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ABSTRACT

Introduction: Opioid overdoses have reached crisis proportions. One response has been to increase the availability of naloxone HCl (commonly referred to by the generic name naloxone), which reverses the effects of opioid overdose. The Medical Priority Dispatch System (MPDS®) includes instructions by which the Emergency Medical Dispatcher (EMD) can prompt the caller to find and use naloxone on overdose victims. However, these instructions are only provided on dispatch Chief Complaint (CC) Protocols on which overdoses are expected to be handled.

Objectives: The primary objective of this study was to determine the distribution of CC Protocols and determinant codes on which overdose (or likely overdose) cases were handled. The secondary objective was to characterize the frequency of naloxone administration on scene by Emergency Medical Services (EMS) providers and relate this to patient acuity.

Methods: This was a retrospective, descriptive, and uncontrolled study of de-identified EMD and EMS data, from two US Emergency Communications Centers: Richmond Ambulance Authority (RAA), Richmond, VA, and EMS Authority (EMSA), Oklahoma City and Tulsa, Oklahoma. The study sample included all EMS and dispatch cases in which naloxone was administered. A convenience sample of about 4.5 years of ProQA® (software version of MPDS) and corresponding electronic patient care report (ePCR) datasets were collected, from July 2013 to December 2017. The ProQA (dispatch) dataset comprised patient/caller call triage data and ePCR dataset comprised patient/caller data collected on scene by the EMS provider.

Results: A total 5,843 calls where naloxone was administered by EMS were collected during the study period, of which 1,081 (18.5%) were outliers; 4,762 (81.5%) were therefore included in the study. Overall, naloxone was administered by EMS in 0.53% of total cases (0.46% in EMSA and 1.28% in RAA), and the results showed an increasing trend over the years. Naloxone was administered most frequently on five CC Protocols: Unconscious/Fainting (30.0%), Overdose/Poisoning (18.4%), Cardiac or Respiratory Arrest/Death (16.3%), Sick Person (8.1%), and Unknown Problem (6.9%). Overall, the condition of most patients to whom naloxone was administrated improved (52.7%) or remained unchanged (44.6%).

Conclusions: Suspected overdoses are frequently not reported as overdoses. Understanding how opioid overdoses are initially reported to 911 can inform dispatch protocol development, so as to improve identification of opioid overdose and increase the provision of naloxone instructions.

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