Do Patients Require Emergency Department Interventions After Prehospital Naloxone?

OBJECTIVE: Patients receiving naloxone for suspected opioid overdose in the prehospital setting are typically transported to the emergency department (ED) for further evaluation, regardless of Glasgow Coma Scale (GCS). The objective of our study is to determine whether patients with GCS ≥14 after receiving prehospital naloxone received additional doses of naloxone and medical interventions in the ED compared with those with GCS <14 after prehospital naloxone. METHODS: Our retrospective observational study included patients ≥18 years old treated with naloxone and transported by an inner-city hospital-based Emergency Medical Services (EMS) to its affiliated ED from January 2, 2016 to December 31, 2016. Investigators collected demographic data, prehospital interventions, GCS, ED interventions, and dispositions. Institutional Review Board approval was obtained. The main outcome measures were repeat doses of naloxone and ED interventions. RESULTS: In all, 473 patient encounters were reviewed. Most common route of prehospital naloxone administration was intranasal (68%). Nearly two-thirds (n = 473) of patients had GCS ≥14 upon ED arrival. Repeat naloxone was administered to 3.5% (n = 314) of patients with GCS ≥14 versus 14.6% (n = 159) of patients with GCS <14. ED interventions, such as airway maneuvers, laboratory and radiology testing, and cardiac monitoring, were less common among patients who had improved GCS of 14 or higher (n = 314). There were 8 deaths among patients with GCS <14 (n = 159) and no deaths among patients with GCS ≥14 (n = 314). CONCLUSION: Patients with GCS score ≥14 after administration of prehospital naloxone are less likely to receive additional naloxone doses and medical interventions in the ED compared with those with a GCS score <14 after prehospital naloxone and may present an invaluable opportunity for the ED to initiate an addiction treatment program for patients with nonfatal overdose.

Pediatric Transport Practices Among Prehospital Providers.

OBJECTIVE: There are nearly 1000 annual ambulance crashes within the United States involving pediatric patients. In 2012 National Highway Traffic Safety Administration/US Department of Transportation released Best-Practice Recommendations for the Safe Transportation of Children in Emergency Ground Ambulances. The aim of our study was to measure emergency medical services (EMS) providers' knowledge and opinions of how to safely transport pediatric patients. In addition, we aimed to gather information on barriers to safe pediatric transport. METHODS: Members of 1 urban and 2 suburban EMS agencies completed an anonymous survey that assessed level of training, years of experience, exposure to pediatric patients, knowledge of best practices, and opinions about barriers to safe transport of pediatric patients. RESULTS: A total of 114 EMS providers answered the survey. Sixty-three percent were basic life support providers who had more than 10 years of experience in EMS. Ninety-six percent reported that they transported 0 to 5 pediatric patients per week. Twenty percent reported being trained on pediatric safe transport practices. Thirty-two percent of providers reported that personnel did not drive faster when transporting a sick pediatric patient. Eighty-six percent reported that it was unsafe to transport a child on a parent's lap, but 27% reported that it was appropriate to transport a newborn on the stretcher with mom. Thirty-eight percent were comfortable identifying proper restraint system/seat for pediatric patients, and only 35% were comfortable installing/using these devices. Provider-reported barriers to safe transport were identified. DISCUSSION: Our survey demonstrates that despite published best practices for the safe transport of children, many providers are unfamiliar with the safest way to transport these patients. In addition, we identified several existing barriers that may contribute to unsafe practices.