Out-of-hospital use of neuromuscular-blocking agents in the united states

Abstract

OBJECTIVE: A national survey was mailed to state EMS directors to assess the current status of use of neuromuscular-blocking agents (NMBAs) by EMS systems across the United States. METHODS: Initial and second mailings were completed in early 1996 and 1997, respectively. RESULTS: Replies were received from all 50 (100%) states following the second mailing. Twenty-nine (58%) states use NMBAs. Eleven (22%) of the 29 use paralytic drugs only in aeromedical programs. Of the 18 states that use NMBAs in ground-based EMS systems, 11 (22%) use paramedic ambulance staffing exclusively. Registered nurses (RNs) or RN-paramedic teams comprised the majority of the remaining states' staffing configurations. The first reported date of implementation of use of NMBAs was 1985, and there has been a steady trend of additional states launching paralytic drug use over the last 12 years. CONCLUSION: This trend suggests that use of paralytic drugs by paramedics is becoming standard of care in many out-of-hospital systems.