A prehospital protocol for geriatric agitation

Approximately 10% of geriatric patients (adults over the age of 65) transported via ambulance will have a mental status altered from baseline, otherwise known as delirium. Many of these patients will be agitated, posing a management challenge for EMS practitioners. Existing protocols for delirium in the pre-hospital setting were designed for younger adults, who have different etiologies and different levels of tolerance for medications than most older adults. ED-based protocols have already been created to aid in the treatment of patients with this condition. Yet, their applicability is limited, as many involve elaborate diagnostics not available in the prehospital environment. Furthermore, many protocols recommend using medications that are not recommended for older adults. Thus, we created an evidence-based protocol for the prehospital evaluation and treatment of agitated geriatric patients. Our protocol puts specific emphasis on safely avoiding unnecessary administration of and/or high dosages of psychotropic medications. We also emphasize practical management, including non-pharmacologic treatment of this condition in older adults.