Jul 2, 2009 - county area surrounding Portland,. Oregon, using a set of regional EMS protocols. EMS services ... AMX Clackamas County. Clackamas Fire ...
Prehospital Emergency Care
ISSN: 1090-3127 (Print) 1545-0066 (Online) Journal homepage: http://www.tandfonline.com/loi/ipec20
Activated charcoal in the prehospital setting Jon Jui, Mohamud Daya, Terri Schmidt, Don Mcneill & Robert Norton To cite this article: Jon Jui, Mohamud Daya, Terri Schmidt, Don Mcneill & Robert Norton (1997) Activated charcoal in the prehospital setting, Prehospital Emergency Care, 1:4, 296-296 To link to this article: http://dx.doi.org/10.1080/10903129708958828
Published online: 02 Jul 2009.
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Date: 29 January 2016, At: 00:08
ACTIVATED CHARCOAL IN THE
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PREHOSPITAL SETTING To the Editor:-We read with interest the investigation by Allison et al. titled "Potential Time Savings by Prehospital Administration of Activated Charcoal."' We provide physician supervision in a threecounty area surrounding Portland, Oregon, using a set of regional EMS protocols. EMS services are provided to an urban, suburban, rural, and frontier mix. Since 1991, the Portland metropolitan area EMS providers have administered activated charcoal (AC) in the prehospita1 care setting2 Patients who have ingested a compound within six hours, who are conscious and alert, and who have not ingested a substance that is likely to cause a rapid change in mental status (e.g., a tricyclic antidepressant) are candidates for this intervention. On-line medical control (OLMC)is required prior to the administration2 From August 4,1995, to April 10, 1997, administration of charcoal in the prehospital setting was requested in 51 cases within the Portland area. In 50 of the 51 cases, the primary reason for contact was classified as a primary poisoning/overdose. The remaining case was a combination poisoning/overdose and trauma. Thirtythree of 50 patients were female, with a mean age of 26 years (range = 2-90 years). The OLMC physician approved of the use of charcoal in 30 of 51 cases. The mean estimated EMS transport time from contact to arrival at hospital was
16.5 minutes (range 1 4 0 minutes). No adverse reactions were reported in this small series or in our previously reported study.2 Previous authors have documented a significant delay in time from ED arrival to administration of charcoal following EMS transp~rt.~ Crockett , ~ , ~ et al. noted an EMS AC administration mean time of 5 minutes, compared with a mean time of 51.4 minutes with ED AC administration? These data are similar to those of Allison et al., who reported an ED AC administration mean time of 48 minutes.' Wolsey et al. found that the median interval from presentation to gastrointestinal decontamination (charcoal and/or gastric lavage) was 55 minute^.^ It is therefore clear that early administration of AC by EMS personnel significantly shortens the time to administration of AC. Although our data are limited, we feel that in select circumstances, AC is a valuable intervention, especially in the setting of long transport times. However, issues that remain to be addressed include the effectiveness of AC (does it result in less morbidity or morality?), patient compliance (are patients actually willing to take the AC?), timing (how long after an ingestion should AC be given?), need for OLMC contact, and the potential for adverse effects, especially vomiting. We have also noted significant variation among the OLMC physicians in approving the use of charcoal by EMS personnel.2 MD, MPH EMS Medical Director
JON JUI,
Multnomah County Portland, Oregon MOHAMUD DAYA, MD EMS Medical Director Tualatin Valley Fire and Rescue Aloha, Oregon TERRI SCHMIDT, MD Chair, TriCounty Treatment Protocol Committee EMS Medical Director A M X Clackamas County Clackamas Fire District Number One Oak Lodge Fire Milwaukie, Oregon DONMCNEILL, MD Medical Director Postgraduate Paramedic Education Oregon Health Sciences University Portland, Oregon ROBERT NORTON, MD Medical Director Medical Resource Hospital Oregon Health Sciences University Portland, Oregon
References Allison TB, Gough JE, Brown LH, et al. Potential time savings by prehospital administration of activated charcoal. Prehosp Emerg Care. 1997;1:73-5. Norton RL, Milne SF. Use of on-line medical control for toxic exposures. J Toxicol Clin Toxicol. 1995;33545-6. Crockett R, Krishel SJ, Manoguerra A, et al. Prehospital use of activated charcoal: a pilot study. J Emerg Med. 1996; 141335-8. Wolsey BA, McKinney PE. Does transport by ambulance decrease time to gastrointestinal decontamination after overdose? [abstract]. Acad Emerg Med. 1997;4:455.
