Out-of-hospital administration of albuterol for asthma by basic life support providers.
BACKGROUND
Each year, approximately 40,000 patients with acute asthma are transported by the Fire Department of New York City (NYC) Emergency Medical Services (EMS). Out-of-hospital administration of bronchodilator therapy has, however, been restricted by scope of practice to advanced life support (ALS) providers. Since the rapid availability of ALS units cannot always be assured, some individuals with acute asthma may receive only basic life support (BLS) measures in the field.


OBJECTIVE
To demonstrate that basic emergency medical technicians (EMT-Bs) are able to effectively administer nebulized albuterol to asthma patients in the out-of-hospital environment.


METHODS
This was a prospective, observational cohort study of 9-1-1 asthma calls received by the NYC EMS system for patients between the ages of 1 and 65 years. Baseline peak expiratory flow rate (PEFR) and other clinical measures were obtained prior to and following BLS administration of one or two treatments with nebulized albuterol.


RESULTS
Data were available for 3,351 patients over a one-year study period. One out-of-hospital albuterol treatment was given in 60%, while 40% of the patients received two. The PEFRs increased from 40.4% predicted (SD +/-21.0) to 54.8% predicted (SD +/-26.1), for a posttreatment improvement of 14.4% points (95% CI = 13.8 to 15.1). Other clinical outcome measures, including dyspnea index, respiratory rate, and use of accessory muscles, also showed improvement.


CONCLUSIONS
This study demonstrates that EMT-Bs can effectively administer albuterol to acute asthma patients in the out-of-hospital environment.
Richmond
Neal J
NJ
Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, NY 11042, USA. aresilv@aol.com
Silverman
Robert
R
Kusick
Monique
M
Matallana
Luis
L
Winokur
Jules
J
D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000420:Albuterol / Q000008:administration & dosage*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards; D004634:Emergency Medical Technicians; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009519:New York City; D011446:Prospective Studies; D012129:Respiratory Function Tests; D016896:Treatment Outcome
D001993:Bronchodilator Agents; D000420:Albuterol