Role of a prehospital medical system in reducing heroin-related deaths

Bertini, G; Russo, Laura; Cricelli, Fabio; Daraio, Antonia; Giglioli, Cristina; Pini, Corrado; Poli, C; Taddei, Tamara; Taiti, Andrea; Terni, Gianna; Gensini, Gianfranco

doi:10.1097/00003246-199204000-00011

Cited by 29 publications

(13 citation statements)

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“…Other studies have suggested that out-of-hospital naloxone use is effective in reducing opioid-related morbidity and mortality. 10 In comparing patient demographics, our study exhibited similar age and gender distributions compared with other studies. 9,11 Although the immediate effectiveness and safety of out-of-hospital naloxone has been well shown, the need for transport and further medical evaluation in opioid-overdose patients who improve after naloxone administration in the field has been less clear.…”

Section: Discussionsupporting

confidence: 71%

Assessment for Deaths in Out‐of‐hospital Heroin Overdose Patients Treated with Naloxone Who Refuse Transport

Vilke

2003

Academic Emergency Medicine

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Section: Discussionsupporting

confidence: 71%

Assessment for Deaths in Out‐of‐hospital Heroin Overdose Patients Treated with Naloxone Who Refuse Transport

Vilke

2003

Academic Emergency Medicine

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“…The literature is contradictory in considering the relationship of the severity of an overdose to the dose of heroin. A correlation has been noted (Bertini et al . 1992).…”

Section: Prevalence Of Heroin Overdosesupporting

confidence: 61%

“…Infrequent causes of delayed death from heroin overdose are non‐cardiogenic pulmonary edema and aspiration pneumonia. Bertini et al . (1992) found a rate of non‐cardiogenic pulmonary edema of 0.8% and the rate was 0.9% in the study by Sporer, Firestone & Isaacs (1996).…”

Section: Pathophysiology Of Heroin Overdosementioning

confidence: 99%

Take‐home naloxone to reduce heroin death

2005

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At this point the evidence supporting naloxone distribution is primarily anecdotal, although promising. Although the distribution of naloxone holds promise for further reducing heroin overdose mortality, problems remain. Naloxone alone may be insufficient in some cases to revive the victim, and cardiopulmonary resuscitation (CPR), especially rescue breathing, may also be needed. A second dose of naloxone might be necessary. Complications following resuscitation from overdose may infrequently need in-hospital care. Mortality from injecting without anyone else present will be unaffected by take-home naloxone. Take-home naloxone should be studied in a rigorous scientific manner.

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“…Adapted from Hoffman et al [10] The administration of naloxone to a patient with hypoventilation due to opioid overdose is a potentially life-saving prehospital intervention. An Italian study demonstrated that the mortality for overdoses was significantly lower in a city whose EMS systems protocolized administration of naloxone [15]. Subsequently, a protocol for EMS administration of naloxone for opioid overdoses was first published in 1996 [16].…”

Section: Discussionmentioning

confidence: 99%

Validation of Criteria to Guide Prehospital Naloxone Administration for Drug-Related Altered Mental Status

Friedman

Manini

2016

J. Med. Toxicol.

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Introduction We aimed to validate previously derived clinical criteria to predict successful prehospital response to naloxone in patients with altered mental status treated by EMS. We hypothesized that prehospital naloxone criteria would have high sensitivity for effective antidote response, but would be underutilized, in patients with drug-related altered mental status (DRAMS). Methods This study was a secondary data analysis of a prospective cohort of acute DRAMS at an urban ED. Naloxone criteria (respiratory rate (RR) <12, miotic pupils, or drug paraphernalia) and mental status, graded by either AVPU (Alert, Verbal, Painful, Unresponsive) or Glasgow Coma Scales, were abstracted from prehospital care reports. Interventions were compared for effective antidote response (EAR), defined as immediate improvement in RR, AVPU, or GCS. Results EMS transported 249 DRAMS over 17 months (48 % males, mean age 41.5, ALS 33.7 %). Forty-three (17 %) patients met naloxone criteria, of whom 44.2 % received the antidote. Naloxone criteria significantly predicted EAR (OR 7.0, p < 0.05) with 83 % sensitivity (95 % CI, 55-95 %). Miotic pupils (OR 20.0, p < 0.01) outperformed RR (OR 2.3, p = NS) as the best single criterion with 91 % sensitivity (95 % CI, 62-98 %). Conclusions This study validates prehospital criteria to guide naloxone administration. In addition, prehospital naloxone was underutilized for DRAMS. Further studies should address potential barriers to prehospital naloxone administration.

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Role of a prehospital medical system in reducing heroin-related deaths

Cited by 29 publications

References 0 publications

Assessment for Deaths in Out‐of‐hospital Heroin Overdose Patients Treated with Naloxone Who Refuse Transport

Assessment for Deaths in Out‐of‐hospital Heroin Overdose Patients Treated with Naloxone Who Refuse Transport

Take‐home naloxone to reduce heroin death

Validation of Criteria to Guide Prehospital Naloxone Administration for Drug-Related Altered Mental Status

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