Can paramedic or EMT administer an IM med like Haldol or Ativan to help unruly pt?

[~Transplant Nurse~]

So we're watching "Cops" and the episode showed a belligerent person being sat on the back of an ambulance or treatment of a cut on her face. She was kicking and screaming, so the police officer threatened to tase her. We were wondering, once someone is placed in the ambulance, can the paramedic or EMT administer an IM med like Haldol or Ativan to help control their behavior? I'm guessing so, but my husband doesn't think so. Anybody in emergency medicine know?

[loriangel14, RN]

I'm not in ER medicine but I'm thinking wouldn't be able to administer it without an order from an MD.

[LegzRN]

Was she drunk? Because haldol is a no no in acute intoxication, although I've seen it given to drunk people and work. And unless they had a standing protocol, they'd have to call med command.

[~Transplant Nurse~]

She was drunk- Thanks for the tip. Im not sure how paramedics carry out orders- protocols or verbals?

[micuRNEMTP]

Short answer: EMTs and Paramedics work on standing orders/protocols set by a Medical Director or MedControl.

Long Story:Totally dependent on employer and Medical Director.

My former employer did not allow for use of medication in this aspect, due to the nature of not "knowing/getting" the whole picture. Why is this patient out of control? Head injury? CVA? DKA? Hepatic Encephalopathy? Exposure to various toxins or drugs?

Last: Having worked for 3 different EMS companies over the years, I can say that none of those 3 carried Haldol. Nor did any of them have an order for using Ativan to "calm" down a patient. But succinylcholine goes a long way towards making those violent patients a lot more compliant...

Easy, it's just a joke...

[micuRNEMTP]

And yes Paramedics can administer IM meds. Its all up to the Medical Control/Director.

[LegzRN]

Short answer: EMTs and Paramedics work on standing orders/protocols set by a Medical Director or MedControl.

Long Story:Totally dependent on employer and Medical Director.

My former employer did not allow for use of medication in this aspect, due to the nature of not "knowing/getting" the whole picture. Why is this patient out of control? Head injury? CVA? DKA? Hepatic Encephalopathy? Exposure to various toxins or drugs?

Last: Having worked for 3 different EMS companies over the years, I can say that none of those 3 carried Haldol. Nor did any of them have an order for using Ativan to "calm" down a patient. But succinylcholine goes a long way towards making those violent patients a lot more compliant...

Easy, it's just a joke...

Haha, a little therapeutic intubation? Just wondering, do trucks run with succ? Do you do RSI?

I have had patients arrive via EMS post versed administration to calm them down.

[Altra, BSN, RN]

If she was sitting in the back of an open ambulance ... there are places where medics provide treatment such as minor suturing in the field, without having to take the patient to an ER, prior to their trip to jail.

Haldol given pre-hospital? No -- the onset of action is too long to be of any pre-hospital value. Haldol is an anti-psychotic. Combativeness does not necessarily equal psychosis.

[Altra, BSN, RN]

Just wondering, do trucks run with succ? Do you do RSI?

I have had patients arrive via EMS post versed administration to calm them down.

Do you work in an ER? And if so ... do you not see patients arrive via EMS having been intubated??

[LegzRN]

I have never once received a patient intubated via rapid sequence induction from the field.

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

I've never seen an EMS drug box that included Haldol. Sometimes Versed or Etomidate, but essentially it's ACLS drugs, and sometimes morphine is given for pain. Combative pts in the back of an ambulance are to be avoided. Creative behavior modification is common, such as police siamese friendship bracelets, or apply the stretcher straps with the patient face down on the stretcher, among other methods absolutely not approved, but survival comes first.

[rn/writer, RN]

EMTs couldn't give any behavioral meds when I was still running. Not sure about paramedics. But as others have said, it can be dicey, at best, to medicate someone who is belligerent without knowing what they have already taken and what precipitated the call.

Is this someone with a head bonk from an MVA who is combative from their injury? Has this person already taken street drugs. Are they intoxicated? Have they been exposed to noxious fumes or CO? Or any combination thereof? EMS folks don't want to mask injuries or consciousness problems and they don't want to make drug or alcohol impairment worse.

I know medics who laid paper pillowcases loosely over the faces of spitters who were in spider straps. Another one held his crooked elbow an inch away from a guy's Adam's apple when he kept wiggling out of a CID strap and banging his head on the back of the long board. As long as the guy kept lying flat there was no problem.

It's a tough call when someone is totally out of control. We would sometimes have a cop ride in back with us, but that could get the patient more riled up. A lot of times the cops would follow us in the squad and we would threaten to pull over if the patient didn't settle down. Only had to do that a couple of times. Usually, they would throttle back to avoid seeing the cops, who didn't speak to them nearly as nicely as we did.