Activated charcoal is most effective if given within 1 hour of overdose.
Prehospital administration of charcoal can be challenging, but may save significant time compared to waiting until arrival to the ED. The patient has to be transported by EMS, registered, seen by a provider, order for charocal placed...
Two studies evaluated the time difference between prehospital and hospital administration of GI decontamination.
Study 1 found median time to activated charcoal in the ED was 82 minutes.
Study 2 found mean time to activated charcoal by EMS was 5 minutes, compared to 51 if held until arrival to ED.
Bottom line: Don't underestimate the amount of time that goes by before you evaluate non-crashing patients upon arrival to the ED. If the story supports an overdose and the patient doesn't have contraindications for receiving charcoal, recommend it be given in the prehospital setting for greatest potential benefit.
References
Wax PM, Cobaugh DJ. Prehospital gastrointestinal deconatmination of toxic ingestions: a missed opportunity. Am J Emerg Med 1998;16:114-6.
Crockett R, et al. Prehospital use of activated charcoal: a pilot study. J Emerg Med 1996;14(3):335-8.
