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Description of Medication Administration by Emergency Medical Services during Mass-casualty Incidents in the United States

Published online by Cambridge University Press:  03 February 2016

Mazen El Sayed*
Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon Emergency Medical Services and Prehospital Care Program, American University of Beirut Medical Center, Beirut, Lebanon
Hani Tamim
Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
N. Clay Mann
Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UtahUSA
Correspondence: Mazen J. El Sayed, MD, MPH, FAAEM, FACEP Department of Emergency Medicine American University of Beirut Medical Center P.O. Box - 11-0236 Riad El Solh Beirut 1107 2020 Email:



Emergency Medical Services (EMS) preparedness and availability of essential medications are important to reduce morbidity and mortality from mass-casualty incidents (MCIs).


This study describes prehospital medication administration during MCIs by different EMS service levels.


The US National EMS Public-Release Research Dataset maintained by the National Emergency Medical Services Information System (NEMSIS) was used to carry out the study. Emergency Medical Services activations coded as MCI at dispatch, or by EMS personnel, were included. The Center for Medicare and Medicaid Services (CMS) service level was used for the level of service provided. A descriptive analysis of medication administration by EMS service level was carried out.


Among the 19,831,189 EMS activations, 53,334 activations had an MCI code, of which 26,110 activations were included. There were 8,179 (31.3%) Advanced Life Support (ALS), 5,811 (22.3%) Basic Life Support (BLS), 399 (1.5%) Air Medical Transport (AMT; fixed or rotary), and 38 (0.2%) Specialty Care Transport (SCT) activations. More than 80 different medications from 18 groups were reported. Seven thousand twenty-one activations (26.9%) had at least one medication administered. Oxygen was most common (16.3%), followed by crystalloids (6.9%), unknown (5.2%), analgesics (3.2%) mainly narcotics, antiemetics (1.5%), cardiac/vasopressors/inotropes (0.9%), bronchodilators (0.9%), sedatives (0.8%), and vasodilators/antihypertensives (0.7%). Overall, medication administration rates and frequencies of medications groups significantly varied between EMS service levels (P<.01) except for “Analgesia (other)” (P=.40) and “Pain medications (nonsteroidal anti-inflammatory drug; NSAID)” (P=.07).


Medications are administered frequently in MCIs, mainly Oxygen, crystalloids, and narcotic pain medications. Emergency Medical Services systems can use the findings of this study to better prepare their stockpiles for MCIs.

El SayedM, TamimH, MannNC. Description of Medication Administration by Emergency Medical Services during Mass-casualty Incidents in the United States. Prehosp Disaster Med. 2016;31(2):141149.

Original Research
© World Association for Disaster and Emergency Medicine 2016 

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