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The Safety, Efficacy, and Expediency of Albuterol Nebulizer Administration by BLS Providers

Published online by Cambridge University Press:  01 March 2023

Patrick J. Matthews ,
Douglas R. Ader ,
Cecelia K. Harrison ,
Paige J. Ostahowski  and
Jason T. Nomura
Patrick J. Matthews*
Affiliation:
Christiana Care Health System, Newark, Delaware USA Delaware Office of Emergency Medical Services, Smyrna, Delaware USA
Douglas R. Ader
Affiliation:
Christiana Care Health System, Newark, Delaware USA
Cecelia K. Harrison
Affiliation:
Christiana Care Health System, Newark, Delaware USA
Paige J. Ostahowski
Affiliation:
Christiana Care Health System, Newark, Delaware USA
Jason T. Nomura
Affiliation:
Christiana Care Health System, Newark, Delaware USA
*
Correspondence: Patrick Matthews, MD Department of Emergency Medicine Christiana Care Hospital, Christiana Care Health System 4755 Ogletown-Stanton Road Newark, Delaware 19718 USA E-mail: patrickmatthews7@gmail.com
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Abstract

Introduction:

Many Emergency Medical Service (EMS) systems in the United States restrict albuterol therapy by scope of practice to Advanced Life Support (ALS). The State of Delaware has a two-tiered EMS system in which Basic Life Support (BLS) arrives on scene prior to ALS in the majority of respiratory distress calls.

Study Objective:

This study sought to evaluate the safety, efficacy, and expedience of albuterol administration by BLS compared to ALS.

Methods:

This retrospective observational study used data collected from July 2015 through January 2017 throughout a State BLS albuterol pilot program. Pilot BLS agencies participated in a training session on the indications and administration of albuterol, and were then authorized to carry and administer nebulized albuterol. Heart rate (HR), respiratory rate (RR), and pulse oximetry (spO2) were obtained before and after albuterol administration by BLS and ALS. The times from BLS arrival to the administration of albuterol by pilot BLS agencies versus ALS were compared. Study encounters required both BLS and ALS response. Data were analyzed using chi-square and t-test as appropriate.

Results:

Three hundred eighty-eight (388) incidents were reviewed. One hundred eighty-five (185) patients received albuterol by BLS pilot agencies and 203 patients received albuterol by ALS. Of note, the population treated by ALS was significantly older than the population treated by BLS (61.9 versus 51.6 years; P <.001). A comparison of BLS arrival time to albuterol administration time showed significantly shorter times in the BLS pilot group compared to the ALS group (3.50 minutes versus 8.00 minutes, respectively; P <.001). After albuterol administration, BLS pilot patients showed improvements in HR (P <.01), RR (P <.01), and spO2 (P <.01). Alternately, ALS treatment patients showed improvement in spO2 (P <.01) but not RR (P = .17) or HR (P = 1.00). Review by ALS or hospital staff showed albuterol was indicated in 179 of 185 BLS patients and administered correctly in 100% of these patients.

Conclusion:

Patients both received albuterol significantly sooner and showed superior improvements in vital signs when treated by BLS agencies carrying albuterol rather than by BLS agencies who required ALS arrival for albuterol. Two-tiered EMS systems should consider allowing BLS to carry and administer albuterol for safe, effective, and expedient treatment of respiratory distress patients amenable to albuterol therapy.

Keywords

albuterolBasic Life SupportdyspneaEmergency Medical Services
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 38 , Issue 2 , April 2023 , pp. 149 - 152
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Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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