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The Safety, Efficacy, and Expediency of Albuterol Nebulizer Administration by BLS Providers
- Patrick J. Matthews, Douglas R. Ader, Cecelia K. Harrison, Paige J. Ostahowski, Jason T. Nomura
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- Journal:
- Prehospital and Disaster Medicine / Volume 38 / Issue 2 / April 2023
- Published online by Cambridge University Press:
- 01 March 2023, pp. 149-152
- Print publication:
- April 2023
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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.
A Comparison of Efficacy of Treatment and Time to Administration of Naloxone by BLS and ALS Providers
- Kenneth Nugent, Patrick Matthews, Jamie Gissendaner, Mia Papas, Deborah Occident, Avkash Patel, Michelle Johnson, Ross E. Megargel, Jason T. Nomura
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- Journal:
- Prehospital and Disaster Medicine / Volume 34 / Issue 4 / August 2019
- Published online by Cambridge University Press:
- 19 July 2019, pp. 350-355
- Print publication:
- August 2019
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Introduction:
The administration of naloxone therapy is restricted by scope of practice to Advanced Life Support (ALS) in many Emergency Medical Services (EMS) systems throughout the United States. In Delaware’s two-tiered EMS system, Basic Life Support (BLS) often arrives on-scene prior to ALS, but BLS providers were not previously authorized to administer naloxone. Through a BLS naloxone pilot study, the researchers sought to evaluate BLS naloxone administration and timing compared to ALS.
Hypothesis:After undergoing specialized training, BLS providers would be able to appropriately administer naloxone to opioid overdose patients in a more timely manner than ALS providers.
Methods:This was a retrospective, observational study using data collected from February 2014 through May 2015 throughout a state BLS naloxone pilot program. A total of 14 out of 72 state BLS agencies participated in the study. Pilot BLS agencies attended a training session on the indications and administration of naloxone, and then were authorized to carry and administer naloxone. Researchers then compared vital signs and the time of BLS arrival to administration of naloxone by BLS and ALS. Data were analyzed using paired and independent sample t-tests, as well as chi-square, as appropriate.
Results:A total of 131 incidents of naloxone administration were reviewed. Of those, 62 patients received naloxone by BLS (pilot group) and 69 patients received naloxone by ALS (control group). After naloxone administration, BLS patients showed improvements in heart rate (HR; P < .01), respiratory rate (RR; P < .01), and pulse oximetry (spO2; P < .01); ALS patients also showed improvement in RR (P < .01), and in spO2 (P = .005). There was no significant improvement in HR for ALS providers (P = .189).
There was a significant difference in arrival time of BLS to the time of naloxone administration between the two groups, with shorter times in the BLS group compared to the ALS group (1.9 minutes versus 9.8 minutes; P < .01); BLS administration was 7.8 minutes faster when compared to ALS administration (95% CI, 6.2-9.3 minutes).
Conclusions:Patients improved similarly and received naloxone therapy sooner when treated by BLS agencies carrying naloxone than those who awaited ALS arrival. All EMS systems should consider allowing BLS to carry and administer naloxone for an effective and potentially faster naloxone administration when treating respiratory compromise related to opiate overdose.
Contributors
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- By Mark S. Aloia, Ellemarije Altena, Peter Anderer, Christopher L. Asplund, Nitin Bangera, Jeroen S. Benjamins, Daniela Berg, Bohdan Bybel, Vincenza Castronovo, Suk-tak Chan, Michael W. L. Chee, Pietro Cortelli, Michael Czisch, Joseph T. Daley, Thien Thanh Dang-Vu, Yazmín de la Garza-Neme, Lourdes DelRosso, Derk-Jan Dijk, Maria Engström, Thorleif Etgen, Bruce J. Fisch, Ariane Foret, Patrice Fort, Steffen Gais, Anne Germain, Jana Godau, Andrew L. Goertzen, William A. Gomes, Ronald M. Harper, Seung Bong Hong, Romy Hoque, Scott A. Huettel, Yuichi Inoue, Alex Iranzo, Mathieu Jaspar, Zayd Jedidi, Alejandro Jiménez-Genchi, Eun Yeon Joo, Gerhard Klösch, Karsten Krakow, Rajesh Kumar, Caroline Kussé, Hans-Peter Landolt, Helmut Laufs, Jeffrey David Lewine, Camilo Libedinsky, Michael L. Lipton, Mordechai Lorberboym, Cheng Luo, Pierre-Hervé Luppi, Paul M. Macey, Pierre Maquet, Laura Mascetti, Christelle Meyer, Sarah Moens, Vincenzo Muto, Shadreck Mzengeza, Eric Nofzinger, Takashi Nomura, Daniela Perani, Jennifer R. Ramautar, Bernd Saletu, Michael T. Saletu, Gerda Saletu-Zyhlarz, Christina Schmidt, Monika Schönauer, Richard J. Schwab, Sophie Schwartz, Keivan Shifteh, Sanjib Sinha, Victor I. Spoormaker, Ryan P. J. Stocker, A. Jon Stoessl, Diederick Stoffers, A. B. Taly, Robert Joseph Thomas, Michael J. Thorpy, Emily Urry, Jason Valerio, Ysbrand D. Van Der Werf, Gilles Vandewalle, Hans P. A. Van Dongen, Eus J. W. Van Someren, Vinod Venkatraman, Frederic von Wegner, Thomas C. Wetter, Dezhong Yao
- Edited by Eric Nofzinger, University of Pittsburgh, Pierre Maquet, Université de Liège, Belgium, Michael J. Thorpy
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- Book:
- Neuroimaging of Sleep and Sleep Disorders
- Published online:
- 05 March 2013
- Print publication:
- 07 March 2013, pp viii-xii
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