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EMS runs for suspected opioid overdose: Implications for surveillance and prevention

机译：EMS因怀疑阿片类药物过量而运行：对监测和预防的意义

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Background. Opioid (including prescription opiate) abuse and overdose rates in the United States have surged in the past decade. The dearth and limitations of opioid abuse and overdose surveillance systems impede the development of interventions to address this epidemic. Objective. We explored evidence to support the validity of emergency medical services (EMS) data on naloxone administration as a possible proxy for estimating incidence of opioid overdose. Methods. We reviewed data from Baltimore City Fire Department EMS patient records matched with dispatch records over a 13-month time period (2008-2009) based on 2008 Census data. We calculated incidence rates and patient demographic and temporal patterns of naloxone administration, and examined patient evaluation data associated with naloxone administration. Results were compared with the demographic distributions of the EMS patient and city populations and with prior study findings. Results. Of 116,910 EMS incidents during the study period for patients aged 15 years and older, EMS providers administered naloxone 1,297 times (1.1% of incidents), an average of 100 administrations per month. The overall incidence was 1.87 administrations per 1,000 residents per year. Findings indicated that naloxone administration peaked in the summer months (31% of administrations), on weekends (32%), and in the late afternoon (4:00-5:00 pm [8%]); and there was a trend toward peaking in the first week of the month. The incidence of suspected opioid overdose was highest among male patients, white patients, and those in the 45-54-year age group. Findings on temporal patterns were comparable with findings from prior studies. Demographic patterns of suspected opioid overdose were similar to medical examiner reports of demographic patterns of fatal drug-or alcohol-related overdoses in Baltimore in 2008-2009 (88% of which involved opioids). The findings on patient evaluation data suggest some inconsistencies with previously recommended clinical indications of opioid overdose. Conclusions. While our findings suggest limitations of EMS naloxone administration data as a proxy indicator of opioid overdose, the results provide partial support for using these data for estimating opioid overdose incidence and suggest ways to improve such data. The study findings have implications for an EMS role in conducting real-time surveillance and treatment and prevention of opioid abuse and overdose.
机译：背景。在过去十年中，阿片类药物（包括鸦片处方药）的滥用和药物过量率呈上升趋势。阿片类药物滥用和药物过量监测系统的缺乏和局限性阻碍了针对这一流行病的干预措施的发展。目的。我们探索了证据来支持关于纳洛酮管理的紧急医疗服务（EMS）数据的有效性，作为估计阿片类药物过量发生率的可能替代指标。方法。我们根据2008年人口普查数据，回顾了巴尔的摩市消防局EMS患者记录与调度记录相匹配的数据，这些记录在13个月的时间段内（2008-2009年）。我们计算了纳洛酮给药的发生率，患者人口统计和时间模式，并检查了与纳洛酮给药相关的患者评估数据。将结果与EMS患者和城市人口的人口分布以及先前的研究结果进行比较。结果。在研究期间针对15岁及15岁以上患者的116,910例EMS事件中，EMS提供者使用了纳洛酮1,297次（占事件的1.1％），平均每月进行了100次给药。总体发生率是每年每1000名居民1.87个主管部门。研究结果表明，纳洛酮的给药高峰在夏季（占给药的31％），周末（32％）和午后（下午4：00-5：00 pm [8％]）达到高峰;并且在本月的第一周有达到峰值的趋势。在男性患者，白人患者以及45-54岁年龄组中，疑似阿片类药物过量的发生率最高。时间模式的发现与先前研究的发现相当。疑似阿片类药物过量的人口统计学特征与医学检查员的报告相似，即2008-2009年巴尔的摩致命药物或酒精相关过量药物的人口统计学特征（88％涉及阿片类药物）。患者评估数据的发现表明与先前推荐的阿片类药物过量临床指征存在某些矛盾之处。结论。尽管我们的发现表明EMS纳洛酮管理数据不能作为阿片类药物过量的替代指标，但结果为使用这些数据估算阿片类药物过量发生率提供了部分支持，并提出了改善此类数据的方法。研究结果对EMS在进行阿片类药物滥用和药物过量的实时监测，治疗和预防中的作用具有重要意义。

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