Research Day

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Abstract Title: FIRST 100 CASES OF BLS FIRST RESPONDER ADMINISTERED NALOXONE IN A STATEWIDE EMS SYSTEM Abstract ID: 240 Abstract Category: Clinical Research BACKGROUND: In October 2015, a midwestern state law mandated that all BLS first responder (FR) agencies be trained and equipped to administer naloxone to suspected opioid-overdose patients. Although well intentioned, several questions have arisen: does naloxone use displace emphasis on early positive pressure ventilation (PPV), is naloxone being appropriately administered, and does the mandate affect patient outcome. The purpose of this study is to evaluate the first 100 cases of FR administered naloxone (FR-naloxone) for administration appropriateness and state protocol adherence which calls for intranasal naloxone after PPV initiation and when ALS is delayed by >5 minutes. METHODS: A retrospective chart review was performed utilizing the statewide EMS information system, filtering on “naloxone” as a medication administered. Beginning with the implementation date of 10/15/2015, the first one-hundred first-responder naloxone administrations were reviewed by a three-investigator panel. Data were abstracted from each case, including initial impression of mental and respiratory status, airway interventions performed, known history of opioid abuse, and timing of ALS arrival. Data were analysed using standard descriptive statistics. RESULTS: Of the first 100 patients, 71% were male, and the median age was 35.5 (18-89) years. Seventy-five percent of naloxone administrations were provided to patients with pulses and inadequate respirations. PPVs were given prior to naloxone in 51.3% of patients with inadequate respirations. History of prior drug use was reported by the FR in 66% of cases. FRs initiated PPV in 39.4% of known drug abuse patients versus 61.7% in those without known abuse (p=0.0337). ALS reportedly arrived within 5 minutes of FR arrival in 38% of cases, >5 minutes in 17% of cases, and in 57% of cases there was no reference to ALS response time. CONCLUSION: Adherence to the state naloxone protocol appears poor among FRs. Based on initial patient evaluation, the majority of patients given naloxone had an inadequate respiratory effort. Pre-naloxone PPV was frequently not reported in patients with decreased respirations. A history of known drug abuse was associated with less frequent PPV. ALS arrived within 5 minutes of FR-naloxone in at least one-third of patients.



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