Emergency physicians reported variable experiences with sedation before hospital arrival, but the survey did not measure a midazolam failure rate.
What the source reports
Of 679 invited Dutch emergency physicians, 293 responded and 251 completed the survey. Midazolam, droperidol and combinations were common choices for extreme agitation. Thirty-nine percent reported that prehospital midazolam was often insufficient. Prior treatment, agitation severity, training and personal experience influenced subsequent choices.
Limits and uncertainty
These were clinicians’ recollections and preferences, rather than prospectively observed patient outcomes. Nonresponse and selective participation could affect the findings. Perceived insufficient sedation may reflect dose, route, elapsed time, underlying illness or the practical constraints of transport.
Implications for forensic review
When evaluating an escalation of sedation, reconstruct what was actually administered before arrival and when reassessment occurred. A survey response cannot establish that a particular dose was ineffective or inappropriate. The paper provides context for variation in emergency practice, while the individual record must explain the treatment sequence and response.
Source and related reading
Source reviewed: National survey of Dutch emergency physicians on pharmacological sedation practices for extreme agit (PMC13087722). Forensic applications above are interpretive analysis of the supplied paper.
Related reading: Korean ERCP Survey Measured Clinician Preferences Rather Than Sedation Safety.