Initial management of poisoned patients in emergency medical services and non-poisoning hospitals in Tehran : the comparison between expected and performed managements

Background: There is no clear data on the adherence of emergency medical services (EMS) paramedics and hospital staff rather than those working in poisoning centers to the guidelines for managing acutely poisoned patients in developing countries. Methods: During a 6-month period, all EMS-managed poisoned patients along with those initially managed in a non-poisoning center before being referred to a poisoning hospital in Tehran, Iran, were instructed. Then the indications for administrating the activated charcoal (AC) as well as performing gastric lavage (GL) and tracheal intubation were studied and compared to the recommended guidelines. Results: A total of 3347 cases, including 1859 males (55.6%), were evaluated. There were significant differences between expected and performed endotracheal intubations in both EMS and other medical centers (P-value = 0.002 and 0.001, respectively) as well as the administration of GL and AC in other medical centers (P-values= 0.003 and 0.03, respectively). Conclusion: More extensive educational programs should be established to improve the preliminary management of poisoned patients performed by EMS paramedics and staff of hospitals other than poisoning centers.