Gregory 1 Patrick Gregory Dale Powell English 1101 1 May 2012 Albuterol Sulfate: A New Tool for EMT-Bs

Asthma is a problem in America. In the year 2000, approximately 14 million adults and 6.3 million children were diagnosed with asthma (Bryson et al.). Asthma accounted for 1.8 million emergency department visits, 465,000 hospital admissions, and 4,487 deaths (Bryson et al.). Given this information, it is no surprise that asthma is a leading cause for ambulance response in the United States (Bryson et al.). Albuterol sulfate has long been a tool for paramedics and advanced emergency medical technicians (EMTs), but has universally withheld from the basic EMT level. Albuterol is a lifesaving medication that is used when a patient cannot breathe because their airway is inflamed. This simple to use life-saving medication needs to be added for standing order administration to the national practicum for basic EMTs set forth by the National Highway and Traffic Safety Association. Albuterol is a beta 2 selective bronchodilator that is indicated for shortness of breath secondary to bronchoconstriction that is often associated with asthma, chronic obstructive pulmonary disease (COPD) and other reactive airway diseases (Doyle 633-34) (Kee and Hayes 150-69). It mechanism of action relaxes smooth muscle in the airway that is constricted (Kee and Hayes 150-69). When these airway muscles relax, the airway dilates allowing more oxygen to pass to the lungs and allows the patients to breathe easier. It is administered in the prehospital setting using a small volume nebulizer and eight liters of oxygen per minute. The patient inhales the mist created by the nebulizer. The pre-hospital dosage is 2.5 milligrams of

Gregory 2 albuterol diluted in three milliliters of sterile water to yield a 0.083% solution. The contraindications for this drug are allergy to the drug itself as well as symptomatic tachycardia (rapid heart rate). Side effects reported may include palpitations (fast or irregular heartbeat), anxiety, headache, vertigo (dizziness sensation), and diaphoresis (sweating) (Kee and Hayes 15069). The primary 911-ambulance provider in New York City (FDNY) thought that basic life support (BLS) crews should be able to administer this life-saving medication. In 1999, they performed a pilot study where BLS units would be able to administer albuterol under certain conditions (Silverman et al.). These conditions were the patient had to be between the ages of 1 65 years of age, have a complaint of dyspnea (shortness of breath), and have a prior diagnosis of asthma (Silverman et al.). Also, a condition of this study was that a BLS unit was dispatched because an ALS unit was not available at the time of call (Silverman et al.). During the study period (January 1, 1999 January 1, 2000), there were about 46,966 calls for asthma related problems and 9,961 one of the calls were handled by BLS units (Silverman et al.). The study determined that BLS crews could effectively administer albuterol to acute asthma patients safely and effectively in the pre-hospital setting. A second study published in 2004 by Prehospital Emergency Care also looked at allowing BLS crews administer albuterol. It too was based on a one-year observation where basic EMTs administered inhaled beta agonists (albuterol) to acute asthma patients. The study, while on a smaller scale, was overwhelmingly conclusive. The study included 190 patients with ages ranging from one month to 92 years of age (Markenson et al.). Of the 190 patients studied, 41 were pediatric patients (age 18 and under) and 149 were adult patients (age 19 and older) (Markenson et al.). The study concluded that BLS providers could correctly identify

Gregory 3 bronchospasm in patients experiencing asthma 87.4% of the time and when included with the diagnosis of COPD, allergic reaction, and anaphylaxis the percentage of accurate assessment and treatment using albuterol soared over 94% (Markenson et al.). The marker for this was that the attending emergency department physician agreed with the transporting EMTs that the patient was indeed having difficulty in breathing related to bronchospasm (Markenson et al.). The skill of administering these nebulized treatments to patients is not new for BLS providers. Currently, they are trained in the skill per the national standard curriculum, but current limitations only allow them to assist patients administering their own medication (Limmer and O'Keefe 380-85). EMTs are also allowed to assist administering albuterol to patients in the form of a metered dosed inhaler (Limmer and O'Keefe 380-85). In summation, it is very clear that BLS providers in EMS are competent healthcare providers and are capable of administering this medication safely and effectively. Ninety-four percent of the time, basic EMTs recognized a patient having dyspnea related to bronchoconstriction and successfully treated the patient by administered this drug. Folks, BLS providers are the front-line to EMS. Not every ambulance can respond with an ALS crew and it is senseless to prohibit these knowledgeable personnel from performing a skill that a five year old can. Millions of people self-administer this medication with a nebulizer every day without any adverse effects. It is time that we allow the basic EMTs responding to them administer it to them as well.

Gregory 4 Works Cited Bryson, David, et al. A Model Protocol for Emergency Medical Services Management of Asthma Exacerbations. Prehospital Emergency Care 10.4: 418-429. ProQuest: Nursing & Allied Health/Dissertation Abstracts. Web. 22 Apr. 2012. Doyle, Rita M., ed. Nursing 2008 Drug Handbook. N.p.: Lippincott Williams & Wilkins, 2008. Print. Kee, Joyce LeFever, and Evelyn R. Hayes. Pharmacology: A Nursing Process Approach. 5th ed. St. Louis: Elsevier, 2006. Print. Limmer, Daniel, and Michael F. OKeefe. Emergency Care. 11th ed. Upper Saddle River: Pearson, 2009. Print. Markenson, David, et al. Albuterol Sulfate Administration by EMT-Basics: Results of a Demonstration Project. Prehospital Emergency Care 8.1: 34-40. ProQuest: Nursing & Allied Health/Dissertation Abstracts. Web. 22 Apr. 2012. Silverman, Robert, et al. Out-of-Hospital Administration of Albuterol for Asthma by Basic Life Support Providers. Academic Emergency Medicine 12.5: 396-403. ProQuest: Nursing & Allied Health/Dissertation Abstracts. Web. 22 Apr. 2012.