EVIDENCE LIBRARY
EMS Protocol Review Found Limited Older-Adult Guidance Despite Frequent Midazolam Standing Orders
A review of published state EMS protocols found that geriatric modifications were uncommon. It evaluated documents rather than actual treatment decisions or outcomes.
A review of published state EMS protocols found that geriatric modifications were uncommon. It evaluated documents rather than actual treatment decisions or outcomes.
What was reviewed
The investigators examined thirty-four state protocols and the National Model Guidelines using a structured set of elements. Most included agitation guidance, and midazolam was a frequent standing-order medication.
Only about one-third addressed older adults. Some specified dose reduction, while guidance about restraint criteria, escalation, and medication selection generally lacked older-adult modifications.
Document scope limits conclusions
Only publicly available protocols were included. Twelve states were excluded because suitable public documents were unavailable and use of the national model was not reported. Mandatory rules and adaptable model documents served different purposes.
A state template may also differ from an agency’s operative protocol. The review did not observe whether clinicians individualized doses or whether a protocol feature changed patient harm.
Practical use
This is a historical document review, not a statement of a currently binding local rule. In an EMS case, obtain the protocol actually in force, local adaptations, clinician assessment, and administered doses. The study can identify questions about geriatric guidance, but cannot establish that an individual midazolam administration breached a standard or caused a complication.
Source paper
Original analysis of the supplied journal article, identified as PMC13237759.