Prehospital pharmacotherapeutic interventions: recommendations for medication administration by EMT-A and EMT-I...

Because many communities lack prehospital advanced life support (ALS) services, increasing public access to such care is important. The present study was completed to establish an epidemiological database defining prehospital pharmacotherapeutic interventions by ALS rescue teams, in the hope of developing recommendations for medication administration by non-ALS personnel. Data were collected on 333 patients, including indication for pharmacotherapy, patient age, ambulance field time, route of medication administration, adverse effects of pharmacotherapy, efficacy of pharmacotherapy, additional ALS interventions, and patient medication/past medical history. Medications studied included albuterol nebulizer treatments (albuterol), aminophylline, amyl nitrite, atropine, bretylium tosylate, dexamethasone sodium phosphate, dextrose 50% (D-50), diazepam, diphenhydramine, dopamine, epinephrine 1 mg/1 mL, epinephrine 1 mg/10 mL, furosemide, glucagon, ipecac, isoproterenol, lidocaine, morphine sulfate, naloxone, nitroglycerin tablets (nitroglycerin), sodium bicarbonate, and verapamil. Albuterol, D-50, and nitroglycerin were used more often than other medications, accounting for total pharmacotherapeutic interventions for 228 persons (68.47% of total patients), including 100% of all pediatric patients. Partial pharmacological needs for an additional 20 patients also were satisfied by these agents. In all, albuterol, D-50, and nitroglycerin accounted for 250 of 395 total medication interventions (63.29%). No inappropriate use, point estimate [(0)/(333) (0.00% to 0.90%)], or unmet need, point estimate [(0)/(3,613) (0.00% to 0.08%)], of care was noted. When faced with communities lacking ALS rescue services, albuterol, D-50, and nitroglycerin are recommended for administration by emergency medical technician-ambulance and intermediate level rescuers, because of the high rate of use, relative ease of administration, and high benefit/low complication rates associated with these medications.