Emergency units respond to a report of an unconscious child in a school, where you arrive to find a seven-year-old boy seizing in a restroom. Teachers tell you that he was excused to go to the bathroom, and when he didn't return, a staff member went to check and found him seizing. That was over 10 minutes ago; he hasn't stopped seizing the entire time. The child is cyanotic and in full tonic-clonic activity. After accessing his medical records, school staff deny any previous medical conditions. The nearest medical center is 20 minutes away. Your partner is managing the airway and ventilations while you attempt vascular access and pharmacotherapy. You quickly administer glucagon 1 mg intramuscular and attempt to establish an IV. After two attempts on the flailing child with no veins, you give up. He is still cyanotic and into his 20th minute of seizure activity. You look through your kit and find the IO setup open and contaminated. Now what?

Why Intranasal?
     All emergency care providers, particularly those working in the prehospital environment, are faced with conditions in which their patient urgently needs a medication administered. ALS providers are particularly familiar with intravenous, intramuscular and subcutaneous methods. This article will discuss the recent literature and improvements in delivery systems that result in the potential for widespread utilization of intranasal (IN) drug administration.

     Intranasal drug delivery is supported by recent research into new forms of drug delivery and is emerging as a promising method of delivering medications directly to the bloodstream through absorption across the nasal mucous membranes. This method of delivery can eliminate the need for intravenous catheters or intramuscular needles, thereby reducing needlestick risk while simultaneously delivering effective drug levels. The potential for widespread application of intranasal drug delivery may significantly enhance emergency patient care and increase the pool of emergency care providers who can provide safe and timely medication administration.

A Safer Option
     There is a significant risk associated in EMS with using needles to administer medication. There have been enhancements in the design of safety systems for emergency care, such as needleless catheters and intravenous systems, but there remains a significant risk in the uncontrolled environment.