Prehospital Emergency Care最新文献

{"title":"Emergency Medical Services Utilization of Medication for Opioid Use Disorder: A Narrative Review of the Literature and Analysis of Prehospital Buprenorphine Protocols.","authors":"Kasha Bornstein, David Rayburn","doi":"10.1080/10903127.2025.2486292","DOIUrl":"10.1080/10903127.2025.2486292","url":null,"abstract":"<p><strong>Objectives: </strong>This narrative review examines the current literature and prehospital buprenorphine protocols, discusses the available outcomes data of existing protocols, identifies protocol variations, and highlights challenges and opportunities associated with prehospital medication for opioid use disorder (MOUD) initiation.</p><p><strong>Methods: </strong>PubMed was searched for articles from 1/1/2010 to 2/1/2025, using keywords \"Prehospital Buprenorphine,\" \"Emergency Medical Services Buprenorphine,\" \"EMS Medication for Opioid Use Disorder,\" and \"Prehospital MOUD.\" All EMS protocols from the website http://www.emsprotocols.org (Acid Remap, LLC) were reviewed, supplemented with internet searches. A data dictionary was developed to categorize protocol characteristics; categories of responses included minimum Clinical Opiate Withdrawal Scale (COWS) scores, initial and maximum buprenorphine dosages, adjunct medications for withdrawal symptoms, online medical control (OMC) consultation requirements, minimum age, contraindications and exclusion criteria, and post-induction follow-up.</p><p><strong>Results: </strong>Six statewide prehospital MOUD protocols were identified, along with regional protocols in 21 states and Washington, DC. Details were available for 42 state or regional protocols. Initial dosing across all protocols ranged between 4 and 24 mg. Maximum dosing ranged between 8 and 48 mg. The median initial and total dosage was 16 mg and 24 mg, respectively. Adjunctive medication for withdrawal was available in 61.9% of protocols. Treatment with MOUD was limited to mobile integrated health/community paramedicine programs in 19% of protocols. Otherwise, administration was permitted <i>via</i> standing order in 52.4% and required physician authorization in 26.2% of protocols. The minimum COWS scores ranged between 5 and 8, with 71.5% of protocols requiring a COWS score >7. Most (59.5%) protocols specified 18 years as the minimum age, while 23.8% specified 16 years. Buprenorphine was contraindicated for pregnant patients in 38% of protocols, while 9.6% of protocols required OMC consultation. Ten peer-reviewed studies evaluating EMS MOUD protocols outcomes were identified, most of which reported successful initiation, linkage to care, and retention for significant proportions of patients evaluated for opioid overdose and/or opioid withdrawal symptoms.</p><p><strong>Conclusions: </strong>Prehospital MOUD protocol design varies significantly, and best practices remain unknown, particularly regarding protocol inclusion criteria, dosing regimens, adjunctive medications, and resources to ensure continuity. The available data suggest protocols with more permissive inclusion criteria and comprehensive service provision are associated with higher rates of linkage to care.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"407-419"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editor's Introduction to Special Issue on Enhancing Prehospital Care for Patients with Opioid Use Disorder.","authors":"Remle P Crowe","doi":"10.1080/10903127.2025.2496231","DOIUrl":"10.1080/10903127.2025.2496231","url":null,"abstract":"","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"323-324"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying the Local Emergence of Medetomidine Through Prehospital Collaborations.","authors":"Brian Rettger, Brittany P Chapman, Alex Krotulski, Ronald Gigliotti, Jyothi Polackal, Deborah Olabisi, John Nguyen, Brian Cotoni, Michael Hunter, Roland Clayton Merchant, Sara Walton, Barry K Logan, Patricia Mae Martinez, Stacy N Weisberg, John P Broach, Kavita M Babu","doi":"10.1080/10903127.2025.2491752","DOIUrl":"10.1080/10903127.2025.2491752","url":null,"abstract":"<p><strong>Objectives: </strong>Medetomidine, an alpha-two receptor agonist, has been recently detected as an adulterant of the illicit opioid supply in multiple states and observed to complicate clinical management of opioid overdoses through sedation, hypotension, and/or bradycardia. Our goal is to describe the process through which a novel adulterant of illicit opioids was identified in our community, and describe the process through which this information was disseminated to key stakeholders, including emergency medical services, emergency medicine and internal medicine providers, local and state departments of health, harm reduction advocates, people who drugs, and lay media.</p><p><strong>Methods: </strong>After a paramedic from Worcester Emergency Medical Services described an increase in overdose alert activity, we were able to obtain blood specimens from two patients during a cluster of overdoses. These blood specimens were sent to a research laboratory for analytical toxicology testing.</p><p><strong>Results: </strong>Analyses of the two patient blood samples identified the presence of fentanyl, xylazine, and medetomidine. These patients were noted to be bradycardic and hypotensive on presentation to care, an observation that did not reflect the use of fentanyl alone. We subsequently reviewed our findings with local and state departments of health, local harm reduction agencies lay media, and patients presenting to our mobile addiction clinic.</p><p><strong>Conclusions: </strong>Medetomidine, an emerging adulterant, further complicates the clinical care of exposed patients in overdose and magnifies features of xylazine exposure. In this case, prehospital data and clinical observation led to the identification of medetomidine in our community. With appropriate analytical toxicology resources, pre-hospital providers can translate clinical observation into new drug or adulterant identification, improving clinical care and public health.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"338-342"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Providing Performance Feedback and Patient Outcome Follow-Up to Emergency Medical Services (EMS) is Associated with Subsequent Improved Clinical Performance.","authors":"Sarayna S McGuire, Aaron Klassen, Anuradha Luke, Lisa Rentz, Chad P Liedl, Aidan F Mullan, Matthew D Sztajnkrycer","doi":"10.1080/10903127.2024.2383323","DOIUrl":"10.1080/10903127.2024.2383323","url":null,"abstract":"<p><strong>Objective: </strong>Emergency Medical Services (EMS) clinicians desire performance feedback (PF) and patient outcome follow-up (POF). Within our agency, both a peer-review and feedback/outcome (PF/POF) process exist. Our objective was to determine whether receiving feedback and outcome data improved future clinical care amongst EMS, based upon peer-review scores.</p><p><strong>Methods: </strong>This retrospective cohort study took place between 1/1/2020 and 6/7/2023 within an EMS agency site with 22,000 average annual 9-1-1 calls. Requests for PF/POF were submitted on an individual basis beginning June 2020 and completed by a dedicated EMS nurse, EMS physician, or emergency medicine (EM) resident. Peer-review of select high-acuity cases were scored by two Quality Assurance (QA) specialists within the categories of assessment, treatment, disposition/outcome and process/administrative guidelines. Association between overall peer-review score and number of PF/POF requests at time of assessment was evaluated by linear regression.</p><p><strong>Results: </strong>A total of 378 PF/POF requests were received, with the most common patient complaints being cardiac (<i>n</i> = 105; 27.8%, including 49 (13.0%) out of hospital cardiac arrests), altered mental status/neurologic (<i>n</i> = 103; 27.2%), trauma (<i>n</i> = 61; 16.1%, including 2 (0.5%) traumatic arrests); and respiratory distress (<i>n</i> = 47; 12.4%). A total of 378 runs meeting QA criteria were peer-reviewed post-PF/POF process implementation, including 337 (89.2%) cardiac/respiratory arrests, 27 (7.1%) with difficult airway management, and 14 (3.7%) major trauma/traumatic arrests. The number of prior PF/POF requests made by the team leader was associated with higher overall peer-review scores. Team leaders with <u>></u>5 prior PF/POF requests had a peer-review score 0.39 points greater (95% CI: 0.16 - 0.62, <i>p</i> = 0.001) than those with <5 prior requests. The number of prior PF/POF requests amongst the entire crew was also associated with higher peer-review scores. Crews that collectively had <u>></u>5 prior PF/POF requests had an increase in peer-review score 0.32 points greater (95% CI: 0.14 - 0.50, <i>p</i> < 0.001) than those with <5 prior requests.</p><p><strong>Conclusion: </strong>Providing performance feedback and patient outcome follow-up to EMS is associated with improved peer-review scores of clinical performance. Future studies should assess if those that are submitting cases for feedback/outcome are higher performers at baseline or if the process of receiving feedback/outcome improves their performance.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"632-638"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141760507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Emergency Mental Health Dispatch Training by a 9-1-1 Medical Dispatcher Assisting a Caller Expressing Suicidal Intent: A Case Report.","authors":"Lori L Boland, Kelly E Ryan, Jonathan M Flynn, Angie Fox, Joey L Duren","doi":"10.1080/10903127.2024.2399800","DOIUrl":"10.1080/10903127.2024.2399800","url":null,"abstract":"<p><p>A growing number of individuals with unmet mental health needs in the United States rely on emergency medical services during mental health crises, and 9-1-1 emergency medical dispatchers (EMD) are often a critical lifeline to help. Unfortunately, current industry-standard dispatching protocols and training required for EMD certification largely lack specificity for managing 9-1-1 calls related to mental health emergencies. The purpose of this report is to illustrate the value of additional targeted training for EMDs that enables them to more effectively assist callers struggling with mental illness or suicidal thoughts. We review a 9-1-1 call in which an EMD utilized specific strategies and language learned during a 3-day emergency mental health dispatch (EMHD) training course to assist a middle-aged male who was expressing suicidal intent with a firearm. Key principles and phrasing from the training were used successfully by the EMD to dissuade the caller from self-harm, and he was ultimately safely met by first responders on scene and transported for care. We also share post-call recollections and reactions from the EMD to demonstrate how in addition to reducing risks for callers and their families, EMHD training has the potential to reduce on-scene risks for field responders and may increase confidence and mitigate negative stress responses in EMDs. Emergency medical services systems in the United States should continue to explore enhanced training and protocols to improve care for 9-1-1 callers experiencing mental health crises.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"96-99"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Performance of ChatGPT-4 and Gemini Ultra 1.0 for Quality Assurance Review in Emergency Medical Services Chest Pain Calls.","authors":"Graham Brant-Zawadzki, Brent Klapthor, Chris Ryba, Drew C Youngquist, Brooke Burton, Helen Palatinus, Scott T Youngquist","doi":"10.1080/10903127.2024.2376757","DOIUrl":"10.1080/10903127.2024.2376757","url":null,"abstract":"<p><strong>Objectives: </strong>This study assesses the feasibility, inter-rater reliability, and accuracy of using OpenAI's ChatGPT-4 and Google's Gemini Ultra large language models (LLMs), for Emergency Medical Services (EMS) quality assurance. The implementation of these LLMs for EMS quality assurance has the potential to significantly reduce the workload on medical directors and quality assurance staff by automating aspects of the processing and review of patient care reports. This offers the potential for more efficient and accurate identification of areas requiring improvement, thereby potentially enhancing patient care outcomes.</p><p><strong>Methods: </strong>Two expert human reviewers, ChatGPT GPT-4, and Gemini Ultra assessed and rated 150 consecutively sampled and anonymized prehospital records from 2 large urban EMS agencies for adherence to 2020 National Association of State EMS metrics for cardiac care. We evaluated the accuracy of scoring, inter-rater reliability, and review efficiency. The inter-rater reliability for the dichotomous outcome of each EMS metric was measured using the kappa statistic.</p><p><strong>Results: </strong>Human reviewers showed high interrater reliability, with 91.2% agreement and a kappa coefficient 0.782 (0.654-0.910). ChatGPT-4 achieved substantial agreement with human reviewers in EKG documentation and aspirin administration (76.2% agreement, kappa coefficient 0.401 (0.334-0.468), but performance varied across other metrics. Gemini Ultra's evaluation was discontinued due to poor performance. No significant differences were observed in median review times: 01:28 min (IQR 1:12 - 1:51 min) per human chart review, 01:24 min (IQR 01:09 - 01:53 min) per ChatGPT-4 chart review (<i>p</i> = 0.46), and 01:50 min (IQR 01:10-03:34 min) per Gemini Ultra review (<i>p</i> = 0.06).</p><p><strong>Conclusions: </strong>Large language models demonstrate potential in supporting quality assurance by effectively and objectively extracting data elements. However, their accuracy in interpreting non-standardized and time-sensitive details remains inferior to human evaluators. Our findings suggest that current LLMs may best offer supplemental support to the human review processes, but their current value remains limited. Enhancements in LLM training and integration are recommended for improved and more reliable performance in the quality assurance processes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"210-217"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141559570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Methodology for Linking 9-1-1 Dispatch Categories with a Death Registry: Mortality Rates of Selected Dispatch Categories.","authors":"Karl A Sporer, Kristen M Bascombe, Tarak K Trivedi, Timothy Hong, Mary P Mercer","doi":"10.1080/10903127.2024.2372442","DOIUrl":"10.1080/10903127.2024.2372442","url":null,"abstract":"<p><strong>Objectives: </strong>Medical Priority Dispatch System (MPDS) is a system used to assign medical 9-1-1 calls to one of 35 chief complaints that are further categorized in order of increasing priority, Alpha through Echo. In this descriptive study we demonstrate the methodology of matching MPDS codes to a county mortality registry. We also evaluated the ability of select MPDS codes (fall, respiratory, sick person, and abdominal pain) to predict mortality up to 30 d for all ages transported by Alameda County Emergency Medical Services (EMS).</p><p><strong>Methods: </strong>Using Alameda County EMS data, we conducted a retrospective review of all EMS encounters that occurred from November 1, 2011, to November 1, 2016. To describe mortality in this population, we identified unique patients and linked them to the Alameda County Public Health Death Registry. We identified mortality at 48 h, 7 d, and 30 d after an EMS encounter.</p><p><strong>Results: </strong>Approximately 99% of the EMS encounters were matched with unique patient identifiers, yielding a study sample of 202,431 (4% less than age 18, 53% between ages 18-65, and 43% over age 65). Patients with a respiratory chief complaint had the highest mortality percentage in each age group (0.23%, 2.7%, and 14.55% respectively). There was no correlation between the MPDS code and mortality for patients less than age 18. An increase in Alpha through Echo designation for respiratory complaints in patients 18-65 and older than 65 years corresponded with an increase in 30-day mortality.</p><p><strong>Conclusions: </strong>This study demonstrates an upward trend in mortality with increasing acuity of Alpha through Echo designations for adult patients with respiratory complaints. Mortality increased with age in this cohort. Most of the deaths occurred after 7 days.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"259-265"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of a Post-Overdose Outreach Program in King County, Washington: Lessons Learned Through Continuous Quality Improvement.","authors":"Hannah N Collins, Amy J Poel, Jennifer Liu, Megin Parayil, Sarah Gimbel, Julia E Hood","doi":"10.1080/10903127.2024.2399214","DOIUrl":"10.1080/10903127.2024.2399214","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency Medical Services patients who survive overdose are at high risk for subsequent overdose and death. Programs that seek to link overdose survivors to harm reduction and treatment services are increasingly common, though they vary in design and measured effect. Public Health - Seattle & King County (PHSKC) used a continuous quality improvement (CQI) process to assess and improve a phone-based model for post-overdose outreach in King County, Washington.</p><p><strong>Methods: </strong>King County Emergency Medical Services (KC-EMS) health records are queried weekly to identify suspected opioid overdose and other drug-related encounters. Patients treated by KC-EMS that met outreach eligibility criteria were contacted by phone and offered referrals to local services. Three Plan-Do-Study-Act (PDSA) cycles were sequentially implemented to iteratively assess program indicators and implement program adaptations. The PDSA cycles varied in terms of eligibility criteria, outreach modality, and level of resources devoted to phone number searches. Program indicators and corresponding costs were measured for each phase and calculated per month, per eligible patient, and per patient referred to services.</p><p><strong>Results: </strong>During the initial call-based outreach pilot, the fewest number of patients met eligibility criteria (monthly average =39) and were referred to services (monthly average =2). In Phase Two, outreach shifted to automated texting and eligibility criteria expanded, resulting in an increase in the monthly average number of eligible patients (monthly average =137) and patients referred to services (monthly average =3). Phase Three adaptations expanded eligibility criteria further but limited outreach to patients with a phone number documented in their KC-EMS record, resulting in an average of 405 eligible patients per month and four patients that were referred to services. The costs per patient referred to services changed from $454 in Phase one to $589 in Phase Two to $279 in Phase Three.</p><p><strong>Conclusions: </strong>The PDSA process helped PHSKC's post-overdose outreach team identify adaptations to improve the efficiency of the post-overdose outreach program. The number of people referred to services was modest, reflecting the challenges of post-incident phone-based outreach. Our experience highlights the value of incorporating CQI processes in ongoing program operations and the need for a multi-pronged overdose prevention strategy.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"546-549"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The CARE Overdose Response Team in Chicago: A Multidisciplinary Out-of-Hospital Post-Opioid Overdose Intervention.","authors":"Megan Weston, Dora Khoury, David Kwon, Sarah Richardson, Lauretta E Omale, Antonio D Jimenez, Jonathan Zaentz, Katie Tataris, Miao Jenny Hua","doi":"10.1080/10903127.2024.2441485","DOIUrl":"10.1080/10903127.2024.2441485","url":null,"abstract":"<p><strong>Objectives: </strong>In 2021, the opioid overdose crisis led to 1441 fatalities in Chicago, the highest number ever recorded. Interdisciplinary post-overdose follow-up teams provide care at a critical window to mitigate opioid-related risk and associated fatalities. Our objective was to describe a pilot follow-up program in Chicago including eligible overdose incidents, provision of response team services, and program barriers and successes.</p><p><strong>Methods: </strong>Chicago's Crisis Assistance Response and Engagement Overdose Response Team (CARE ORT) was piloted starting February 1, 2023 across three neighborhoods that collectively responded to an average of 6-7 opioid-related Emergency Medical Services (EMS) incidents each day, among the highest in Chicago. The program involved a two-member field response team consisting of a community paramedic and a peer recovery coach that followed-up with individuals who experienced an opioid overdose in the previous 24-72 h to offer connections to treatment, overdose education and harm reduction kits including naloxone.</p><p><strong>Results: </strong>During its 14-month pilot, there were 2875 eligible overdose events within the pilot area. A total of 723 (25.2%) individuals received an outreach attempt, of which 65 individuals (9.0%) were reached and accepted services. Most overdose incident locations were in public locations (78.4%), but most of the patients that CARE ORT served had overdosed in a private residence (76.9%) and reported being stably housed (71.0%). Among the 65 individuals reached and served, 31 (47.7%) had a prior overdose event in the past 12 months and 32 (49.2%) accessed naloxone in the past three months. Twenty-nine out of 65 CARE ORT patients (44.6%) were referred to outpatient, inpatient or residential treatment and 19 of those (65.5%) for medication assisted recovery with buprenorphine, methadone, or naltrexone.</p><p><strong>Conclusions: </strong>The CARE ORT model proved successful in engaging predominantly older, non-Hispanic Black men in post-overdose outreach who were stably housed. While the number of individuals reached compared to the total eligible individuals was low, the program successfully navigated multiple barriers of limited EMS referral information, limited accuracy of data management, and urban realities of public overdose locations to reach a marginalized patient population with a high risk of mortality.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"534-539"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precipitated Withdrawal Induced by Prehospital Naloxone Administration.","authors":"Lindsey A Vandergrift, Amber D Rice, Keith Primeau, Joshua B Gaither, Rachel D Munn, Philipp L Hannan, Mary C Knotts, Adrienne Hollen, Brian Stevens, Justin Lara, Melody Glenn","doi":"10.1080/10903127.2024.2449505","DOIUrl":"10.1080/10903127.2024.2449505","url":null,"abstract":"<p><strong>Objectives: </strong>Buprenorphine is becoming a key component of prehospital management of opioid use disorder. It is unclear how many prehospital patients might be eligible for buprenorphine induction, as traditional induction requires that patients first have some degree of opioid withdrawal. The primary aim of this study was to quantify how many patients developed precipitated withdrawal after receiving prehospital naloxone for suspected overdose, as they could be candidates for prehospital buprenorphine. The secondary objective was to identify associated factors contributing to precipitated withdrawal, including dose of naloxone administered, and identify rate of subsequent transport.</p><p><strong>Methods: </strong>A retrospective cohort study reviewing electronic patient care reports (ePCRs) from March 2019 to April 2023 in a single Emergency Medical Services (EMS) system was performed. Cases were included if naloxone was administered during the prehospital interval and excluded if the patient was in cardiac arrest upon arrival and died on scene. Precipitated opioid withdrawal was defined using reliably available ePCR data points measured by the Clinical Opiate Withdrawal Scale: administration of an antiemetic or sedative, persistent tachycardia, or new tachycardia after naloxone. Descriptive statistics were calculated to quantify the incidence of precipitated withdrawal. Risk ratios were calculated to identify variables associated with outcomes of interest. A subgroup analysis was performed examining patients explicitly diagnosed with an overdose by EMS.</p><p><strong>Results: </strong>During the study period, 4561 individuals were given naloxone, and 2124 (46.2%) met our proxy criteria for precipitated withdrawal. Patients who received multiple doses of naloxone were more likely to meet our precipitated withdrawal definition versus those who received a single dose (RR 1.2, 95% CI 1.12-1.28). Patients who experienced precipitated withdrawal were more likely to accept transportation than those who did not experience withdrawal (RR 1.08 95% CI 1.04-1.12). Persistent tachycardia (80.3%) was the most common criterion met for our definition of precipitated withdrawal.</p><p><strong>Conclusions: </strong>Almost half of patients who received a dose of prehospital naloxone for suspected overdose met our proxy criteria for precipitated withdrawal. Patients who met our precipitated withdrawal definition were more likely to have received greater doses of naloxone and were more likely to accept transport to an emergency department.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"367-373"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}