No IV, No Problem: a cross-sectional analysis of prehospital antiemetic therapy

Nausea is a frequent complaint in the emergency department as well as in the prehospital setting. Though CBEMS providers may often encounter nausea secondary to illness or intoxication, there may be limited options for antiemetic therapy at the BLS level. We performed a cross-sectional analysis of statewide prehospital nausea management protocols to examine the availability of antiemetic therapies within BLS and ALS scopes of practice. As suspected, prehospital nausea management varies widely with level of licensure and geographic location. Though many states have oral or injectable ondansetron available for ALS providers, few states allow BLS providers to administer ondansetron. Some states allow all providers to use alternative strategies including P6 acupressure or isopropyl alcohol aromatherapy. Recent clinical trials suggest that isopropyl alcohol aromatherapy may be more effective than intravenous ondansetron for subjective nausea relief. However, there has been low adoption of these alternative antiemetic therapies in EMS, especially at the BLS level. The majority of CBEMS agencies registered with NCEMSF are likely unable to provide antiemetic therapy when operating at the BLS level. Future research should examine the safety and feasibility of implementing new antiemetic therapies such as isopropyl alcohol aromatherapy at the BLS level.