title: Use of Out-of-Hospital Ethanol Administration to Improve Outcome in Mass Methanol Outbreaks.
abstract: Methanol poisoning outbreaks are a global public health issue, with delayed treatment causing poor outcomes. Out-of-hospital ethanol administration may improve outcome, but the difficulty of conducting research in outbreaks has meant that its effects have never been assessed. We study the effect of out-of-hospital ethanol in patients treated during a methanol outbreak in the Czech Republic between 2012 and 2014.
  
  
  
  This was an observational case-series study of 100 hospitalized patients with confirmed methanol poisoning. Out-of-hospital ethanol as a "first aid antidote" was administered by paramedic or medical staff before the confirmation of diagnosis to 30 patients; 70 patients did not receive out-of-hospital ethanol from the staff (12 patients self-administered ethanol shortly before presentation).
  
  
  
  The state of consciousness at first contact with paramedic or medical staff, delay to admission, and serum methanol concentration were similar among groups. The median serum ethanol level on admission in the patients with out-of-hospital administration by paramedic or medical staff was 84.3 mg/dL (interquartile range 32.7 to 129.5 mg/dL). No patients with positive serum ethanol level on admission died compared with 21 with negative serum ethanol level (0% versus 36.2%). Patients receiving out-of-hospital ethanol survived without visual and central nervous system sequelae more often than those not receiving it (90.5% versus 19.0%). A positive association was present between out-of-hospital ethanol administration by paramedic or medical staff, serum ethanol concentration on admission, and both total survival and survival without sequelae of poisoning.
  
  
  
  We found a positive association between out-of-hospital ethanol administration and improved clinical outcome. During mass methanol outbreaks, conscious adults with suspected poisoning should be considered for administration of out-of-hospital ethanol to reduce morbidity and mortality.
authors.affiliation: Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic. Electronic address: sergey.zakharov@vfn.cz.
authors.forename: Sergey
authors.initials: S
authors.lastname: Zakharov
authors.affiliation: Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic.
authors.forename: Daniela
authors.initials: D
authors.lastname: Pelclova
authors.affiliation: Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Urban
authors.affiliation: Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic; Department of Biomimetic Electrochemistry, J. Heyrovsky Institute of Physical Chemistry of the AS CR, Prague, Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Navratil
authors.affiliation: Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic.
authors.forename: Olga
authors.initials: O
authors.lastname: Nurieva
authors.affiliation: Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic.
authors.forename: Katerina
authors.initials: K
authors.lastname: Kotikova
authors.affiliation: Department of Ophthalmology, General University Hospital, Prague, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Diblik
authors.affiliation: Department of Toxicology and Forensic Medicine, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic.
authors.forename: Ivana
authors.initials: I
authors.lastname: Kurcova
authors.affiliation: Institute of Biophysics and Informatics, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic.
authors.forename: Jaromir
authors.initials: J
authors.lastname: Belacek
authors.affiliation: Institute of Biophysics and Informatics, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Komarc
authors.affiliation: Pharmacology, Toxicology, and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Eddleston
authors.affiliation: Norwegian CBRNe Center of Medicine, Department of Acute Medicine, Oslo University Hospital, Oslo, Norway.
authors.forename: Knut Erik
authors.initials: KE
authors.lastname: Hovda
mesh_terms: D000328:Adult; D018153:Czech Republic / Q000453:epidemiology; D004196:Disease Outbreaks; D000431:Ethanol / Q000097:blood / Q000627:therapeutic use*; D006801:Humans; D000432:Methanol / Q000506:poisoning*; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000431:Ethanol; D000432:Methanol