Multiple Naloxone Administrations Among Emergency Medical Service Providers is Increasing

Details

• Alternative Title:
  Prehosp Emerg Care
• Personal Author:
  Faul, Mark ; Lurie, Peter ; Kinsman, Jeremiah M. ; Dailey, Michael W. ; Crabaugh, Charmaine ; Sasser, Scott M.
• Description:
  Background ; Opioid overdoses are at epidemic levels in the United States. Emergency Medical Service (EMS) providers may administer naloxone to restore patient breathing and prevent respiratory arrest. There was a need for contemporary data to examine the number of naloxone administrations in an EMS encounter. ; Methods ; Using data from the National Emergency Medical Services Information System, we examined data from 2012-5 to determine trends in patients receiving multiple naloxone administrations (MNAs). Logis tic regression including demographic, clinical, and operational information was used to examine factors associated with MNA. ; Results ; Among all events where naloxone was administered only 16.7% of the 911 calls specifically identified the medical emergency as a drug ingestion or poisoning event. The percentage of patients receiving MNA increased from 14.5% in 2012 to 18.2% in 2015, which represents a 26% increase in MNA in 4 years. Patients aged 20-29 had the highest percentage of MNA (21.1%). Patients in the Northeast and the Midwest had the highest relative MNA (Chi Squared = 539.5, p < 0.01 and Chi Squared = 351.2, p < 0.01, respectively). The logistic regression model showed that the adjusted odds ratios (aOR) for MNA were greatest among people who live in the Northeast (aOR = 1.18, 95% CI = 1.13-1.22) and for men (aOR = 1.13, 95% CI = 1.10-1.16), but lower for suburban and rural areas (aOR = 0.76, 95% CI = 0.72-0.80 and aOR = 0.85, 95% CI = 0.80-0.89) and lowest for wilderness areas (aOR = 0.76, 95% CI = 0.68-0.84). Higher adjusted odds of MNA occurred when an advanced life support (ALS 2) level of service was provided compared to basic life support (BLS) ambulances (aOR = 2.15, 95% CI = 1.45-3.16) and when the dispatch complaint indicated there was a drug poisoning event (aOR = 1.12, 95% CI = 1.09-1.16). Reported layperson naloxone administration prior to EMS arrival was rare (1%). ; Conclusion ; This study shows that frequency of MNA is growing over time and is regionally dependent. MNA may be a barometer of the potency of the opioid involved in the overdose. The increase in MNAprovides support for a dosage review. Better identification of opioid related events in the dispatch system could lead to a better match of services with patient needs.
• Subjects:
  • Adolescent
  • Adult
  • Aged
  • Analgesics, Opioid
  • Child
  • Child, Preschool
  • Databases, Factual
  • Emergency Medical Services
  • Female
  • Humans
  More +
• Keywords:
  • Naloxone
  • opioid
  • EMS
  • overdose
  • heroin
• Source:
  Prehosp Emerg Care. 21(4):411-419
• Pubmed ID:
  28481656
• Pubmed Central ID:
  PMC6026856
• Document Type:
  Text
• Funding:
  CC999999/Intramural CDC HHSUnited States/
• Genre:
  Journal Article
• Volume:
  21
• Issue:
  4
• Download URL:
  https://stacks.cdc.gov/view/cdc/56643/cdc_56643_DS1.pdf
• File Type:
  [PDF - 377.92 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:26354b82ac38cf2276b88f62d5fcc5be89223ccfe234946ad53daa672f8b4b7e61d12060f8ef2f2474f8c44990603881cf63efc62dc6e1aa743b0e2a72a1e608