EMS Protocol of the Week - Excited Delirium (Adult and Pediatric)

Ever wonder why the occasional crew would look to give a whopping 10mg IM midazolam to the curmudgeonly, 50-pound grandma?

Historically, the only protocol that has allowed for sedative medications to be given to facilitate transport has been that for excited delirium, which by definition is supposed to be the hypermetabolic state in which the patient that is presenting an acute risk to self or others; there has not been a protocol for the simply agitated, uncooperative patient. That is still the case now, but in instances of dangerously aggressive geriatrics and pediatrics, there is now a greater shift to weight-base dosing when administering these meds. This has been an overarching change to many of the updated protocols this year, and it means that while the young, large, violent adult may still get the appropriate 10mg IM midazolam by Standing Order, the old, tiny, violent nana might only get 5mg, or less. Time will tell, but hopefully this leads to fewer instances of oversedation, without a large increase in OLMC calls requesting additional meds.

Happy sedating! www.nycremsco.org and the protocol binder for more.

Dave