Citation

McCann MK, Jusko TA, Jones CMC, Seplaki CL, Cushman JT. Prehosp. Emerg. Care 2020; ePub(ePub): ePub.

Affiliation

Department of Emergency Medicine, University of Rochester, School of Medicine and Dentistry, Rochester NY, USA.

Copyright

(Copyright © 2020, National Association of EMS Physicians, Publisher Informa - Taylor and Francis Group)

DOI

10.1080/10903127.2020.1731029

PMID

32073921

Abstract

BackgroundAcross the spectrum of patient care for opioid overdose, an important, yet frequently overlooked feature is the bystander, or witness to the overdose event. For other acute medical events such as cardiac arrest and stroke, research supports that the presence of a bystander is associated with better outcomes. Despite the similarities, however, this well-established conceptual framework has yet to be applied in the context of overdose patient outcomes. The objective of this study was to assess the association between the nature of the bystander-patient relationship and prehospital care measures in patients being treated for opioid overdose.

METHODSA retrospective cohort study was conducted among adults who received naloxone in the prehospital setting for suspected opioid overdose. Patients were identified using a pre-existing, longitudinal registry documenting all prehospital administrations of naloxone by first responders in a midsized community. Individuals who received at least one naloxone administration for a suspected opioid overdose between June 1^st, 2016 to July 31^st, 2018, with available EMS and medical record data were eligible for study inclusion. Bystander type was defined referencing psychology literature and were categorized as: close (spouse/family), proximal (friends), and distal (no relation to patient). The association between bystander type and prehospital patient care measures were estimated using logistic and linear regression models.

RESULTSA total of 602 opioid overdose encounters among 545 patients were identified. Patents tended to be male (67.2%), white (73.6%), and aged 25-44 years (57.1%). Among patients with proximal bystanders present, average time to naloxone administration was 2.4 minutes less (95% CI -4.6, -0.2), compared to distal bystanders, after adjusting for covariates. Overdose encounters with 911 dispatch codes more indicative of opioid overdose (i.e., 'overdose/poisoning' vs 'unconscious/fainting') were associated with having a close or proximal bystander present compared to a distal bystander (OR_{close vs. distal}=1.8, 95% CI =1.0, 3.3; OR_{proximal vs. distal}=3.6, 95% CI =1.8, 7.1).

CONCLUSIONPresence of a proximal bystander during an overdose event is associated with dispatch codes indicative of an overdose and shorter times to naloxone administration compared with those with distal bystanders. These findings offer opportunities for public education and engagement of overdose harm reduction strategies.

Language: en

Keywords

Emergency Medical Services; First Responder; Naloxone; Opioid; Overdose