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

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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?

for a person choosing to be out of control, a Taser can be very theraputic.

Remember ACLS principles: Stable pts get drugs, unstable pt's get electricity.

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for a person choosing to be out of control, a Taser can be very theraputic.

Remember ACLS principles: Stable pts get drugs, unstable pt's get electricity.

lol love it

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Specializes in ER, Prehospital, Flight.

In theory, giving Ativan or Valium could be given to an unruly pt, however, not for the scenario given. Perhaps a prolonged scene time or something outside the norm. I can't think of a scenario where there aren't better routes or "creative behavior modification" (well stated, by the way) which would be more appropriate. I would be in contact with medical control before administering the meds for that reason.

Haldol is within the protocol for flights, but not ground crews that I know of or the one I work for. Scene and transport time being big factors with ground times being typically much shorter and the meds would not take effect before the pt is handed off.

Short answer, in theory, could happen. Not likely, and better options probably available. Too many "what ifs" as already posted that would need ruled out first.

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Specializes in Emergency Department.

EMT cannot give Haldol. The only medications EMT-B are allowed to administer or assist with are oxygen, nitro, epi-pen, albuterol inhaler, activated charcoal, and oral glucose. I am not sure if paramedics carry haldol. I have never seen them actually administer it in the field before. Paramedics have medical control they can call for advice and permission to give certain drugs not in their normal standing orders. They don't need to call for things such as giving epi or lidocaine in a code. Where I am paramedics can do RSI. By the way the ACLS comment on unstable patients getting electricity is hilarious.

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Specializes in Vascular Neurology and Neurocritical Care.
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.

True, combativeness does not necessarily equal psychosis, but Haldol can be given to control behavioral disturbances in individuals that are not necessarily psychotic. Haldol and other antipsychotics are frequently used in dementia/Alzheimer's patients in order to reduce the behavioral disturbances/socially inappropriate behavior that stems from the disease process. That being said, I agree that Ativan or another benzo would definitely 95% of the time be more appropriate for sedation/"calming" purposes that Haldol.

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Specializes in Adult and Pediatric Vascular Access, Paramedic.
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.

Better do your research before you answer questions that you are lacking knowledge on!

In my state (in the northeast) we CAN give up to 10 mg of IM Haldol as well as Ativan PREHOSPITAL WITHOUT medical control for out of control patients!! (at the paramedic level only of course).

Haldol can work in as little as 10 minutes, it takes 30-60 minutes for it to reach its PEAK PLASMA CONCENTRATIONS.

It is very benifical prehospital as it can be dangerous trying to tackle a patient for lack of a better term while they are out of control trying to hit, punch, kick, and spit on you while your trying to extricate them, and your trying to keep them secured to a stretcher in a moving ambulance which is of course a very confined space!

You are forgetting too that not every place has a 5 minute transport time to the hospital. You are also forgetting on scene time usually around 10 minutes or more, especially for someone out of control.

So yes Haldol does have a benefit for pre hospital providers and our safety and that of the patients!!

I read that some people's argument is that it is chancy not knowing what is going on with the patient, but I am quite comfortable with my assessment skills and will use the Haldol for presumed non medical related psychotic type behavor, otherwise I stick with Ativan. Having worked as paramedic for the past several years and as an ER RN I know that the ER is just going to do the same on arrival, after all its impossible to do an appropriate assessent on a wild patient!! Around here our ERs appreciate when give the Haldol or Ativan for them!

Of course I always attempt to use verbal communication first to try and calm the patient down prior to turning to chemical restraint!

Happy

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To clarify this topic, every state has their own protocols, and some jurisdictions get approval for extra or pilot programs, so meds, skills, interventions vary. Also there is a difference of levels of prehospital providers. Here in Maryland the highest is EMT-Paramedics, which can do a wide array of interventions and carry alot of meds. They have really upped the anty here lately with their knowledge and skill, it is impressive.

I have been an EMT-Basic (low level, think BLS) provider for the last 10 years. I would love to see the gap between nurses and EMT's be closed. Before I was a nurse, I ran 911 and commercial transport. On several occasions I was called while on a BLS unit to transfer very inappropriate pts including s/p codes, active MI's etc. The staff had no clue what to ask for when calling our dispatch, which resulted in increased wait times for pt's to get to a higher level of care because they had to wait on a paramedic unit to get there. If you need to call for ground transport for interfacility transport, the best thing you can do is relay the big facts to the dispatcher, he/she will know what is needed.

In Maryland, they currently are doing a pilot program for RSI for Paramedics only, and also can give Haldol for violent pt's and severe n/v with medical consult. To sum it up, basically there are alot of standing order protocols, also they operate with a wide array of protocols that require a med consult with the receiving facility to carry out. It is not cut and dry throughout the states or jurisdictions for that matter.

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Specializes in ED, Neuro, Management, Clinical Educator.

Prehospital providers don't give sedatives in this area either. I presume this is so we don't get a bunch of sleeping patients brought in to us with nothing going on for us to assess, and probably because of the risk of respiratory depression induced by the drugs.

I will say, though, that I've seen my fair share of loud obnoxious jerks get RSI'd immediately upon arrival to the ED. The really unruly ones that we can't get an IV into have been RSI'd through an IO...

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Wow, I'm truly shocked at the EMS services in some areas. Paramedics absolutely can give Haldol prehospital, heck we even have Droperidol on the ambulance. We can also give Ativan or Versed to sedate combative patients. All without consultation with an MD.

I will second another posters comment; if you have a patient who is combative from a head bleed, how are you supposed to know he has a head bleed if he keeps fighting you? Furthermore, benzos are potentiated by alcohol, so anti-psychotics are the drug of choice in combative drunks.

Paramedics can give a wide variety of drugs and preform a wide variety of procedures depending on local protocol. Unfortunately most paramedics lack the appropriate education for said medications and procedures and in my experience most paramedics get vary nervous around chemical sedation so it might not be a common site in your ER.

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Specializes in CCT.

I'm a medic, not a nurse.

Our service has standing orders for IV or IM lorazepam or IV/IM/IN midazolam for agitated patients. In addition we are able to treat pain as a "possible cause of agitation" and as such have standing orders for fentanyl IV/IM/IN, which can be administered with the benzos. Finally, we can RSI suspected conditions that will lead to decreased LOC (head injuries, stroke, ect) or to reduce massively increased metabolisim (certain drug ODs). Typical RSI sequence is fentanyl, etomidate and roccuronium, followed by fentanyl and a benzo for ongoing sedation/pain management. There's a couple of different sequences with some discretion in the meds based on assessment.

For those who are concerned about "not knowing what's going on". People generally don't make their medical condition better by being combative. The head injury is doing nothing good for his ICP and hypoxia. The meth/crack/PCP overdose is not helping out his base metabolic rate (and the resultant tissue hypoxia) by trying to kick your rear end into next week. The alcohol OD isn't helping out his airway. If we sedate these patients into airway compromise (unlikely) we have the tools, from a jaw thrust and suction all the way up to plastic between the vocal cords, to deal with this. Yes a sedated patient may slow down hospital course, but it will be certainly less slowed down than wrestling my patient to the hospital, stopping in the ED and waiting for a doc to provide orders for sedation and/or intubation, then gathering the staff/equipment/meds and performing said intervention prior to being able to perform any diagnotstics.

EMS education is dismal in places, and I do believe a lot of interventions need to be reevaluated. However pain management and sedation are not among those, and if anything need to be increased.

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My old service was really at the forefront of proactive treatment of all patients, back many years ago. Our protocols allowed for lots of thinking on the fly for treatment.

We utilized RSI in the field as early as 1996. In addition, we pushed hard for the hypothermia protocol for post-cardiac arrest resuscitation through the use of iced saline to lower the core temp.

Paramedics come with vast amounts of critical knowledge, and while it may not be in the realm of rehab, dialysis, or wound/ostomy care, we are quite adept at what we do. We (RNs and Paramedics) would learn a lot from one another.

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Paramedics come with vast amounts of critical knowledge, and while it may not be in the realm of rehab, dialysis, or wound/ostomy care, we are quite adept at what we do. We (RNs and Paramedics) would learn a lot from one another.

The Paramedic training does not contain much critical care training as far as medications and equipment. There is not even enough A&P to build for a good foundation for critical care knowledge at the appropriate level in the majority of programs in the US. Their rotations in the critical care world during their clinicals is slim to nil in some places. Even the pathetic CCEMT-P course is barely a good overview and no company should ever believe a Paramedic is capable of doing critical care transport right after that course. But, unfortunately many do. The sooner you realize the limitations of the Paramedic the sooner they can get around to seeing they need to advance their education. Paramedics in other countries have the equivalent of a Bachelors degree and then go on for post grad work to do critical care transport.

For the original question, an EMT can not administer meds such as haldol.

Some Paramedics can but it also comes down to their intent. If it is for abuse or amusement or for lack of understanding of certain medical conditions which has come into controversy in recert times with the "dart" treatment, that is an entirely different situation. If it is for controlling a patient who requires medical treatment, with the appropriate documentation, great.

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