BLS Meds – Zofran ODT

I believe there are several medications that BLS could give patients with very little risk and much gain to patient care (if they were allowed to by their states and/or their service’s medical directors). I do not subscribe to the notion that only paramedics should be able to give medicine. In my state – Connecticut – BLS can give ASA and epinephrine in the form of an epi-pen, but only with the approval of their service’s medical director. When I was first an EMT in Connecticut, we could not even have given these two medications. BLS is also allowed to assist a patient with their own nitro or breathing inhaler.

If there is one medication I would give to BLS services aside from the epi-pen, it would be Zofran (Ondansetron) ODT. Zofran is not life-saving like the epi-pen, but it can significantly ease a patient’s comfort. As EMS struggles to define itself and prove its worth, the one area that we can do well in if we focus on it is comfort care. Nausea and vomiting is one of the most common patient presentations, and one of its most unpleasant. And it is something we can if not fix, than at least moderate with a simple dissolvable pill.

While it has not been studied at the BLS level, it has proven safe and effective at the paramedic level for both adults and pediatrics with nausea and vomiting.(1, 2) The patient population who can benefit from it is large (it is the most administered drug by many paramedic services), and the contraindications (hypersentsitivity) are small. I am not advocating making nausea and vomiting a routine BLS call. Paramedics should still be dispatched for nausea and vomiting because they are often symptoms of very serious illness. I am saying if paramedics are not available or if the presenting case is a clear cut case of an otherwise healthy person with the flu or a GI bug, then it is something BLS can safely handle, provided the service’s medical director agrees and is comfortable with the education and training of the BLS providers he oversees. (Instead of spending so much time practicing spinal immobilization, we can teach our BLS about Zofran, Tylenol and Benadryl, and perhaps other meds I will be discussing in subsequent posts that I believe can make a difference in patient’s health and comfort, and satisfaction with the health care system, including EMS).

(1) Warden , prospective evaluation of ondansetron for undifferentiated nausea and vomiting in the prehospital setting – Prehosptal Emergency Care, January-March 2008.

(2) Salvucci, ondansetron is safe and effective for prehospital treatment of nausea and vomiting by paramedics. Prehospital Emergency Care Jan-March 2011

8 Comments

  • Jason says:

    Thanks for posting this. I’d never even heard of this medicine until now–it’s not even mentioned in BLS training in New Mexico. We are licensed to administer quite a bit of medication out here, but we don’t have anything in our scope for GI distress, other than transport.

  • CJ Ewell says:

    The other big contraindication is prolonged QT syndrome. Ondansetron can length the QT interval. While this is not routinely screened for, it is important to know about.

  • Joe says:

    Agreed. We usually can’t cure the problem but we can make it bearable.

  • J. Farrow says:

    Due to our remote location our Medical Director authorized our BLS crews an advanced scope including IV Access and certain IV/IM medications. One of the medications is Zofran. We haven’t had any problems thus far and they have been giving it for over a year.

  • Christopher says:

    The QT prolongation concerns with Zofran are overblown. As long as you’re not dumping 32-64mg onboard they’ll be Ok.

    (much like concerns over Haldol, Droperidol, etc)

  • josh says:

    I agree with Christopher. There have been no studies to my recollection that demonstrated significant QT prolongation (>500ms) at 4 or 8mg, so shouldn’t be a worry. Zofran would be a great drug for BLS to give.

  • Apex1297 says:

    No one has mentioned the worst side effect, anaphylaxis.

  • Christopher says:

    Apex1297,

    I’m not aware of any higher propensity for hypersensitivity reactions to ondansetron as compared to the other popular antiemetics; but, considering the others are mostly antihistamines this may not be entirely from out in left field.

    As for PO ondansetron, the ODT form is given out like candy in our service area and by our hospital so it seems like something that would have reared its ugly head if it were a substantial issue.

    IV ondansetron’s biggest problem is rapid IVP can result in syncope…which because I was a sinner (not giving drugs at the proper rate) and have personally seen.

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Peter Canning

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