Dr. Tim Wolfe of Wolfe Tory Medical in Salt Lake City, UT, introduced the LMA MAD (Mucosal Atomization Device) Nasal into his EMS system in 1999, to use for naloxone and midazolam. More recently, it has been used throughout the state on children with severe pain being transported by local EMS. Wolfe says they rarely were given pain medications, “so we introduced nasal fentanyl as a statewide protocol to treat severe pain.” The LMA MAD Nasal makes controlling difficult patients safer for everyone involved, he adds.
“It has had a significant impact on several issues in our system,” Wolfe notes. He says this needle-free, intranasal drug delivery product allows staff to eliminate the risk of a needle stick, and reduce Level III bloodborne pathogen exposure. He says it also allows them to make nasal midazolam the primary treatment of status epilepticus.
Wolfe, who invented the product, says that time management and clinical efficiency—since it takes just seconds to deliver and Basic-level medics can be easily trained—are the top two benefits of the LMA MAD Nasal. “It is another tool to make a medic’s job easier,” he says. “It will not replace IV therapy, but should probably replace most IM, SQ and all rectal treatment options.”
The product also gives patients a better experience, with fewer painful needle sticks to start an IV.
For a medic, the LMA MAD Nasal offers exact dosing with exact volume. Wolfe says the medic does need to realize, however, that it is not an instant effect. “It takes a few minutes to absorb the drug via the nose, but compared to the time it would have taken to start the IV, and for a drug to cross the blood-brain barrier, it is as fast or faster,” he explains. Medics must also continue to support ventilation while the drug is absorbing.
He adds research has shown fewer intubations and fewer hospital admissions following this treatment. Parents in Wolfe’s community are able to treat their children with home nasal naloxone delivered via the LMA MAD Nasal.