds, and 52% consider toxicological causes.
• Recommendations for naloxone administration, electrocardiograms, and supplemental oxygen varied, with many protocols lacking specific parameters, especially for pediatric patients.

Conclusions:

• Prehospital protocols for altered mental status demonstrate wide variability among EMS agencies in California.
• The developed evidence-based recommendations offer a framework for EMS medical directors to standardize and improve the diagnosis and treatment of AMS in prehospital settings.