Related Experiment Video
Updated: Apr 27, 2026
A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
Exploring Current Emergency Medical Services Approaches to Manage Agitated Older Adult Patients: An Analysis of
Joshua Lachs1, Rana Barghout1, William Haussner2
1Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA.
Background:
Agitation in older adults presents unique challenges for emergency medical services (EMS) clinicians. To safely assess, treat, and transport these patients, EMS providers must manage this agitation, which is often caused by delirium or behavioral symptoms of dementia. Strategies routinely used in younger patients, such as physical restraints and chemical sedatives, have a much higher risk of causing harm in older adults. EMS provider practices in this area are understudied. Our objective was to examine U.S. state protocols for guidance on agitation management in older adults.
Methods:
We reviewed publicly available statewide EMS protocols and the National EMS Model Guidelines to identify agitation management guidance and whether modifications for older adults were included. We assessed each protocol for the presence of 26 elements using a standardized approach.
Results:
We analyzed 34 state protocols and the National Model Guidelines. While 33 protocols (97%) included guidance for managing agitation and 19 protocols (58%) included pediatric-specific considerations, only 11 (33%) addressed older adults. Among these, the most common modification was sedative medication dose reduction (9 protocols, 27%). No protocols included modifications to guidance/criteria for physical restraint use, prioritization/escalation between physical restraint and chemical sedation, or sedative medication selection for older adults. Guidance on medication selection varied: 29 protocols (88%) included standing orders for sedative medications, most commonly midazolam (27 protocols, 82%), ketamine (23 protocols, 70%), haloperidol (17 protocols, 52%). Only 7 protocols (21%) included specific dose adjustments for older adults, typically a 50% reduction. Benzodiazepines were most commonly recommended, while antipsychotics were less common.
Conclusions:
Most state EMS protocols provide guidance on management of agitated patients, including use of physical restraints and chemical sedatives, yet modifications or specific guidance for older adults are uncommon. Recognizing and addressing this gap represents an important opportunity to improve quality of prehospital care for older adults.
Related Concept Videos
01:15Drug Dosing: Geriatric Patients
01:14SBAR II: Application of SBAR
SBAR Report from a Nurse to a Health Care Provider
S: "Hello, Dr. Smith. This is Jane, RN, from the Med Surg unit. I am calling to tell you about Ms. White in Room 210, who is experiencing increased pain and redness at her incision site. Her recent...
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:27Pharmacodynamics in Geriatric Patients: Effects of Age
01:30Specialized Care Centers and Settings-I
Daycare centers
They provide several functions. Some facilities care for healthy newborns and children whose parents work, while others are medically focused and care for...
01:28Acute Coronary Syndrome IV: Interprofessional Care