Prehospital pharmacotherapeutic interventions: Recommendations for medication administration by EMT-A and EMT-I personnel

Abarbanell, Neal Robert

doi:10.1016/0735-6757(94)90027-2

Cited by 7 publications

(3 citation statements)

References 11 publications

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“…This resulted in improvement in patient condition, as shown by increase in spO2 and decrease in RR. Other studies assessing urban EMS systems have found similar results, 2,9 although the study by Abarbanell, et al 2 targeted EMT-Intermediate/EMT-Advanced providers which are not recognized in all EMS systems. The BLS agencies who participated in this study served various population density districts, including urban and rural, making these findings relevant to most EMS environments throughout the country.…”

Section: Discussionmentioning

confidence: 78%

“…Albuterol has been shown to be a safe and effective first-line treatment for bronchospasm, leading to improvement in patient condition, and thus becoming the primary initial therapy for most asthma exacerbations. 2 Albuterol is generally considered a safe and effective first-line therapy. However, albuterol administration is not without adverse effects and risks do exist.…”

Section: Discussionmentioning

confidence: 99%

“…Earlier administration of albuterol is important in lessening the severity of respiratory distress caused by these disease processes. 2 While several prehospital studies have demonstrated patient improvement after treatment with beta-agonists for asthma, [3][4][5][6] many EMS systems restrict the use of albuterol to paramedics in the prehospital setting. However, the availability of paramedics and other Advanced Life Support (ALS) personnel is limited in many areas, particularly in more rural environments.…”

Section: Introductionmentioning

confidence: 99%

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The Safety, Efficacy, and Expediency of Albuterol Nebulizer Administration by BLS Providers

Matthews

Ader

Harrison

et al. 2023

Prehosp. Disaster med.

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Introduction: Many Emergency Medical Service (EMS) systems in the United States restrict albuterol therapy by scope of practice to Advanced Life Support (ALS). The State of Delaware has a two-tiered EMS system in which Basic Life Support (BLS) arrives on scene prior to ALS in the majority of respiratory distress calls. Study Objective: This study sought to evaluate the safety, efficacy, and expedience of albuterol administration by BLS compared to ALS. Methods: This retrospective observational study used data collected from July 2015 through January 2017 throughout a State BLS albuterol pilot program. Pilot BLS agencies participated in a training session on the indications and administration of albuterol, and were then authorized to carry and administer nebulized albuterol. Heart rate (HR), respiratory rate (RR), and pulse oximetry (spO2) were obtained before and after albuterol administration by BLS and ALS. The times from BLS arrival to the administration of albuterol by pilot BLS agencies versus ALS were compared. Study encounters required both BLS and ALS response. Data were analyzed using chi-square and t-test as appropriate. Results: Three hundred eighty-eight (388) incidents were reviewed. One hundred eighty-five (185) patients received albuterol by BLS pilot agencies and 203 patients received albuterol by ALS. Of note, the population treated by ALS was significantly older than the population treated by BLS (61.9 versus 51.6 years; P <.001). A comparison of BLS arrival time to albuterol administration time showed significantly shorter times in the BLS pilot group compared to the ALS group (3.50 minutes versus 8.00 minutes, respectively; P <.001). After albuterol administration, BLS pilot patients showed improvements in HR (P <.01), RR (P <.01), and spO2 (P <.01). Alternately, ALS treatment patients showed improvement in spO2 (P <.01) but not RR (P = .17) or HR (P = 1.00). Review by ALS or hospital staff showed albuterol was indicated in 179 of 185 BLS patients and administered correctly in 100% of these patients. Conclusion: Patients both received albuterol significantly sooner and showed superior improvements in vital signs when treated by BLS agencies carrying albuterol rather than by BLS agencies who required ALS arrival for albuterol. Two-tiered EMS systems should consider allowing BLS to carry and administer albuterol for safe, effective, and expedient treatment of respiratory distress patients amenable to albuterol therapy.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Safety, Efficacy, and Expediency of Albuterol Nebulizer Administration by BLS Providers

Matthews

Ader

Harrison

et al. 2023

Prehosp. Disaster med.

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Emergency medical technician treatment of hypoglycemia without transport

Strote

Simons

Eisenberg

2008

The American Journal of Emergency Medicine

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EMS Knowledge and Skills in Rural North Carolina: A Comparison with the National EMS Education and Practice Blueprint

Brown

Copeland²,

Gough

et al. 1996

Prehosp. Disaster med.

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Introduction:Many state and local emergency medical services (EMS) systems may wish to modify provider levels and their scope of practice to align their systems with the recommendations of the National Emergency Medical Services Education and Practice Blueprint. To determine any changes that may be needed in a typical EMS system, the knowledge and skills of EMS providers in one rural area of North Carolina were compared with the knowledge and skills recommended in the National Emergency Medical Services Education and Practice Blueprint.Methods:A survey listing 175 items of patient care-oriented knowledge and skills described in the National Emergency Medical Services Education and Practice Blueprint was developed. EMS providers from five rural eastern North Carolina counties were asked to identify on the survey those items of knowledge and skills they believed they possessed. The skills and knowledge selected by the respondents at the five different North Carolina levels of certification were compared with the knowledge and skills listed for comparable provider levels delineated by the National Emergency Medical Services Education and Practice Blueprint. The proportions of the recommended skills reported to be possessed by the respondents were compared to determine which North Carolina certification levels best correlate with the Blueprint.Results:One hundred forty-five EMS providers completed the survey. The proportion of recommended skills and knowledge reported to be possessed by Emergency Medical Technicians (EMTs) ranked significantly lower than did the skills and knowledge reported to be possessed by respondents at other levels in five of the 10 Blueprint elements. The proportion of recommended skills and knowledge reported to be possessed by EMT-Defibrillator-level personnel ranked lower than did those reported to be possessed by respondents at other levels in seven of the 10 Blueprint elements. The proportion of recommended skills and knowledge reported to be possessed by EMT-Intermediates ranked lower than did those reported to be possessed by respondents at other levels in nine of the 10 Blueprint elements. The proportion of recommended skills and knowledge reported to be possessed by EMT-Advanced Intermediates ranked lower than were the skills and knowledge reported to be possessed by respondents at other levels in two of the 10 Blueprint elements. Finally, the proportion of recommended skills and knowledge reported to be possessed by EMT-Paramedics ranked lower than were those reported to be possessed by respondents at other levels in one of the 10 Blueprint elements.Conclusion:In North Carolina, combining the EMT and EMT-Defibrillator levels and eliminating the EMT-Intermediate level would create three levels of certification, which would be more consistent with levels recommended by the Blueprint. The results of this study should be considered in any effort to revise the levels of EMS certification in North Carolina and in planning the training curricula for bridging those levels. Other states may require similar action to align with the National Emergency Medical Services Education and Practice Blueprint.

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Prehospital pharmacotherapeutic interventions: Recommendations for medication administration by EMT-A and EMT-I personnel

Cited by 7 publications

References 11 publications

The Safety, Efficacy, and Expediency of Albuterol Nebulizer Administration by BLS Providers

The Safety, Efficacy, and Expediency of Albuterol Nebulizer Administration by BLS Providers

Emergency medical technician treatment of hypoglycemia without transport

EMS Knowledge and Skills in Rural North Carolina: A Comparison with the National EMS Education and Practice Blueprint

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