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Safety and Efficacy of an On-Site Intensive Treatment Protocol for Mild and Moderate Sympathomimetic Toxicity at Australian Music Festivals

Published online by Cambridge University Press:  06 December 2019

Ned Douglas Open the ORCID record for Ned Douglas [Opens in a new window] ,
James Carew ,
Damian Johnson ,
Madeline Green ,
Nicholas Wilson ,
Jake Donovan ,
Tim Mulherin ,
Lachlan Holbery-Morgan ,
Elyssia Bourke  and
Erin Smith
Ned Douglas*
Affiliation:
Event Medical Services Australia, Moonee Ponds, Victoria, Australia
James Carew
Affiliation:
Event Medical Services Australia, Moonee Ponds, Victoria, Australia
Damian Johnson
Affiliation:
Event Medical Services Australia, Moonee Ponds, Victoria, Australia
Madeline Green
Affiliation:
Event Medical Services Australia, Moonee Ponds, Victoria, Australia
Nicholas Wilson
Affiliation:
Event Medical Services Australia, Moonee Ponds, Victoria, Australia
Jake Donovan
Affiliation:
Event Medical Services Australia, Moonee Ponds, Victoria, Australia
Tim Mulherin
Affiliation:
Event Medical Services Australia, Moonee Ponds, Victoria, Australia
Lachlan Holbery-Morgan
Affiliation:
Event Medical Services Australia, Moonee Ponds, Victoria, Australia
Elyssia Bourke
Affiliation:
Event Medical Services Australia, Moonee Ponds, Victoria, Australia
Erin Smith
Affiliation:
Edith Cowan University, School of Medical and Health Sciences, Joondalup, Western Australia, Australia James Cook University, College of Public Health, Medical, and Veterinary Sciences, Townsville, Queensland, Australia
*
Correspondence: Ned Douglas, MB BS, BMedSci, FANZCA 1 Alexandra St, Pascoe Vale, 3044 Melbourne, Victoria, Australia E-mail: [email protected]
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Abstract

Introduction:

Serotonin and sympathomimetic toxicity (SST) after ingestion of amphetamine-based drugs can lead to severe morbidity and death. There have been evaluations of the safety and efficacy of on-site treatment protocols for SST at music festivals.

Problem:

The study aimed to examine the safety and efficacy of treating patients with SST on-site at a music festival using a protocol adapted from hospital-based treatment of SST.

Methods:

The study is an audit of presentations with SST over a one-year period. The primary outcome was need for ambulance transport to hospital. The threshold for safety was prospectively defined as less than 10% of patients requiring ambulance transport to hospital.

The protocol suggested patients be treated with a combination of benzodiazepines; cold intravenous (IV) fluid; specific therapies (cyproheptadine, chlorpromazine, and clonidine); rapid sequence intubation; and cooling with ice, misted water, and convection techniques.

Results:

One patient of 13 (7.7%) patients with mild or moderate SST required ambulance transport to hospital. Two of seven further patients with severe SST required transport to hospital.

Conclusions:

On-site treatment may be a safe, efficacious, and efficient alternative to urgent transport to hospital for patients with mild and moderate SST. The keys to success of the protocol tested included inclusive and clear education of staff at all levels of the organization, robust referral pathways to senior clinical staff, and the rapid delivery of therapies aimed at rapidly lowering body temperature. Further collaborative research is required to define the optimal approach to patients with SST at music festivals.

Keywords

drug-induced hyperthermiamass gatheringserotonin toxicity
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 1 , February 2020 , pp. 41 - 45
Copyright
© World Association for Disaster and Emergency Medicine 2019

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References

Drug Induced Deaths August 2018 Drug Trends Bulletin. https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/Drug%20Induced%20deaths%20August%202018%20Drug%20Trends%20Bulletin.pdf. Accessed January 2019.Google Scholar
Byard, RW, Gilbert, J, James, R, Lokan, RJ.Amphetamine derivative fatalities in South Australia – is “ecstasy” the culprit? Am J Forensic Med Pathol. 1998;19(3):261.10.1097/00000433-199809000-00013CrossRefGoogle ScholarPubMed
Green, AR, Mechan, AO, Elliott, JM, O’Shea, E, Colado, MI.The pharmacology and clinical pharmacology of 3,4-methylenedioxymethamphetamine (MDMA, “ecstasy”). Pharmacol Rev. 2003;55(3):463–508.10.1124/pr.55.3.3CrossRefGoogle Scholar
Rusyniak, DE, Sprague, JE.Toxin-induced hyperthermic syndromes. Med Clin North Am. 2005;89(6):1277–1296.10.1016/j.mcna.2005.06.002CrossRefGoogle ScholarPubMed
Richards, JR, Albertson, TE, Derlet, RW, Lange, RA, Olson, KR, Horowitz, BZ.Treatment of toxicity from amphetamines, related derivatives, and analogues: a systematic clinical review. Drug Alcohol Depend. 2015;150:1–13.CrossRefGoogle ScholarPubMed
Gowing, LR, Henry-Edwards, SM, Irvine, RJ, Ali, RL.The health effects of ecstasy: a literature review. Drug Alcohol Rev. 2002;21(1):53–63.10.1080/09595230220119363CrossRefGoogle ScholarPubMed
Isbister, GK, Buckley, NA, Whyte, IM.Serotonin toxicity: a practical approach to diagnosis and treatment. Med J Aust. 2007;187(6):361–365.10.5694/j.1326-5377.2007.tb01282.xCrossRefGoogle ScholarPubMed
Mills, EM, Banks, ML, Sprague, JE, Finkel, T.Pharmacology: uncoupling the agony from ecstasy. Nature. 2003;426(6965):403–404.10.1038/426403aCrossRefGoogle ScholarPubMed
Rusyniak, DE, Tandy, SL, Hekmatyar, SK, et al. The role of mitochondrial uncoupling in 3,4-methylenedioxymethamphetamine-mediated skeletal muscle hyperthermia and rhabdomyolysis. J Pharmacol Exp Ther. 2005;313(2):629–639.10.1124/jpet.104.079236CrossRefGoogle ScholarPubMed
Levi, M.Hemostasis and thrombosis in extreme temperatures (hypo- and hyperthermia). Semin Thromb Hemost. 2018;44(7):651–655.Google Scholar
Levine, M, Truitt, CA, O’Connor, AD.Cardiotoxicity and serotonin syndrome complicating a milnacipran overdose. J Med Toxicol Off J Am Coll Med Toxicol. 2011;7(4):312–316.10.1007/s13181-011-0167-1CrossRefGoogle ScholarPubMed
Paratz, ED, Cunningham, NJ, MacIsaac, AI.The cardiac complications of methamphetamines. Heart Lung Circ. 2016;25(4):325–332.10.1016/j.hlc.2015.10.019CrossRefGoogle ScholarPubMed
Tek, DA, Olshaker, JS. Hyperthermia, pulmonary edema, and disseminated intravascular coagulation in an 18-year-old military recruit. Ann Emerg Med. 1990;19(6):715–722.10.1016/S0196-0644(05)82487-4CrossRefGoogle Scholar
Goldstein, S, Richards, JR.Sympathomimetic Toxicity. Treasure Island, Florida USA: StatPearls Publishing; 2018.Google Scholar
Foong, A-L, Patel, T, Kellar, J, Grindrod, KA.The scoop on serotonin syndrome. Can Pharm J CPJ. 2018;151(4):233–239.CrossRefGoogle ScholarPubMed
Dunkley, EJC, Isbister, GK, Sibbritt, D, Dawson, AH, Whyte, IM.The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM Int J Med. 2003;96(9):635–642.10.1093/qjmed/hcg109CrossRefGoogle ScholarPubMed