A new drug developed in Australia by Queensland Ambulance Service (QAS) can effectively calm down violent patients. The drug is droperidol and was found to sedate patients nearly 70% faster than other sedative methods such as midazolam. Droperidol was also found to be three times more effective than midazolam. According to QAS Executive Manager of Clinical Policy Development, Lachlan Parker, roughly a week after the data on droperidol was published, requests for the drug were needed in many ambulance services in the United Kingdom and New Zealand.
"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," explains Mr Parker, "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. It's also simple to administer, there are much fewer side-effects, it rarely over-sedates and patients wake up much nicer. We're so happy to finally have a safe drug to use. And because we've also collated data on comparing droperidol with midazolam outside the hospital setting, we've produced one of the true practice-changing pieces of research. We can now demonstrate to other paramedics just how effective the drug is for us. I believe we'll see droperidol embedded extensively in ambulance services around the world."
Steven Miles, the Queensland Minister for Health and Ambulance Services, explains that the discovery of droperidol, is a project that carves a positive path across international healthcare systems. "Sadly, there are thousands of incidents each year where frontline healthcare workers are subject to violent outbursts, mostly as a result of alcohol and drug abuse," he said. "It's fantastic to see Queensland research making a positive impact in protecting our first responders and emergency department clinicians. Projects like this highlight the importance of investing in medical research and finding new, more effective and more efficient ways of providing vital health services to Queenslanders." Droperidol was introduced by QAS in 2016 as one of the several initiatives to decrease the escalating violence against health care workers from violent patients, these patients were often intoxicated. Mr. Parker advocated the use of droperidol based on research that included Princess Alexandra Hospital emergency physician and clinical toxicologist, Dr. Colin Page, who also evaluated droperidol.
Dr. Page’s research confirms that droperidol was more safe and effective in a pre-hospital setting that mimics an emergency medicine environment. "The days of repeated doses of midazolam being given by paramedics are over, it just takes too long to sedate patients using this drug and it is more dangerous," explains Dr. Page. "We're now pushing for paramedics and clinicians to administer the droperidol intramuscularly - there is no need for people to use it intravenously - and to stop mixing different sedatives.
"Based on our extensive research, the standard protocol for violent patients should be 10 mg droperidol (65 to 75% effective) followed by a second dose of 10 mg (which is 95% effective) and then ketamine."
Sources: Emergency Medicine Foundation (Australia), Journal of Prehospital Emergency Care
