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Prehospital Naloxone Administration as a Public Health Surveillance Tool: A Retrospective Validation Study

Published online by Cambridge University Press:  10 June 2015

Heather A. Lindstrom ,
Brian M. Clemency ,
Ryan Snyder ,
Joseph D. Consiglio ,
Paul R. May  and
Ronald M. Moscati
Heather A. Lindstrom*
Affiliation:
Department of Emergency Medicine, University at Buffalo, Buffalo, New YorkUSA
Brian M. Clemency
Affiliation:
Department of Emergency Medicine, University at Buffalo, Buffalo, New YorkUSA
Ryan Snyder
Affiliation:
Department of Emergency Medicine, University at Buffalo, Buffalo, New YorkUSA
Joseph D. Consiglio
Affiliation:
Department of Mathematics and Computer Science, John Carroll University, Cleveland, OhioUSA
Paul R. May
Affiliation:
Department of Emergency Medicine, University at Buffalo, Buffalo, New YorkUSA
Ronald M. Moscati
Affiliation:
Department of Emergency Medicine, University at Buffalo, Buffalo, New YorkUSA
*
Correspondence: Heather A. Lindstrom, PhD Department of Emergency Medicine Erie County Medical Center 462 Grider St.Buffalo, New York 14215 USA E-mail: HLindstrom@ecmc.edu
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Abstract

Background

Abuse or unintended overdose (OD) of opiates and heroin may result in prehospital and emergency department (ED) care. Prehospital naloxone use has been suggested as a surrogate marker of community opiate ODs. The study objective was to verify externally whether prehospital naloxone use is a surrogate marker of community opiate ODs by comparing Emergency Medical Services (EMS) naloxone administration records to an independent database of ED visits for opiate and heroin ODs in the same community.

Methods

A retrospective chart review of prehospital and ED data from July 2009 through June 2013 was conducted. Prehospital naloxone administration data obtained from the electronic medical records (EMRs) of a large private EMS provider serving a metropolitan area were considered a surrogate marker for suspected opiate OD. Comparison data were obtained from the regional trauma/psychiatric ED that receives the majority of the OD patients. The ED maintains a de-identified database of narcotic-related visits for surveillance of narcotic use in the metropolitan area. The ED database was queried for ODs associated with opiates or heroin. Cross-correlation analysis was used to test if prehospital naloxone administration was independent of ED visits for opiate/heroin ODs.

Results

Naloxone was administered during 1,812 prehospital patient encounters, and 1,294 ED visits for opiate/heroin ODs were identified. The distribution of patients in the prehospital and ED datasets did not differ by gender, but it did differ by race and age. The frequency of naloxone administration by prehospital providers varied directly with the frequency of ED visits for opiate/heroin ODs. A monthly increase of two ED visits for opiate-related ODs was associated with an increase in one prehospital naloxone administration (cross-correlation coefficient [CCF]=0.44; P=.0021). A monthly increase of 100 ED visits for heroin-related ODs was associated with an increase in 94 prehospital naloxone administrations (CCF=0.46; P=.0012).

Conclusions

Frequency of naloxone administration by EMS providers in the prehospital setting varied directly with frequency of opiate/heroin OD-related ED visits. The data correlated both for short-term frequency and longer term trends of use. However, there was a marked difference in demographic data suggesting neither data source alone should be relied upon to determine which populations are at risk within the community.

LindstromHA, ClemencyBM, SnyderR, ConsiglioJD, MayPR, MoscatiRM. Prehospital Naloxone Administration as a Public Health Surveillance Tool: A Retrospective Validation Study. Prehosp Disaster Med. 2015;30(4):1–5.

Keywords

drug overdoseEmergency Medical Servicesnaloxoneopioidsurveillance
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 30 , Issue 4 , August 2015 , pp. 385 - 389
Copyright
© World Association for Disaster and Emergency Medicine 2015 

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