Droperidol & Haloperidol in the Field
Objective: Use droperidol or haloperidol only for the agitated patient your protocol names. Screen for a long QT interval and for medical causes. Do not combine them with other sedatives without a plan. Your protocol card sets the amount.
Why this matters
Droperidol and haloperidol are antipsychotics for the agitated patient your protocol names. They can prolong the QT interval. They can cause stiffness, dystonia, and restlessness. They are not ketamine, and they are not midazolam. Your protocol card sets the amount.
Deaths in this setting come from several sedatives given together, plus an airway nobody is watching, or from a medical cause treated as a psychiatric problem. Check glucose, oxygen, head injury, and a post-seizure state before you decide this is only agitation. This site does not list milligrams.
- Check glucose, oxygen, and a real differential before the syringe: hypoxia, low glucose, head injury, a post-seizure state, or severe agitation with a medical emergency.
- If you carry droperidol or haloperidol, use the protocol dose, the protocol route, and a monitor when you can place one.
- QT risk is real. A known long QT, other QT-prolonging drugs, and severe electrolyte problems are reasons to choose a different protocol drug.
Clinical sequence
- Scene safety first. Use verbal de-escalation if it can work in the next few seconds. If it cannot, use physical restraint plus the medication your protocol names.
- Check glucose as soon as you can. Have an airway plan. Ketamine, a benzodiazepine, or droperidol or haloperidol is a protocol choice. Do not give all three.
- After the patient is quiet: monitor, check oxygen saturation, use waveform capnography if they are sedated, and get a 12-lead if you can. Choose the destination. Do not leave them face-down and unwatched.
- Muscle twisting later is treated with diphenhydramine or benztropine per protocol. See the diphenhydramine lesson.
Teaching points
- These are different drug classes. Benzodiazepines act on GABA. Ketamine is a dissociative drug. Droperidol and haloperidol block dopamine. Mixing them without a plan is how the airway fails.
- 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 by the intramuscular route and still affects the QT interval. It is not a pain medicine.
- The cause may be medical. High temperature, acidosis, and a hard struggle need sedation, cooling, and a hospital. They are not a psychiatric hold at the house.
- For agitation, check glucose and the airway first.
- The protocol drug is this one. I am not adding another sedative.
- I will check the QT interval when I can get a tracing.
- After they are quiet, put them on a monitor and choose the destination.
Common errors
- Giving ketamine, then midazolam, then droperidol because none of them seemed to work yet.
- No glucose check on a sweating, violent patient who may be hypoglycemic.
- Walking away from a now-silent patient who is no longer protecting the airway.
Practice
One-minute check
Two pictures. Name the first three actions for each. (1) A 22-year-old, sweating, struggling hard, temperature 104°F. (2) A 70-year-old with known psychiatric illness, quieter after intramuscular droperidol, now snoring.
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. Your protocol still decides.
- ACEP droperidol policy — Droperidol is a reasonable agitation drug. QT monitoring still belongs in the plan.
- AHA 2025 Part 9: Adult ALS — A sedated or peri-arrest patient still needs an airway, a glucose, and a monitor.
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.