Evaluation of a new EMS asthma protocol in New York City: a preliminary report.
BACKGROUND
In July 1996, the New York City (NYC) regional EMS implemented a new protocol whereby EMS personnel in the prehospital setting could administer 125 mg of intravenous methyl prednisolone to asthma patients as one of their medical options following telephone consultation with a medical control physician.


OBJECTIVE
To determine whether this protocol had any effect on hospital admission rates or the emergency department (ED) length of stay.


METHODS
This retrospective chart review focused on the 219 (of 603 total) patients who arrived to the ED by ambulance over a two-year period whose ED diagnosis was asthma. There were 81 patient encounters in year 1, and 138 in year 2. Eleven of the year 2 group received prehospital steroids. The study took place at an urban 911 receiving, Level 2 ED.


RESULTS
Of the group who received prehospital steroids, none resulted in hospital admission. Due to the small sample size in the steroid-receiving group, the differences in these admission rates are not yet significant. No differences were detected in the ED length of stay between the two patient groups (157 vs. 160 minutes in year 2, p = 0.9).


CONCLUSIONS
The differences in admission rates suggested by this study suggest a simple yet potentially powerful tool for improving patient outcome in the treatment of asthma.
Stead
L
L
Department of Medicine, Cabrini Medical Center, New York, New York, USA. latha@stead.com
Whiteside
T
T
D000208:Acute Disease; D000328:Adult; D000465:Algorithms; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D015897:Comorbidity; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006439:Hemodynamics; D006760:Hospitalization / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D009519:New York City; D012189:Retrospective Studies
D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone