Antiemetic management preferences for paramedic providers: A cross-sectional survey

Abstract

IntroductionParamedics are commonly called to complaints of nausea and vomiting with the treatment of these conditions being either antiemetics or palliative measures.  Historically, there have been several antiemetics available to paramedics across Australia and New Zealand with their use varied dependent on each region of practice. The objective of this research was to create a snapshot in time and determine which antiemetics have been used by paramedics, their preferences of use, and their beliefs regarding each antiemetic.MethodsUsing a cross-sectional and online survey, paramedics from across Australia and New Zealand were invited to answer questions regarding their demographics, antiemetics used in practice and then preferences regarding these antiemetics. A 5-point Likert scale and free text qualitative answers were also used to identify particular views and beliefs on the efficacy of the varying antiemetics.Results476 paramedics participated in the study. The participants were predominantly male n=344 (72.3%).  Ondansetron was found to be the most preferred antiemetic for general use in nausea and vomiting n = 378 (82%) with the second line choice being metoclopramide n = 62 (13.4%).  Exceptions to this were for prochlorperazine, which showed a high preference for nausea related to migraine n=179 (56.2%) or vertigo or motion sickness n=243 (42%).ConclusionPreferences and decision making for choosing ondansetron over other antiemetics were primarily its efficacy, minimal side effects and availability.  An exception to ondansetron’s preferred usage was prochlorperazine, which was the preferred medication for cases involving nausea with motion sickness or vertigo.  Historically, metoclopramide has been the most common antiemetic in paramedic practice but is not generally preferred as first line due to its contraindications, perceived lower efficacy over other antiemetics and risk of side effects.