title: A retrospective review of the prehospital use of activated charcoal.
abstract: OBJECTIVE
  We studied the complications and timing implications of prehospital activated charcoal (PAC). Appropriateness of PAC administration was also evaluated.
  
  
  METHODS
  We retrospectively reviewed prehospital records over 32 months for overdose cases, where PAC was administered. Cases were assessed for amount and type of ingestant, clinical findings, timing of PAC, timing of transport and arrival into the emergency department (ED), and complications. Encounter duration in cases of PAC was compared with that, for all cases during the study period, where an overdose patient who did not receive activated charcoal was transported.
  
  
  RESULTS
  Two thousand eight hundred forty-five total cases were identified. In 441 cases, PAC was given; and complications could be assessed. Two hundred eighty-one of these had complete information regarding timing of ingestion, activated charcoal administration, and transport. The average time between overdose and PAC was 49.8 minutes (range, 7-199 minutes; median, 41.0 minutes; SD, 30.4 minutes). Complications included emesis (7%), declining mental status (4%), declining blood pressure (0.4%), and declining oxygen saturation (0.4%). Four hundred seventeen cases of PAC had documentation of timing of emergency medical service (EMS) arrival on scene and arrival at the ED. Average EMS encounter time was 29 minutes (range, 10-53 minutes; median, 27.9 minutes). Two thousand forty-four poisoning patients were transported who did not receive PAC. The average EMS encounter time for this group was 28.1 minutes (range, 4-82 minutes; median, 27.3 minutes), not significantly different (P =.114).
  
  
  CONCLUSIONS
  Prehospital activated charcoal did not appear to markedly delay transport or arrival of overdose patients into the ED and was generally safe.
authors.affiliation: Department of Emergency Medicine, UCSD, San Diego, CA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Villarreal
authors.affiliation: Department of Emergency Medicine, UCSD, San Diego, CA; Division of Emergency Medical Services, UCSD, San Diego, CA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Kahn
authors.affiliation: Department of Emergency Medicine, UCSD, San Diego, CA; Division of Emergency Medical Services, UCSD, San Diego, CA; Rescue Department, San Diego Fire, San Diego, CA.
authors.forename: James V
authors.initials: JV
authors.lastname: Dunford
authors.affiliation: Rescue Department, San Diego Fire, San Diego, CA.
authors.forename: Ekta
authors.initials: E
authors.lastname: Patel
authors.affiliation: Department of Emergency Medicine, UCSD, San Diego, CA; Rural Metro Ambulance Company, San Diego, CA; Division of Medical Toxicology, UCSD, San Diego, CA. Electronic address: rfclark@ucsd.edu.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Clark
mesh_terms: D000931:Antidotes / Q000627:therapeutic use*; D002606:Charcoal / Q000627:therapeutic use*; D062787:Drug Overdose / Q000188:drug therapy*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D011041:Poisoning / Q000188:drug therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000931:Antidotes; D002606:Charcoal