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A Comparison of Efficacy of Treatment and Time to Administration of Naloxone by BLS and ALS Providers

Published online by Cambridge University Press:  19 July 2019

Kenneth Nugent ,
Patrick Matthews ,
Jamie Gissendaner ,
Mia Papas ,
Deborah Occident ,
Avkash Patel ,
Michelle Johnson ,
Ross E. Megargel  and
Jason T. Nomura
Kenneth Nugent*
Affiliation:
Emergency Department, Christiana Care Health System, Newark, Delaware, USA
Patrick Matthews
Affiliation:
Emergency Department, Christiana Care Health System, Newark, Delaware, USA Delaware Office of Emergency Medical Services, Smyrna, Delaware, USA
Jamie Gissendaner
Affiliation:
Emergency Department, Christiana Care Health System, Newark, Delaware, USA
Mia Papas
Affiliation:
Emergency Department, Christiana Care Health System, Newark, Delaware, USA
Deborah Occident
Affiliation:
Emergency Department, Christiana Care Health System, Newark, Delaware, USA
Avkash Patel
Affiliation:
Emergency Department, Christiana Care Health System, Newark, Delaware, USA
Michelle Johnson
Affiliation:
Delaware Office of Emergency Medical Services, Smyrna, Delaware, USA
Ross E. Megargel
Affiliation:
Emergency Department, Christiana Care Health System, Newark, Delaware, USA Delaware Office of Emergency Medical Services, Smyrna, Delaware, USA
Jason T. Nomura
Affiliation:
Emergency Department, Christiana Care Health System, Newark, Delaware, USA
*
Correspondence: Kenneth Nugent, MD 633 S. St. Mary’s St. Unit 5405 San Antonio, Texas 78205 USA E-mail: Nugent.kenneth@gmail.com
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Abstract

Introduction:

The administration of naloxone therapy is restricted by scope of practice to Advanced Life Support (ALS) in many Emergency Medical Services (EMS) systems throughout the United States. In Delaware’s two-tiered EMS system, Basic Life Support (BLS) often arrives on-scene prior to ALS, but BLS providers were not previously authorized to administer naloxone. Through a BLS naloxone pilot study, the researchers sought to evaluate BLS naloxone administration and timing compared to ALS.

Hypothesis:

After undergoing specialized training, BLS providers would be able to appropriately administer naloxone to opioid overdose patients in a more timely manner than ALS providers.

Methods:

This was a retrospective, observational study using data collected from February 2014 through May 2015 throughout a state BLS naloxone pilot program. A total of 14 out of 72 state BLS agencies participated in the study. Pilot BLS agencies attended a training session on the indications and administration of naloxone, and then were authorized to carry and administer naloxone. Researchers then compared vital signs and the time of BLS arrival to administration of naloxone by BLS and ALS. Data were analyzed using paired and independent sample t-tests, as well as chi-square, as appropriate.

Results:

A total of 131 incidents of naloxone administration were reviewed. Of those, 62 patients received naloxone by BLS (pilot group) and 69 patients received naloxone by ALS (control group). After naloxone administration, BLS patients showed improvements in heart rate (HR; P < .01), respiratory rate (RR; P < .01), and pulse oximetry (spO2; P < .01); ALS patients also showed improvement in RR (P < .01), and in spO2 (P = .005). There was no significant improvement in HR for ALS providers (P = .189).

There was a significant difference in arrival time of BLS to the time of naloxone administration between the two groups, with shorter times in the BLS group compared to the ALS group (1.9 minutes versus 9.8 minutes; P < .01); BLS administration was 7.8 minutes faster when compared to ALS administration (95% CI, 6.2-9.3 minutes).

Conclusions:

Patients improved similarly and received naloxone therapy sooner when treated by BLS agencies carrying naloxone than those who awaited ALS arrival. All EMS systems should consider allowing BLS to carry and administer naloxone for an effective and potentially faster naloxone administration when treating respiratory compromise related to opiate overdose.

Keywords

Basic Life SupportEmergency Medical Servicesnaloxoneopioid overdoseprehospital
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 4 , August 2019 , pp. 350 - 355
Copyright
© World Association for Disaster and Emergency Medicine 2019 

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