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Background: The safety and effectiveness of intramuscular olanzapine or haloperidol compared to midazolam as the initial pharmacological treatment for acute agitation in emergency departments (EDs) has not been evaluated. Methods: A pragmatic, randomised, double-blind, active-controlled trial was conducted from December 2014 to September 2019, in six Hong Kong EDs. Patients (aged 18–75 years) with undifferentiated acute agitation requiring parenteral sedation were randomised to 5 mg intramuscular midazolam (n = 56), olanzapine (n = 54), or haloperidol (n = 57). Primary outcomes were time to adequate sedation and proportion of patients who achieved adequate sedation at each follow-up interval. Sedation levels were measured on a 6-level validated scale (ClinicalTrials.gov Identifier: NCT02380118). Findings: Of 206 patients randomised, 167 (mean age, 42 years; 98 [58·7%] male) were analysed. Median time to sedation for IM midazolam, olanzapine, and haloperidol was 8·5 (IQR 8·0), 11·5 (IQR 30·0), and 23·0 (IQR 21·0) min, respectively. At 60 min, similar proportions of patients were adequately sedated (98%, 87%, and 97%). There were statistically significant differences for time to sedation with midazolam compared to olanzapine (p = 0·03) and haloperidol (p = 0·002). Adverse event rates were similar across the three arms. Dystonia (n = 1) and cardiac arrest (n = 1) were reported in the haloperidol group. Interpretation: Midazolam resulted in faster sedation in patients with undifferentiated agitation in the emergency setting compared to olanzapine and haloperidol. Midazolam and olanzapine are preferred over haloperidol's slower time to sedation and potential for cardiovascular and extrapyramidal side effects. Funding: Research Grants Council, Hong Kong.

Background A straight line–based model is often used to calculate the distance between an out‐of‐hospital cardiac arrest (OHCA) and the location of an automated external defibrillator (AED). This model may be inaccurate as it overlooks any obstacles between the OHCA and AED. This study aimed to elucidate the effect of the straight line–based and walking route–based calculation on the average distance between an historical OHCA and the closest AED and the coverage rate of AEDs, ie, the proportion of historical OHCAs that were within 100 meters of an AED. It is hoped that the findings will help policy makers in deploying AEDs in optimal urban settings. Methods and Results This was an observational study conducted in Hong Kong. The average distance between an historical OHCA and its closest AED and the coverage rate of AEDs were calculated with both the straight line–based and walking route–based model. A total of 1637 AEDs and 5119 cases of OHCA were included for analysis. The average distances calculated by the straight line–based and walking route–based model were 230.8 and 545.3 meters, respectively. The coverage rate calculated by the straight line–based model was 30.04%, while that by the walking route–based model was 11.17%. Conclusions The straight line–based model may underestimate the average distances and overestimate the coverage rate in an urban setting. The walking route–based model may be more useful for studies of AED deployment in urban cities.