The Journal of Emergency Medicine, Vol 15, No I. pp 13- 17, 1997 Copyright 0 1997 Elsevier Science Inc. Printed in the USA. All rights reserved 07%46'9lW $17.00 d. .oo ELSEVIER PI1 SO736-4679( %)00259-4 THE EFFICACY OF tNTFlAWENOlJS DIpomRIw)L IN THE PREHOSPITAL SETTING Carlo L. Rosen, MD,* Alan F. Ratliff, EMT-P,t Richard E. Wolfe, MD,* Scott W. Branney, MD,$ E. Jedd Roe, MD,* and Peter T. Pons, MD+ *The Department of Emergency Medicine, Massachusetts General Hospital and The Division of Emergency Meddne, Harvard Medical School, Boston, Massachusetts, TParamedic Division, Denver General Hospital, Denver, Colorado, +The Denver Health and Hospitals Residency in Emergency Medicine, Denver, Colorado Reprint Address: Carlo L. Rosen, MD, Emergency Medicine Residency Office, Clinics 115, Massachusetts General Hospital, 32 Fruit Street, Boston, MA 02114 0 Abstract-Droperidol is used for sedating combative patients in the emergency department (ED). We performed a randomized, prospective, double-blind study to evahmte the efficacy of droperidol in the management of combative patients in the prehospital setting. Forty-six patients intra- venously received tbe contents of ~-CCvials of saline or droperidol (5 mg). Paramedics used a 5-point scale to quantify agitation levels prior to and 5 and 10 min after . . adrnuurscration of the viaIs. Twenty-three patients received droperldol and 23 received sake. At 5 min, patients in the droperidol group were sigMcantly less agitated than were patients in the sahe group. At 10 min, this difference was t.Elevenpatientsinthesakgroup(48%) required more sedation after arrival in the ED versus 3 patients (13%) in the droperidol group. We conclude that droperidol is effective in sedating combative patients in the prehospital se&g. Copyright 0 1997 Elsevier Science Inc. 0 Keywords-droperidol; prehospital; sedation; combat- ive: intravenous INTRODUCTION Combative patients in the field put themselves and the paramedics at risk for physical harm. Historically, physi- Presented at The Society for Academic Emergency Medicine Meeting, SanAntonio, May 1995. cal restraints have been used to control these patients. Chemical restraint is now felt to be more humane and safer for controlling combative patients ( 1) in the emer- gency department (ED) and is safe and effective for acute sedation(2-4). Agents that are presently used for sedation in the ED include benzodiazepines and neuro- leptics. The use of benzodiazepinesin the prehospital setting is not well studied and may be limited by adverse effects that may include respiratory depression, hypoten- sion, and paradoxical worsening of agitation (5-7 ) . Droperidol, a butyrophenone, has been used in the ED and by some prehospital systems(3 ) . Droperidol has a greater sedative effect and causesfewer acute dystonic reactionsthan do other butyrophenones, such ashaloperi- do1(5,8). To date, there are no studiesdemonstratingits efficacy in the prehospital setting. We conducted a prospective, randomized, double- blind trial to evaluate the efficacy of droperidol in control- ling combative patients in the prehospital setting. MATERIALS AND METJXBDS After Institutional Review Board approval, the study was conducted from September1994 through October 1995 in a metropolitan-hospital-based 911 paramedic system with more than 5 1,000patient encounters each year. Pa- - RECEIVED: 17 January 1996; FINALSUBMISSIONRECEIVED: 21 May 1996; ACCEPTED: 11 June 1996 13