Retrospective Study of Midazolam Protocol for Prehospital Behavioral Emergencies

Area of Science:

• Prehospital care
• Emergency medicine
• Pharmacology

Background:

• Agitated patients present significant challenges in prehospital settings for both care and provider safety.
• Midazolam is commonly used for agitation in emergency departments, but prehospital data are limited.
• This study examines midazolam use for behavioral emergencies in a large urban EMS system.

Purpose of the Study:

• To evaluate the effectiveness and safety of midazolam for treating acute agitation in the prehospital setting.
• To test the hypothesis that midazolam improves clinical conditions without causing significant deterioration.

Main Methods:

• Retrospective review of 294 patient care reports from February 2014 to June 2016.
• Midazolam administered via intramuscular (IM), intranasal (IN), or intravenous (IV) routes for acute agitation.
• Analysis included descriptive statistics and t-tests to compare route effectiveness.

Main Results:

• Midazolam was administered to 257 patients, with 73.5% showing improved condition.
• The majority of doses were 5 mg (92.9%), primarily via IM (52.0%) and IN (40.8%) routes.
• Adverse events were infrequent (3.4%), with no significant difference in effectiveness between IM and IN routes.

Conclusions:

• A prehospital midazolam protocol is associated with reduced patient agitation.
• The protocol demonstrated a low rate of adverse events, supporting its use in prehospital settings.
• Midazolam is an effective option for managing prehospital behavioral emergencies.