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Abstract
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BackgroundAlthough most US emergency medical services (EMS) systems collect time-to-treatment data in their electronic prehospital patient care reports (PCRs), analysis of these data seldom appears in publications. We believe EMS agencies should routinely analyze at least the initial time-to-treatment data for various potentially life-threatening conditions on quality review. This step not only assures that protocol-required treatments have been provided but can discover avoidable delays and, when necessary, drive protocol and treatment priority change.The purpose of this study was to analyze the interval from 9-1-1 call receipt until the first administration of naloxone to adult opioid overdose victims to demonstrate the quality assurance importance of analyzing time-to-treatment data.
METHODRetrospective analysis of times from 9-1-1 call receipt to initial naloxone treatment in adult opioid overdose victims treated by EMS personnel in Richmond, VA, between 1/1/19 and 10/24/21. The analysis excluded victims <18 years of age and cases where a bystander, police, or a health care worker gave naloxone before EMS arrival. We compared data collected before and during the COVID-19 pandemic to determine any effect it may have had on the analysis.
RESULTSA total of 582 opioid overdose cases were analyzed. The mean patient age was 40.7 years [95% CI 39.6, 41.8], and 405 were males (69.6%). EMS units arrived at the scene in 6.7 minutes from the 9-1-1 call receipt. It took 1.8 minutes to reach the victim, and 8.6 additional minutes to administer the first naloxone regardless of administration route (70.4% intravenous, 26.1% intranasal, 2.7% intraosseous, 0.7% intramuscular). EMS personnel administered the first naloxone 17.1 minutes after the 9-1-1 call receipt, with 50.3% of the delay occurring after EMS contacted the patient. There was no statistically significant difference in the times-to-treatment before vs. during the pandemic.
CONCLUSIONThe interval from 9-1-1 call receipt until initial EMS administration of naloxone was substantial during our analysis period and did not change significantly during the COVID-19 pandemic. We believe our findings provide an important example that supports why EMS agencies should analyze initial time-to-treatment data, especially for life-threatening conditions, beyond assuring that protocol-required treatments have been provided. Based on our analysis, fire department crews now carry intranasal naloxone, and intranasal naloxone is given to "impaired" opioid overdose victims by either fire department or EMS personnel, whoever arrives first. We are continuing to collect data on intervals-to-treatment prospectively and monitoring our critical process and treatment intervals. We are using the plan-do-study-act model for improving our process and carrying out a change. We plan to share our results in a future publication once we have sufficient data.
Language: en |