Paramedic PapersTopic
Toxicology research
13 recent papers on toxicology in paramedic and prehospital care, newest first. Each has a plain-English summary, the study design, the main finding and caveat, and what it means for Australian practice.
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Kratom derivative withdrawal treated prehospital
A US case series describes community paramedics treating severe withdrawal from concentrated kratom derivatives (7-hydroxymitragynine and MGM-15) with full-dose buprenorphine and rapid linkage to outpatient medication for opioid use disorder, with both patients retained in treatment at 30 days.
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Prehospital flumazenil: 69 doses, no seizures
A five-year Kansas review of 69 prehospital flumazenil administrations for suspected benzodiazepine overdose found clinical improvement with no seizures or adverse events recorded, even where possible contraindications existed.
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US prehospital buprenorphine growing fast
A national cross-sectional analysis of 167 million US EMS encounters found 2,180 prehospital buprenorphine administrations between 2020 and 2023, rising from 33 to 1,574 per year, with 80% of patients improving and only 16% of 911 cases transported.
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Prehospital olanzapine for meth toxicity
Population-based Winnipeg cohort evaluating a 2018 policy letting paramedics give olanzapine for methamphetamine intoxication — treated patients were far more likely to be transported to ED (aOR 11.83) and seen by a doctor, and less likely to leave before being seen (aOR 0.56).
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Ice-water immersion wins for drug hyperthermia
A systematic review of 71 studies (1,932 patients) comparing cooling methods for drug-induced (and exercise-induced) hyperthermia found ice-water and cold-water immersion fastest at ~0.16–0.17 °C/min and clearly superior to passive cooling.
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Poisoning OHCA rising in young Japanese adults
In 1.4 million Japanese EMS-treated OHCAs, poisoning-related arrest was rare (0.27%) but its share rose in adults aged 18–29 (adjusted OR 1.027/year) while falling in older groups, with no improvement in neurological outcomes over the decade.
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No evidence to change ALS in toxic arrest
A systematic review of intra-arrest treatment modifications for toxicological cardiac arrest found only four observational studies, all at critical risk of bias, with no evidence supporting any change to standard advanced life support.
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Medetomidine withdrawal transfers on dexmedetomidine
Cohort of 100 interfacility transfers on dexmedetomidine infusions for medetomidine withdrawal — transports were largely uncomplicated but profound hypertension was common (39%), reflecting the growing US opioid-supply adulterant problem
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SGLT-2 inhibitor hypoglycaemic ketoacidosis
Case report of severe hypoglycaemic ketoacidosis in an SGLT2 inhibitor user requiring insulin — a reminder these agents can produce ketosis with atypical glucose readings that muddle the diabetic-emergencies picture
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Fatal illicit drug toxicity: mostly polysubstance OHCA
Case series of 46 deaths in Victoria's EDNAV toxicosurveillance registry (2020–2025) — 67% had out-of-hospital cardiac arrest, 91% were polysubstance with mixed stimulant–sedative patterns most common (methamphetamine 54%, heroin 52%), and hypoxic brain injury was the most frequent terminal complication.
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Paramedic views on prehospital buprenorphine
Abstract not yet available (ahead-of-print). Qualitative case study of paramedic perspectives on prehospital buprenorphine implementation in emergency medical services.
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NAEMSP: EMS role in opioid use disorder
NAEMSP position statement outlining EMS roles in opioid use disorder treatment, including harm reduction, medication-assisted treatment initiation, and referral pathways.
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IM naloxone better than IN for overdose
Nationwide cohort study compared prehospital outcomes for initial intranasal versus intramuscular naloxone administration in suspected opioid overdose.