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Multicenter Study
, 8, 15

Pre-hospital Treatment of Acute Poisonings in Oslo

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Multicenter Study

Pre-hospital Treatment of Acute Poisonings in Oslo

Fridtjof Heyerdahl et al. BMC Emerg Med.

Abstract

Background: Poisoned patients are often treated in and discharged from pre-hospital health care settings. Studies of poisonings should therefore not only include hospitalized patients.

Aims: To describe the acutely poisoned patients treated by ambulance personnel and in an outpatient clinic; compare patients transferred to a higher treatment level with those discharged without transfer; and study the one-week mortality after pre-hospital discharge.

Methods: A one-year multi-centre study with prospective inclusion of all acutely poisoned patients > or = 16 years of age treated in ambulances, an outpatient clinic, and hospitals in Oslo.

Results: A total of 3757 health service contacts from 2997 poisoning episodes were recorded: 1860 were treated in ambulances, of which 15 died and 750 (40%) were discharged without transfer; 956 were treated in outpatient clinic, of which 801 (84%) were discharged without transfer; and 941 episodes were treated in hospitals. Patients discharged alive after ambulance treatment were mainly poisoned by opiates (70%), were frequently comatose (35%), had respiratory depression (37%), and many received naloxone (49%). The majority of the patients discharged from the outpatient clinic were poisoned by ethanol (55%), fewer were comatose (10%), and they rarely had respiratory depression (4%). Among the hospitalized, pharmaceutical poisonings were most common (58%), 23% were comatose, and 7% had respiratory depression. Male patients comprised 69% of the pre-hospital discharges, but only 46% of the hospitalized patients. Except for one patient, who died of a new heroin overdose two days following discharge from an ambulance, there were no deaths during the first week after the poisonings in the 90% of the pre-hospital discharged patients with known identity.

Conclusion: More than half of the poisoned patients treated in pre-hospital treatment settings were discharged without transfer to higher levels. These poisonings were more often caused by drug and alcohol abuse than in those who were hospitalized, and more than two-thirds were males. Almost half of those discharged from ambulances received an antidote. The pre-hospital treatment of these poisonings appears safe regarding short-term mortality.

Figures

Figure 1
Figure 1
Acute poisonings treated at three health care levels in Oslo during one year. In total, there were 3757 health service contacts (3774 including double contacts the same day) from 2997 poisoning episodes by 2298 individuals. *From the 525 transfers between the ambulances and the hospitals, 15 went to hospitals outside Oslo, 15 had missing identity, 98 were not included in the study at the hospitals for various reasons and 397 were included in the study at the receiving hospital. **From the 570 transfers between ambulances and the outpatient clinic, 54 had missing identity, 249 were not included in the study at the outpatient clinic for various reasons and 267 were included in the study at the outpatient clinic. ***From the 155 transfers between the outpatient clinic and the hospitals, 19 went to hospitals outside Oslo, two had missing identity, 38 were not included in the study at the hospitals for various reasons and 96 were included in the study at the receiving hospital.
Figure 2
Figure 2
Suspected toxic agents in acute poisonings discharged from different levels of health care.

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