What is the initial prehospital Emergency Medical Services (EMS) treatment for pneumonia?

Prehospital EMS Treatment of Pneumonia

The initial prehospital EMS treatment for pneumonia should include oxygen therapy to maintain SpO2 >92%, assessment of severity using vital signs, and supportive care while arranging appropriate transport to a medical facility. 1, 2

Initial Assessment and Monitoring

• Assess vital signs with focus on:

  • Respiratory rate (increased in pneumonia)
  • Oxygen saturation (hypoxemia: SpO2 <92% indicates severity) 1
  • Blood pressure (hypotension suggests severe infection)
  • Heart rate (tachycardia suggests severe infection)
  • Temperature (fever or hypothermia)
  • Mental status (altered mental status indicates severity)

• Use pulse oximetry to guide oxygen requirements and assess severity 1, 3

  • Pulse oximetry is a valuable tool for EMS providers to determine appropriate oxygen therapy
  • Target oxygen saturation >92% unless patient has known COPD with CO₂ retention 2

Oxygen Therapy

• Provide supplemental oxygen for patients with SpO2 <92% 1, 2

  • Start with nasal cannula at 2-6 L/min for mild hypoxemia
  • Progress to simple face mask (5-10 L/min) for moderate hypoxemia
  • Consider non-rebreather mask (10-15 L/min) for severe hypoxemia

• For patients with respiratory distress and hypoxemia despite conventional oxygen:

  • Consider trial of CPAP if available and trained in its use 4
  • Low-FiO2 CPAP (28-30%) has been shown effective in prehospital setting for respiratory emergencies 4

Positioning and Supportive Care

• Place patient in semi-recumbent position (head elevated 30-45°) to:

  • Improve ventilation-perfusion matching
  • Decrease work of breathing
  • Reduce risk of aspiration 2

• Advise patients to:

  • Rest to conserve energy
  • Maintain adequate hydration if able to take fluids orally 1

• Provide analgesia for pleuritic chest pain:

  • Simple analgesia such as paracetamol/acetaminophen if available 1

Transport Decision-Making

• Assess need for hospital referral using severity criteria 1:

  • Presence of hypoxemia (SpO2 <92%)
  • Respiratory distress (increased work of breathing, accessory muscle use)
  • Hemodynamic instability (hypotension, tachycardia)
  • Altered mental status
  • Bilateral or multilobar involvement (if known)
  • Comorbidities increasing risk (COPD, diabetes, heart failure)

• Patients with features of severe infection should be transported urgently to hospital 1

Special Considerations

• For patients with known COPD:

  • Monitor closely for CO₂ retention with high-flow oxygen
  • Target slightly lower oxygen saturations (88-92%) if concerned about CO₂ retention 2

• For patients with severe respiratory distress:

  • Consider early notification to receiving facility for preparation
  • Position for optimal respiratory mechanics
  • Continue close monitoring of vital signs during transport

Common Pitfalls to Avoid

• Delaying oxygen therapy assessment and administration
• Failing to recognize signs of severe pneumonia requiring urgent transport
• Overuse of high-flow oxygen in patients with COPD and risk of CO₂ retention
• Inadequate monitoring during transport
• Not elevating head of bed, which can worsen respiratory mechanics and increase aspiration risk

Remember that prehospital care focuses on supportive measures and rapid transport to definitive care, as antibiotic therapy is typically initiated in the hospital setting after appropriate diagnostic testing.