New drug tames violent patients

Queensland paramedics have identified a significantly faster and safer method of sedating violent patients, and it is attracting interest from other countries.

Following a study, Queensland paramedics have introduced a new drug, droperidol, to quickly and safely calm violent patients fuelled by alcohol and drugs.

With backing from the Emergency Medicine Foundation (EMF) Australasia, the Queensland Ambulance Service (QAS) compared the standard sedative, midazolam, with droperidol in a prehospital setting. QAS found droperidol sedated patients nearly 70% faster, was three times safer and significantly fewer patients needed additional sedation either in the ambulance or once in hospital in comparison to midazolam.

Within a week of the data being published, QAS had received requests for further information from ambulance services in the United Kingdom and New Zealand, according to QAS Executive Manager Clinical Policy Development Lachlan Parker ASM.

“Midazolam is the accepted standard internationally, but it can have significant side effects so there’s been a huge gap in paramedics’ ability to safely sedate violent patients,” said Parker.

“Our paramedics and emergency department staff welcome the impact droperidol is having and there are some amazing stories of how quickly it works to calm really aggressive and violent patients.

“It’s also simple to administer, there are much fewer side effects, it rarely over-sedates and patients wake up much nicer. We’re so happy to finally have a safe drug to use.”

Study-led outcomes

Parker championed the uptake of droperidol based on research involving Princess Alexandra Hospital emergency physician and clinical toxicologist Dr Colin Page, who led the evaluation of the QAS droperidol rollout.

Dr Page said the real value of this latest research was in confirming that droperidol was safer and more effective in the prehospital setting, which mirrored previous results in the emergency department environment.

“The days of repeated doses of midazolam being given by paramedics are over, it just takes too long to sedate patients using this drug and it is more dangerous,” he said.

“We’re now pushing for paramedics and clinicians to administer the droperidol intramuscularly — there is no need for people to use it intravenously — and to stop mixing different sedatives.

“Based on our extensive research, the standard protocol for violent patients should be 10 mg droperidol (65 to 75% effective) followed by a second dose of 10 mg (which is 95% effective) and then ketamine.”

Positive impact

Queensland Minister for Health and Ambulance Services Steven Miles said research projects just like this pave the way for positive change across the healthcare system.

“Sadly, there are thousands of incidents each year where frontline healthcare workers are subject to violent outbursts, mostly as a result of alcohol and drug abuse,” he said.

“It’s fantastic to see Queensland research making a positive impact in protecting our first responders and emergency department clinicians. Projects like this highlight the importance of investing in medical research and finding new, more effective and more efficient ways of providing vital health services to Queenslanders.”

The QAS introduced droperidol in 2016 as one of several initiatives to reduce the escalating violence against paramedics, mostly by drunken patients.

The QAS research comparing droperidol with midazolam is available in the 2018 March edition of the Journal of Prehospital Emergency Care.

Image credit: ©stock.adobe.com/au/Bacho Foto