What medication would be beneficial to add to Emergency Medical Services (EMS)?

From the Guidelines

Tissue Plasminogen Activator (tPA) would be a beneficial medication to add to Emergency Medical Services (EMS) for acute stroke patients, as it has been shown to improve outcomes when administered promptly 1.

Key Points

• The American Heart Association/American Stroke Association recommends that patients with acute stroke be transported to the nearest facility that can operate as a Primary Stroke Center (PSC) unless there is another concomitant imminent life-threatening condition 1.
• EMS activation has been associated with shorter time periods from symptom onset to hospital arrival, decreased time to initial physician examination, and decreased time to initial computed tomography (CT) imaging 1.
• The use of EMS for rapid transportation of patients with acute stroke is crucial, and protocols should be developed to ensure timely identification, care, and transportation of these patients 1.
• While the evidence does not specifically mention the use of tPA in the prehospital setting, its benefits in acute stroke treatment are well-established, and its inclusion in EMS protocols could further improve patient outcomes.

Medication Considerations

• Other medications that may be beneficial in the prehospital setting for acute stroke patients include aspirin and antihypertensive agents, although their use should be guided by established protocols and patient-specific factors 1.
• The selection of medications for EMS use should be based on factors such as likelihood of requirement, proven efficacy, cost, ease of administration, and storage requirements 1.

From the Research

Medication for Emergency Medical Services (EMS)

The following medications have been studied in the context of EMS:

• Buprenorphine: Studies have shown that buprenorphine can be effectively used by EMS to treat opioid use disorder (OUD) in the prehospital setting 2, 3.
• Naloxone: Naloxone is commonly used by EMS to reverse opioid overdoses, but its administration has been increasing over time, with some individuals requiring multiple doses and refusing subsequent care 4.

Benefits of Buprenorphine in EMS

The use of buprenorphine in EMS has several benefits, including:

• High treatment retention rates: Studies have shown that patients who receive buprenorphine from EMS have high treatment retention rates, with 50% of patients remaining in treatment at 7 days and 36% at 30 days 3.
• Low risk of adverse outcomes: Buprenorphine has been shown to be safe and effective in the prehospital setting, with no reported cases of precipitated withdrawal or other adverse outcomes 3.
• Increased patient engagement: The use of buprenorphine in EMS can help increase patient engagement and promote long-term care 2, 3.

Considerations for Implementing Buprenorphine in EMS

When implementing buprenorphine in EMS, the following considerations should be taken into account:

• Protocol development: EMS agencies should develop protocols for the administration of buprenorphine, including dosing and adjunct medications 5.
• Clinician training: EMS clinicians should receive training on the administration of buprenorphine and the management of OUD 5.
• Referrals and follow-up: EMS agencies should establish relationships with local resources and ensure that patients receive follow-up care and referrals to ongoing treatment 5.