Prehospital treatment of acute asthma in a rural state

Background: Acute asthma exacerbations can be Life threatening and are recognizable to emergency medical service (EMS) personnel; however, the therapies and medications which these emergency service personnel can use to treat exacerbations are Limited. Several studies have demonstrated the effective use of beta(2)-agonist therapy in the treatment of patients complaining of wheezing or dyspnea, yet few EMS personnel can administer them. Objective: The purpose of this study was to determine what therapeutic interventions emergency personnel around the state of New Mexico could use when responding to a call for a severe asthma exacerbation. Methods: Questionnaires were distributed over a period of three years, 1992- 1994, to all Emergency Service Agencies in New Mexico. Results: Eighty percent of the emergency medical personnel administer oxygen to patients experiencing acute asthma exacerbations. Seventeen percent of EMS personnel administer epinephrine, 4% administer steroids, and only 23% administer beta, agonists. Only in more populated areas were EMS personnel allowed to administer beta, agonists, and those personnel had to have at least intermediate-level training. Most emergency response teams in the state consisted of EMT Basics and provided only basic Life support services. In rural New Mexico, transport to a hospital can often take over one hour, which left EMS crews feeling helpless. Conclusions: We conclude that due to the rural nature of New Mexico, EMS personnel should be trained in the use of beta, agonists and allowed to administer them to patients with acute asthma exacerbations. In addition, standard protocols for the pre-hospital management of acute asthma exacerbations should be instituted.