From Limited Use to Standard Practice: Retrospective Analysis of Droperidol Administration by Emergency Medical Services (2018–2023)

Objective: This retrospective observational study investigates the usage trends of droperidol (a dopamine receptor antagonist) by Emergency Medical Services (EMS) from 2018 to 2023, focusing on its evolving role in prehospital care. Methods: Using the ESO Solutions, Inc. (ESO) national dataset, we analyzed 56,232,761 EMS cases over six years, examining the rates of droperidol administration by EMS clinicians. We assessed systolic blood pressure (SBP) and heart rate abnormalities after administration, and usage across primary impressions, procedures, and airway interventions. The total database cases grew from 5,536,297 in 2018 to 13,957,073 in 2023, with participating agencies increasing from 1,234 to 3,068. Results: Our findings show an increase in droperidol administration, with doses rising from one in 2018 to 22,372 by 2023. The fraction of doses per million cases increased from 0.18 in 2018 to 1,603 in 2023. Droperidol usage grew from < 0.01% of cases in 2018 to 0.2% in 2023. Primary impressions most associated with droperidol use were Behavioral/Psychiatric (23.4%), Pain (16.1%), and Neurological (13.8%). Among procedures, 12-lead ECG (21.7%) and patient restraint (21.1%) were most frequent. For cases receiving ECGs, top impressions were Gastrointestinal (34.0%) and Neurological (26.0%), with common age ranges being 60– 69 (16.7%) and 50– 59 (16.6%). Within airway management, oxygen administration was used in 69.40% of cases, followed by ETCO2 capnography (16.1%). Post-administration, 77.3% of patients maintained normal SBP, while 10.2% experienced hypotension and 12.4% hypertension. Regarding heart rate, 69.7% exhibited normal rates, with bradycardia in 13.4% and tachycardia in 17.0%. Conclusion: Increasing droperidol utilization by EMS reflects growing adoption in clinical practice. This research highlights the need for ongoing emphasis on evidence-based practices in prehospital care, and advocating for enhanced training and protocol development. Limitations include potential underreporting and variability in protocol adherence, suggesting the need for further investigation into usage barriers and facilitators. Keywords: droperidol, emergency medical services, prehospital care, conscious sedation, agitation, EMS pharmacology