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Exploring Current Emergency Medical Services Approaches to Manage Agitated Older Adult Patients: An Analysis of Statewide Protocols.

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Title: Exploring Current Emergency Medical Services Approaches to Manage Agitated Older Adult Patients: An Analysis of Statewide Protocols.
Authors: Lachs J; Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA., Barghout R; Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA., Haussner W; Department of Emergency Medicine, Hackensack University Medical Center, Hackensack, New Jersey, USA., Hancock D; Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA., Benton E; Department of Emergency Medicine, Hackensack University Medical Center, Hackensack, New Jersey, USA., Dorsett M; Department of Emergency Medicine, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, New York, USA., Peters G; Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA., Cash R; Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA., Holley J; Government and Industry Relations, Priority On Demand, Priority Ambulance, Knoxville, Tennessee, USA., Rosen T; Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA.
Source: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2026 Jul; Vol. 74 (7), pp. 1919-1927. Date of Electronic Publication: 2026 Apr 25.
Publication Type: Journal Article
Language: English
Journal Info: Publisher: Blackwell Science Country of Publication: United States NLM ID: 7503062 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-5415 (Electronic) Linking ISSN: 00028614 NLM ISO Abbreviation: J Am Geriatr Soc Subsets: MEDLINE
Imprint Name(s): Publication: Malden, MA : Blackwell Science
Original Publication: New York [etc.]
MeSH Terms: Psychomotor Agitation*/therapy , Emergency Medical Services*/methods , Emergency Medical Services*/standards , Clinical Protocols*, Hypnotics and Sedatives/therapeutic use ; Antipsychotic Agents/therapeutic use ; Humans ; Aged ; United States ; Practice Guidelines as Topic ; Restraint, Physical ; Female ; Male
Abstract: Background: Agitation in older adults presents unique challenges for emergency medical services (EMS) clinicians. To safely assess, treat, and transport these patients, EMS providers must manage this agitation, which is often caused by delirium or behavioral symptoms of dementia. Strategies routinely used in younger patients, such as physical restraints and chemical sedatives, have a much higher risk of causing harm in older adults. EMS provider practices in this area are understudied. Our objective was to examine U.S. state protocols for guidance on agitation management in older adults.
Methods: We reviewed publicly available statewide EMS protocols and the National EMS Model Guidelines to identify agitation management guidance and whether modifications for older adults were included. We assessed each protocol for the presence of 26 elements using a standardized approach.
Results: We analyzed 34 state protocols and the National Model Guidelines. While 33 protocols (97%) included guidance for managing agitation and 19 protocols (58%) included pediatric-specific considerations, only 11 (33%) addressed older adults. Among these, the most common modification was sedative medication dose reduction (9 protocols, 27%). No protocols included modifications to guidance/criteria for physical restraint use, prioritization/escalation between physical restraint and chemical sedation, or sedative medication selection for older adults. Guidance on medication selection varied: 29 protocols (88%) included standing orders for sedative medications, most commonly midazolam (27 protocols, 82%), ketamine (23 protocols, 70%), haloperidol (17 protocols, 52%). Only 7 protocols (21%) included specific dose adjustments for older adults, typically a 50% reduction. Benzodiazepines were most commonly recommended, while antipsychotics were less common.
Conclusions: Most state EMS protocols provide guidance on management of agitated patients, including use of physical restraints and chemical sedatives, yet modifications or specific guidance for older adults are uncommon. Recognizing and addressing this gap represents an important opportunity to improve quality of prehospital care for older adults.
(© 2026 The Author(s). Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)
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Grant Information: K01 AG088486 United States AG NIA NIH HHS; K24 AG084923 United States AG NIA NIH HHS
Contributed Indexing: Keywords: agitation management; emergency medical services (EMS); prehospital care; sedative medications
Substance Nomenclature: 0 (Hypnotics and Sedatives)
0 (Antipsychotic Agents)
Entry Date(s): Date Created: 20260425 Date Completed: 20260729 Latest Revision: 20260729
Update Code: 20260730
PubMed Central ID: PMC13237759
DOI: 10.1111/jgs.70466
PMID: 42033788
Database: MEDLINE
Description
ISSN:1532-5415
DOI:10.1111/jgs.70466