EMS

Kay Vonderschmidt

EMS IM midazolam usage

• Before RAMPART did your EMS agencies use midazolam?A. No use of midazolam

B. IV use only

C. IM use (per medical director)

D. Other (IN?)

Midazolam other

• Does your EMS system use midazolam via:a. Intranasal?

b. Intrabuccal?

c. None of the above

d. All of the above

Midazolam dosages

• If your EMS system uses midazolam, what is the dosage prior to RAMPARTa. IV/IO/IM 2mg dosages repeatable – up to

8mg or more

b. IV/IO/IM 5mg dosage repeatable up to 10mg

c. IV/IO/IM other

d. IN other

Other benzo’s

• Does your EMS system use other benzo’s for seizures?a. Yes

b. No

Discussion • How quickly did the seizure stop vs.

transport time?– Does transport time factor positively in the

seizure being stopped and remain stopped prior to arrival at ED?• What was the average transport time for the

study? (Termination of sz was 3.3 min for IM)• Did transport time factor into repeat doses?• How many people stopped sz in field but sz again

in ED vs. their transport time?

Discussion• Post RAMPART what should we

recommend when it comes to IM administration?– EMS IM usage? (no autoinjectors yet- needs

FDA approval)– EMS IM doses

• What dose, repeat doses, etc• Adult vs. pedi dosages

Discussion

• Alternative therapy?– Midazolam IN and/or intrabuccal?

Alternative medications?

diazepam?

lorazepam?

Discussions

• Are we concerned about an increase in field intubations with the use of midazolam?– Have there been any other studies using

benzo’s in the field that includes EMS intubations to compare to?

Discussion

• How do we present the findings effectively so that a change in practice will occur?– Conferences– Addition to books (AMLS, etc)– White paper– Other ideas

Questions