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EMS. Kay Vonderschmidt. EMS IM midazolam usage. Before RAMPART did your EMS agencies use midazolam? No use of midazolam IV use only IM use (per medical director) Other (IN?). Midazolam other. Does your EMS system use midazolam via: Intranasal? Intrabuccal ? None of the above

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Ems

EMS

Kay Vonderschmidt


Ems im midazolam usage

EMS IM midazolam usage

  • Before RAMPART did your EMS agencies use midazolam?

    • No use of midazolam

    • IV use only

    • IM use (per medical director)

    • Other (IN?)


Midazolam other

Midazolam other

  • Does your EMS system use midazolam via:

    • Intranasal?

    • Intrabuccal?

    • None of the above

    • All of the above


Midazolam dosages

Midazolam dosages

  • If your EMS system uses midazolam, what is the dosage prior to RAMPART

    • IV/IO/IM 2mg dosages repeatable – up to 8mg or more

    • IV/IO/IM 5mg dosage repeatable up to 10mg

    • IV/IO/IM other

    • IN other


Other benzo s

Other benzo’s

  • Does your EMS system use other benzo’s for seizures?

    • Yes

    • No


Discussion

Discussion

  • How quickly did the seizure stop vs. transport time?

    • Does transport time factor positively in the seizure being stopped and remain stopped prior to arrival at ED?

      • What was the average transport time for the study? (Termination of sz was 3.3 min for IM)

      • Did transport time factor into repeat doses?

      • How many people stopped sz in field but sz again in ED vs. their transport time?


Discussion1

Discussion

  • Post RAMPART what should we recommend when it comes to IM administration?

    • EMS IM usage? (no autoinjectors yet- needs FDA approval)

    • EMS IM doses

      • What dose, repeat doses, etc

      • Adult vs. pedi dosages


Discussion2

Discussion

  • Alternative therapy?

    • Midazolam IN and/or intrabuccal?

      Alternative medications?

      diazepam?

      lorazepam?


Discussions

Discussions

  • Are we concerned about an increase in field intubations with the use of midazolam?

    • Have there been any other studies using benzo’s in the field that includes EMS intubations to compare to?


Discussion3

Discussion

  • How do we present the findings effectively so that a change in practice will occur?

    • Conferences

    • Addition to books (AMLS, etc)

    • White paper

    • Other ideas


Questions

Questions


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