Prehospital Antiemetic Therapy in Campus-Based EMS Services: A Cross-Sectional Analysis of Statewide EMS Protocols

Background: Nausea is a common chief complaint in the prehospital setting, and collegiate-based emergency medical services (CBEMS) providers frequently encounter nausea secondary to alcohol intoxication. Objectives: We hypothesized that high variability would be present in statewide protocols at all prehospital provider levels, limiting the use of these therapies in particular for CBEMS organizations operating at the BLS level. Methods: A cross-sectional analysis of publicly available statewide emergency medical services (EMS) protocols was completed in October 2018 and updated in August 2019 examining presence of antiemetic therapies at each provider level. The licensure levels of CBEMS organizations affiliated with the National Collegiate Emergency Medical Services Foundation (NCEMSF) within each state were obtained from the NCEMSF Organization Database. Results: We identified 33 publicly available model or mandatory statewide EMS protocols which contained an antiemetic protocol/therapy. Of these, five (15.2%) included antiemetic therapies at the basic life support (BLS) level. In addition, 256 NCEMSF-affiliated CBEMS agencies were identified, of which 162 operate at the BLS level. Eight BLS organizations (4.9%) operate in states with statewide protocols that include a BLS therapy for nausea. Conclusions: CBEMS agencies face wide variation in BLS-level nausea therapies depending on statewide protocols. Oral dissolving ondansetron remains largely restricted to the advanced life support (ALS) level. Further research should assess the effectiveness of these therapies in the BLS-level prehospital scope-ofpractice.