title: Description of Medication Administration by Emergency Medical Services during Mass-casualty Incidents in the United States.
abstract: BACKGROUND
  Emergency Medical Services (EMS) preparedness and availability of essential medications are important to reduce morbidity and mortality from mass-casualty incidents (MCIs).
  
  
  OBJECTIVE
  This study describes prehospital medication administration during MCIs by different EMS service levels.
  
  
  METHODS
  The US National EMS Public-Release Research Dataset maintained by the National Emergency Medical Services Information System (NEMSIS) was used to carry out the study. Emergency Medical Services activations coded as MCI at dispatch, or by EMS personnel, were included. The Center for Medicare and Medicaid Services (CMS) service level was used for the level of service provided. A descriptive analysis of medication administration by EMS service level was carried out.
  
  
  RESULTS
  Among the 19,831,189 EMS activations, 53,334 activations had an MCI code, of which 26,110 activations were included. There were 8,179 (31.3%) Advanced Life Support (ALS), 5,811 (22.3%) Basic Life Support (BLS), 399 (1.5%) Air Medical Transport (AMT; fixed or rotary), and 38 (0.2%) Specialty Care Transport (SCT) activations. More than 80 different medications from 18 groups were reported. Seven thousand twenty-one activations (26.9%) had at least one medication administered. Oxygen was most common (16.3%), followed by crystalloids (6.9%), unknown (5.2%), analgesics (3.2%) mainly narcotics, antiemetics (1.5%), cardiac/vasopressors/inotropes (0.9%), bronchodilators (0.9%), sedatives (0.8%), and vasodilators/antihypertensives (0.7%). Overall, medication administration rates and frequencies of medications groups significantly varied between EMS service levels (P<.01) except for "Analgesia (other)" (P=.40) and "Pain medications (nonsteroidal anti-inflammatory drug; NSAID)" (P=.07).
  
  
  CONCLUSIONS
  Medications are administered frequently in MCIs, mainly Oxygen, crystalloids, and narcotic pain medications. Emergency Medical Services systems can use the findings of this study to better prepare their stockpiles for MCIs.
authors.affiliation: 1Department of Emergency Medicine,American University of Beirut Medical Center,Beirut,Lebanon.
authors.forename: Mazen
authors.initials: M
authors.lastname: El Sayed
authors.affiliation: 3Department of Internal Medicine,American University of Beirut Medical Center,Beirut,Lebanon.
authors.forename: Hani
authors.initials: H
authors.lastname: Tamim
authors.affiliation: 4Department of Pediatrics,University of Utah School of Medicine,Salt Lake City,UtahUSA.
authors.forename: N Clay
authors.initials: NC
authors.lastname: Mann
mesh_terms: D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004189:Disaster Planning / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D006801:Humans; D007256:Information Systems; D054527:Mass Casualty Incidents / Q000706:statistics & numerical data*; D008509:Medication Systems / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
keywords: ALS Advanced Life Support; AMT Air Medical Transport; BLS Basic Life Support; CMS Center for Medicare and Medicaid Services; EMS; EMS Emergency Medical Services; IV intravenous; MCI; MCI mass-casualty incident; NEMSIS; NEMSIS National Emergency Medical Services Information System; NSAID nonsteroidal anti-inflammatory drug; SCT Specialty Care Transport; SNS Strategic National Stockpile; TAC Technical Assistance Center; mass-casualty incident; medications; prehospital