Use of flumazenil to treat poisoning in prehospital care

This critical review will explore the use of antidotes for drug toxicity in prehospital care, focusing on flumazenil as a treatment for benzodiazepine poisoning. It will detail the potential for practice development for the role of the ambulance-based paramedic.

Drug overdose (including both accidental and suicidal), drug interactions and drug toxicity secondary to incorrect drug doses can all result in toxicological emergencies, which put ever-increasing demands on the hospital and prehospital settings (Chacko and Peter, 2019).

While in-hospital mortality rates are <0.5% in acutely poisoned patients, a further 5% of patients have other serious clinical outcomes (Kuang et al, 2009). In some cases, appropriate and timely use of an antagonist or antidote can terminate the progression of toxicity; evidence suggests that administration of a specific antidote combined with general supportive care can reduce rates of morbidity and mortality related to life-threatening poisonings (Pillay, 2008). Chacko and Peter (2019) note that, conversely, inappropriate use or delayed administration may result in adverse patient outcomes.