The acute behavioral disturbance is a common problem for emergency medical services. They aimed to investigate the safety and effectiveness of droperidol compared to midazolam in the prehospital setting. Paramedics are using a new drug to quickly calm violent patients and they have the data to prove it works. Researchers found the sedative, droperidol, was a safer and faster option for paramedics to use compared with the internationally accepted, midazolam. The study was published in the Journal of Prehospital Emergency Care.

Australian paramedics are leading the world by introducing a new drug, droperidol, to quickly and safely calm violent patients fueled by alcohol and drugs. With backing from the Emergency Medicine Foundation (EMF) Australasia, the Queensland Ambulance Service (QAS) has also conducted the world's first comparison of the standard sedative, midazolam, with droperidol in a prehospital setting.

QAS found droperidol sedated patients nearly 70% quicker, was three times safer and significantly fewer patients needed additional sedation either in the ambulance or once in hospital in comparison to midazolam. Our paramedics and emergency department staff welcome the impact droperidol is having, and there are some amazing stories of how it quickly it works to calm aggressive and violent patients.

It is also simple to administer; there are much fewer side-effects, it rarely over-sedated and patients wake up much nicer. They are so happy to have a safe drug to use finally. And because they have also collated data on comparing droperidol with midazolam outside the hospital setting, we've produced one of the true practice-changing pieces of research. We can now demonstrate to other paramedics just how effective the drug is for us. 

The QAS introduced droperidol in 2016 as one of several initiatives to reduce the escalating violence against paramedics, mostly by drunken patients. Mr. Parker championed the uptake of droperidol based on research involving Princess Alexandra Hospital emergency physician and clinical toxicologist, Dr. Colin Page. Dr. Page, who has $450,000 Noel Stevenson Fellowship from EMF, led the evaluation of the QAS droperidol roll out.

Dr. Page said the real value of this latest research was in confirming that droperidol was safer and more effective in the prehospital setting, which mirrored previous results in the emergency department environment. The days of repeated doses of midazolam being given by paramedics are over, it just takes too long to sedate patients using this drug, and it is more dangerous. They are now pushing for paramedics and clinicians to administer the droperidol intramuscularly there is no need for people to use it intravenously and to stop mixing different sedatives.

Based on our extensive research, the standard protocol for violent patients should be 10 mg droperidol followed by a second dose of 10 mg and then ketamine. A research showed the importance of evaluating changes in treatment protocols. A Queensland-led initiative is set to change treatment protocols globally and lead to better patient care because there was research funding available for evaluation.