Droperidol & Haloperidol in the Field
Objective: Use droperidol or haloperidol only for the agitated patient your protocol names, screen for QT/medical mimics, and do not combine blindly with other sedatives.
Why This Is Hard
The patient is screaming, so someone reaches for whatever sedative is closest. Droperidol and haloperidol are antipsychotics with QT prolongation and EPS — ACEP/NAEMSP agitation teaching supports droperidol in many EMS systems after the old black-box panic, but they are not ketamine and not midazolam. The street deaths are stacked sedatives plus an unwatched airway, or a medical cause (hypoglycemia, hypoxia, head bleed) treated as “psych.”
- Glucose, oxygen, and a real differential before the syringe: hypoxia, hypo, head injury, post-ictal, excited delirium / hyperactive delirium with severe agitation.
- If you carry droperidol or haloperidol: known dose, IM vs IV per protocol, and a monitor when you can get one on.
- QT risk is real. Congenital long QT, other QT drugs, and electrolyte chaos are reasons to pick a different protocol agent.
Street Sequence
- Scene safety. Verbal de-escalation if it will work in 15 seconds. If not, physical plus chemical per protocol.
- Glucose as soon as you can. Airway plan. Ketamine vs benzo vs butyrophenone is a protocol choice — do not stack all three.
- After they quiet: monitor, SpO₂, EtCO₂ if sedated, 12-lead if feasible, destination.
- EPS / dystonia later is diphenhydramine or benztropine per protocol — see the diphenhydramine cautions lesson.
Field Rules (Education)
- Different drug class. Benzos (GABA), ketamine (NMDA), droperidol/haloperidol (dopamine). Mixing without a plan is how the sat disappears.
- Droperidol has modern EMS support for agitation in many systems; the QT warning is still on the label. Get a tracing when you can.
- Haloperidol is slower IM and still QT-active. It is not a pain medicine.
- The disease may be medical. Hyperthermia, acidosis, and struggle are a chemical-sedation-plus-cooling-plus-destination problem, not a “psych hold” on the porch.
- Agitation — glucose and airway first
- Protocol agent is __ — not stacking
- QT on the list
- After they quiet: monitor and destination
Field Pitfalls
- Ketamine plus midazolam plus droperidol because none of them “worked yet.”
- No glucose on a sweaty, violent diabetic.
- Walking away from a now-silent patient who is no longer protecting an airway.
Practice
60-second drill
Two pictures: (1) 22-year-old, diaphoretic, super-human strength, 104°F; (2) 70-year-old, known psych, quieting after IM droperidol, now snoring. First three actions for each.
Related: Ketamine in the Field, Benzodiazepines in the Field.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; protocol still wins
- ACEP droperidol policy — droperidol is a reasonable agitation agent; QT monitoring still belongs in the plan
- AHA 2025 Part 9: Adult ALS — sedated or peri-arrest patients still need airway, glucose, and a monitor
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.