Disposition Outcomes Following Prehospital Use of Naloxone in a Large Metropolitan City in the United States.

OBJECTIVES: During a drug overdose, research suggests individuals may not call 9-1-1 out of fear of criminal justice concerns. Of those that call, research is inconclusive about the disposition of the emergency transport. We evaluated transport outcomes for adults with opioid-related overdose in the Emergency Medical Services (EMS) of a large metropolitan city in the United States. METHODS: We reviewed the EMS incident report database from the patient care record system for years 2018 to 2022. We queried all records, searching for relevant terms, and two reviewers cross-checked the database to identify cases that did not result in death at the scene. Study outcome was defined as hospital transportation or no transportation. Multivariable logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for hospital transport with patient age, sex, race and ethnicity as the independent variables. RESULTS: We identified 5,482 cases of nonfatal opioid-related overdose. Of these, 4,984 (90.9%) were transported to the hospital; 37 (0.7%) were placed in police custody; 304 (5.5%) were not transferred; and 157 (2.9%) had unknown outcomes. Among 5,288 with data on the transport outcome, the majority were male (65%), and the highest proportion were White (39%). Compared to those who were not transported, each 1-year increase in age was related to a 2% increase in the odds of transportation (OR: 1.02, 95% CI: 1.01-1.02). Compared to White patients, Black and Hispanic patients were 43% OR: 1.43, 95% CI: 1.07-1.90) and 44% (OR: 1.44, 95% CI: 1.03-2.00) more likely to be transported. CONCLUSIONS: Individuals with suspected opioid-related overdose who call 9-1-1 are most often transported to the hospital. Current EMS procedures are successful at on-scene treatment and transportation; however, data on the long-term impact of opioid-related overdoses are still needed.

Public Intoxication: Sobering Centers as an Alternative to Incarceration, Houston, 2010-2017.

In 2010, the Houston police department admitted 20 508 publicly intoxicated individuals into its jail. To address jail overcrowding, the city created a jail diversion policy that allowed law enforcement to admit publicly intoxicated individuals into a new sobering center. By 2017, public intoxication jail admissions had decreased by 95%, freeing valuable resources. A promising public health intervention, sobering centers offer an alternative to incarceration and relieve overuse of emergency services while assisting individuals with substance use issues.

Health Information Exchange in Emergency Medicine.

Emergency physicians often must make critical, time-sensitive decisions with a paucity of information with the realization that additional unavailable health information may exist. Health information exchange enables clinician access to patient health information from multiple sources across the spectrum of care. This can provide a more complete longitudinal record, which more accurately reflects the way most patients obtain care: across multiple providers and provider organizations. This information article explores various aspects of health information exchange that are relevant to emergency medicine and offers guidance to emergency physicians and to organized medicine for the use and promotion of this emerging technology. This article makes 5 primary emergency medicine-focused recommendations, as well as 7 additional secondary generalized recommendations, to health information exchanges, policymakers, and professional groups, which are crafted to facilitate health information exchange's purpose and demonstrate its value.

It's Your House - Come On In.

We are pleased to announce the debut of the House of Delegates Online Testimony page on the TMA website.

Emergency department diversion and trauma mortality: evidence from houston, Texas.

BACKGROUND: This study examined the relation between trauma death rates and hospital diversion in the Houston emergency medical service area. METHODS: A risk analysis and logistic regression were performed comparing death rates for trauma patients hospitalized on significant emergency department diversion days, defined as days when both of two level 1 hospitals were on diversion for more than 8 hours, and on nonsignificant diversion days, defined as one or both hospitals on diversion for fewer than 8 hours or not on diversion at all. RESULTS: The percentage of deaths among all trauma patients, transfers, and nontransfers admitted on significant diversion days was consistently higher than on nonsignificant diversion days, but the difference was not statistically significant. A higher mortality rate, approaching statistical significance, was found for one subgroup of the most severe trauma patients who had been transferred from another hospital. CONCLUSIONS: A possible association between emergency department diversion and death rates in Houston trauma hospitals was found, particularly among the most severe trauma patients transferred from lower-level hospitals. A follow-up study is needed for further investigation of this relation.