title: Ondansetron is safe and effective for prehospital treatment of nausea and vomiting by paramedics.
abstract: OBJCTIVE: The objectives were to evaluate the safety and efficacy of ondansetron in the out-of-hospital treatment of undifferentiated nausea or vomiting.
  
  
  METHODS
  Patients with severe nausea or intractable vomiting who were transported by paramedic-staffed ambulances in eight California counties were treated with intravenous (IV), intramuscular (IM), or oral dissolving tablet (ODT) administration of ondansetron. Data were collected prospectively for a six-month period using an online database. Prospectively defined outcome measures were 1) efficacy as measured by a quantitative visual analog nausea scale and 2) incidence of adverse effects. There were no control or placebo groups.
  
  
  RESULTS
  Data was collected for 2072 patients, but one patient did not receive the medication. Therefore, Ondansetron was administered to 2,071 patients (3.7% of transported patients). Most patients were adult, with only 66 patients less than 18 years old. Of the 2,071 patients, 1,320 (64%) received IV administration, 77 (4%) received IM administration, and 674 (33%) received ODT administration of ondansetron. Intravenous administration resulted in the largest improvements in nausea scores (mean 4.4; 95% confidence interval [CI] 4.2, 4.5), followed by IM (mean 3.6; 95% CI 3.0, 4.3) and ODT (mean 3.3; 95% CI 3.1, 3.5). Overall, the mean decrease in nausea score was 4.0 (95% CI 3.9, 4.1; p < 0.001) on a 10-point scale. After medication administration, four patients had mild hypotension, one had hypertension, two had itching or rash, and one had a brief episode of supraventricular tachycardia that resolved spontaneously.
  
  
  CONCLUSIONS
  Ondansetron is safe and effective for out-of-hospital treatment of nausea and vomiting when administered by paramedics via the IV, IM, or oral route. When available to paramedics, ondansetron is used frequently.
authors.affiliation: Santa Barbara County EMS, Santa Barbara, California, USA.
authors.forename: Angelo A
authors.initials: AA
authors.lastname: Salvucci
authors.forename: Benjamin
authors.initials: B
authors.lastname: Squire
authors.forename: Marc
authors.initials: M
authors.lastname: Burdick
authors.forename: Mark
authors.initials: M
authors.lastname: Luoto
authors.forename: David
authors.initials: D
authors.lastname: Brazzel
authors.forename: Reza
authors.initials: R
authors.lastname: Vaezazizi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000488:Allied Health Personnel / Q000706:statistics & numerical data*; D000932:Antiemetics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002140:California; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D016208:Databases, Factual; D004632:Emergency Medical Services / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000188:drug therapy*; D017294:Ondansetron / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010147:Pain Measurement; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013607:Tablets; D014839:Vomiting / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000932:Antiemetics; D013607:Tablets; D017294:Ondansetron