PREHOSPITAL CARE

Prehospital activated charcoal: the way forward

S L Greene¹, M Kerins², N O’Connor³

¹ Associate Specialist Clinical Toxicology, National Poisons Information Service (London), Guys and St Thomas’ NHS Trust, UK
² Consultant in Emergency Medicine, Accident and Emergency Department, Kings College Hospital, London, UK
³ Consultant in Emergency Medicine, Accident and Emergency Department, Lady of Lourdes Hospital, Ireland

Correspondence to:
Correspondence to:
Dr S L Greene
Medical Toxicology Unit, Avonley Road, New Cross, London SE14 5ER, UK; shaun.greene{at}gstt.nhs.uk

Objectives: Single dose activated charcoal (SDAC) may be an effective method of gastric decontamination when administered to patients within an hour of drug overdose. However, few patients who may benefit from this treatment attend an emergency department within this timeframe. The authors sought to determine the current attitudes of ambulance NHS trusts to recent recommendations that the administration of SDAC should be considered as a prehospital therapy.

Methods: A postal questionnaire was used to determine the current level of use of prehospital activated charcoal by ambulance NHS trusts, the incidence of associated complications, and barriers preventing the routine use of prehospital SDAC.

Results: A completed questionnaire was returned by 36 of the 39 ambulance NHS trusts in the UK (response rate 92%). Currently none of the trusts that responded to the questionnaire provides prehospital SDAC as an intervention. The most common barriers to the provision of prehospital SDAC are the current lack of evidence in the medical literature proving it is effective in improving patient outcome and the lack of a recognised protocol for its administration. Other issues included concerns regarding potential complications, ambulance turnaround times, lack of availability of SDAC, and lack of funding.

Conclusions: A lack of published evidence proving efficacy remains the most important factor in preventing the routine administration of SDAC to appropriate patients in the prehospital environment. Further research in this setting is required to determine the usefulness of this therapy.

Abbreviations: AACT, American Academy of Clinical Toxicology; EAPCCT, European Association of Poisons Centres and Clinical Toxicologists; SDAC, single dose activated charcoal

Keywords: activated charcoal; overdose; ambulance; poisoning

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