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Urgent and emergency care

Australian paramedics first to use droperidol to safely calm violent patients on drugs and alcohol

Paramedics in Australia have become the first to use new antidopaminergic drug droperidol to quickly and safely calm patients who have become violent under the influence of alcohol and drugs.

With backing from the Emergency Medicine Foundation, which funds multidisciplinary emergency medicine research in Australia, the Queensland Ambulance Service (QAS) conducted the world’s first comparison of the standard sedative, midazolam, with droperidol in a prehospital setting. 

The researchers, who published their findings in Prehospital Emergency Care[1], (online, 20 March 2018), found that fewer adverse events occurred in patients treated with droperidol (7%) compared with those who received midazolam (23%).

In addition, the median time to sedation for droperidol was 22 minutes, 8 minutes faster than the median time to sedation for midazolam.

The team also found that additional sedation was required in just 4% of droperidol patients compared with 14% of midazolam patients.

“Midazolam is the accepted standard internationally, but it can have significant side effects so there’s been a huge gap in paramedics’ ability to safely sedate violent patients,” said Lachlan Parker, executive manager of clinical policy development at the QAS.

“Our paramedics and emergency department staff welcome the impact droperidol is having and there are some amazing stories of how it quickly it works to calm really aggressive and violent patients.”

According to the QAS, since the data was published, they have received requests for further information from ambulance services in the UK.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2018.20204804

Readers' comments (1)

  • Queensland is hardly the first.
    David Taylor et al compared droperidol, olanzapine and droperidol with midazolam published in 2017
    Ibitser et al published an RCT of droperidol vs midazolam in 2010
    NSW updated their acute sedation guidelines for ED in 2015 to use droperidol first line ahead of midazolam
    In the prehospital setting, Rosen et al published an RCT on IV droperidol in 1997 and Hick et al ran a pilot with IM droperidol in 2001

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