Out-of-hospital use of neuromuscular-blocking agents in the united states

Abstract

Objective. A national survey was mailed to state EMS directors to assess the current status of use of neuromuscular-blocking agents (NMBAs) by EMS systems across the United States. Methods. Initial and second mailings were completed in early 1996 and 1997, respectively. Results. Replies were received from all 50 (100%) states following the second mailing. Twenty-nine (58%) states use NMBAs. Eleven (22%) of the 29 use paralytic drugs only in aeromedical programs. Of the 18 states that use NMBAs in ground-based EMS systems, 11 (22%) use paramedic ambulance staffing exclusively. Registered nurses (RNs) or RN-paramedic teams comprised the majority of the remaining states' staffing configurations. The first reported date of implementation of use of NMBAs was 1985, and there has been a steady trend of additional states launching paralytic drug use over the last 12 years. Conclusion. This trend suggests that use of paralytic drugs by paramedics is becoming standard of care in many out-of-hospital systems.

Keywords:

• neuromuscular-blocking agents
• paralytic drugs
• rapid-sequence induction
• artificial airway support
• paramedic expanded scope of practice