Airway & Respiratory, Columns, Patient Care

Prehospital Management of Asthma Exacerbations

Review of: Camargo C: “A model protocol for emergency medical services management of asthma exacerbations.” Prehospital Emergency Care. 10(4):418 429, 2006.

The Science
While this paper does not represent original research, it does address the issue of prehospital asthma management in a scientific manner. The abstract states, “Emergency medical services (EMS) is an important part of the continuum of asthma management. The magnitude of the EMS responsibility is very large, with millions of patients with asthma treated each year by EMS personnel. In response to inconsistencies between the 1997 National Asthma Education and Prevention Program asthma guidelines and a variety of existing EMS protocols on the management of asthma exacerbations, the Centers for Disease Control and Prevention convened a workgroup in 2004 to discuss the various opportunities and challenges ahead. At the meeting, and over the ensuing year, the workgroup created a model protocol that was derived from the National Asthma Education and Prevention Program guidelines.”

The author contends that by integrating these recommendations into existing protocols, EMS systems could improve prehospital care for patients with asthma.

The Street
This paper is especially timely when the issue of EMS scope of practice continues to be argued. It presents a logical prehospital protocol for the care of asthma that includes the use of inhaled bronchodilators. The use of nebulizers and metered dose inhalers has generally been a skill reserved for ALS providers. However, this paper proposes that it is appropriate for BLS providers be trained and equipped with them.

BLS providers are more likely to be the first on the scene or even the only rescuer for the entire prehospital encounter of the acute asthmatic. The delivery of inhaled bronchodilators is a safe and effective treatment and significantly improves patient outcomes. My experience is that it is clearly a BLS skill, and systems that have not adopted it merely need to read this paper to realize its awesome potential.