Risk of EMS Transport Refusal After Naloxone

Written by Cliff Freeman

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Patient refusal of EMS transport after opioid overdose is associated with increased risk of repeat pre-hospital encounter for non-fatal overdose.


Why does this matter?
We know that naloxone administration is associated with increased mortality over the following year. So, what can be done about it? With increasing options for initiation of opioid addiction treatment in emergency departments, should we consider aggressively recommending EMS transports for patients receiving naloxone?

A ride to recovery
This was a retrospective review analyzing 1600 encounters in a single fire-based EMS system in which patient contact was made due to concern for opiate overdose and naloxone administration by police, bystanders, or EMS. Many of these were repeat encounters, with only 1308 individuals making up the 1600 runs. 59.3% of patients were transported by EMS during the initial visit. Declining transport was associated with a repeat EMS encounter requiring naloxone with a hazard ratio of 1.66 (95% CI 1.23-2.23). Notably, this was during 2018, when many EDs in the study area were not routinely offering Medication Assisted Treatment or naloxone take-home programs. The question remains if the people who refused transport would also refuse MAT, or if presenting to the ED (or providing MAT in a pre-hospital system) would decrease the rate of future opioid overdoses.

Source
Non-transport after Prehospital Naloxone Administration Is Associated with Higher Risk of Subsequent Non-fatal Overdose. Prehosp Emerg Care. 2021 Feb 26:1-11. doi: 10.1080/10903127.2021.1884324. Epub ahead of print.

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