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 beta₂-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, 19921994, 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 beta₂ agonists. Only in more populated areas were EMS personnel allowed to administer beta₂ 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 beta₂ 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.