Pre-Hospital Pharmacologic Management of Acute Agitation in an Urban Setting

Authors

• Gabby Young, Michigan State University College of Human Medicine Medical Student
• Gabbi Taylor, Michigan State University College of Human Medicine Medical Student
• Alyssa Gill, Michigan State University College of Human Medicine Medical Student
• Katie McCarthy, Michigan State University College of Human Medicine Medical Student
• Larissa Dean, Michigan State University College of Human Medicine Medical Student
• Michelle Padley, Allied Health - Corewell Health West
• Lindsey Ouellette, Michigan State University
• Henry Higby, Emergency Medicine - Corewell Health West
• Todd Chassee, Emergency Medicine - Corewell Health West

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Providing adequate medical treatment for agitated patients is a well-known challenge within the emergency department (ED). Pharmacologic management techniques utilized for agitated patients have been studied in the ED, resulting in current protocols. The goal of this study is to evaluate pharmacologic agents currently in use for agitated patients in the pre-hospital setting, with associated outcomes related to their adverse event profiles, tolerability and symptom mitigation.

A retrospective chart review of patients presenting with pre-hospital agitation who were evaluated at the local hospital system following EMS transport was conducted for the year 2024. Inclusion criteria consisted of transports with an EMS primary impression of psychiatric, behavioral, suicidality and/or substance abuse concern, as well as those with a mental health status evaluation of agitation, combative, strange and inexplicable behavior, state of emotional shock and stress or an unspecified altered mental state. Patients under age 5, or those transported outside of local hospital system were excluded from analysis.

A preliminary review included 98 EMS transports (81 unique patients) correlated with hospital data, from an initial ImageTrend data pull of 8328 records. Repeat patients were transported twice (4), five times (1) and eight times (1). These initial results consisted of 54% (53) male and 46% (45) female patients. The average age of this cohort is 45 (11 - 78 σ 17.1). The five most common initial provider primary impressions were: Alcohol Abuse and Effects (49), Suicide Attempt (16), Psychoactive Substance-Induced Disorder (14), Unspecified convulsions (7) and Opioid related disorders (6). Of the patients given pharmacological treatment for agitation (5) in the EMS setting, two patients received additional medications, one requiring physical restraints. In the ED setting, 39% of patients were given medications for their agitated symptoms, and 15% required restraints. ED dispositions for patients were comprised of 68% discharges, 13% admissions, 7% eloped/AMA/LWBS and 9% transfers.

The early results of this analysis are indicative that patients experiencing agitation in the pre-hospital setting often require additional behavioral management when they arrive in the ED.

Recommended Citation

Young G, Taylor G, Gill A, McCarthy K, Dean L, Padley M, Ouellette L, Higby H, Chassee T. Pre-hospital pharmacologic management of acute agitation in an urban setting. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2063