Linking Emergency Medical Services and Emergency Department Data to Improve Overdose Surveillance in North Carolina

Introduction Linking emergency medical services (EMS) data to emergency department (ED) data enables assessing the continuum of care and evaluating patient outcomes. We developed novel methods to enhance linkage performance and analysis of EMS and ED data for opioid overdose surveillance in North Carolina. Methods We identified data on all EMS encounters in North Carolina during January 1–November 30, 2017, with documented naloxone administration and transportation to the ED. We linked these data with ED visit data in the North Carolina Disease Event Tracking and Epidemiologic Collection Tool. We manually reviewed a subset of data from 12 counties to create a gold standard that informed developing iterative linkage methods using demographic, time, and destination variables. We calculated the proportion of suspected opioid overdose EMS cases that received International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes for opioid overdose in the ED. Results We identified 12 088 EMS encounters of patients treated with naloxone and transported to the ED. The 12-county subset included 1781 linkage-eligible EMS encounters, with historical linkage of 65.4% (1165 of 1781) and 1.6% false linkages. Through iterative linkage methods, performance improved to 91.0% (1620 of 1781) with 0.1% false linkages. Among statewide EMS encounters with naloxone administration, the linkage improved from 47.1% to 91.1%. We found diagnosis codes for opioid overdose in the ED among 27.2% of statewide linked records. Practice Implications Through an iterative linkage approach, EMS–ED data linkage performance improved greatly while reducing the number of false linkages. Improved EMS–ED data linkage quality can enhance surveillance activities, inform emergency response practices, and improve quality of care through evaluating initial patient presentations, field interventions, and ultimate diagnoses.

Adverse events related to bystander naloxone administration in cases of suspected opioid overdose in British Columbia: An observational study

Introduction Take-Home Naloxone programs have been introduced across North America in response to rising opioid overdose deaths. There is currently limited real-world data on bystander naloxone administration, overdose outcomes, and evidence related to adverse events following bystander naloxone administration. Methods The research team used descriptive statistics from Take-Home Naloxone administration forms. We explored reported demographic variables and adverse events among people who received by-stander administered naloxone in a suspected opioid overdose event between August 31, 2012 and December 31, 2018 in British Columbia. We examined and contextualized differences across years given policy, program and drug toxicity changes. We used multivariate logistic regression to examine whether an association exists between number of ampoules of naloxone administered and the odds that the recipient will experience withdrawal symptoms. Results A large majority (98.1%) of individuals who were administered naloxone survived their overdose and 69.2% had no or only mild withdrawal symptoms. Receiving three (Adjusted Odds Ratio (AOR) 1.64 (95% Confidence Interval (CI): 1.08–2.48)) or four or more (AOR 2.19 (95% CI: 1.32–3.62)) ampoules of naloxone was significantly associated with odds of moderate or severe withdrawal compared to receiving one ampoule of naloxone. Conclusions This study provides evidence from thousands of bystander reversed opioid overdoses using Take-Home Naloxone kits in British Columbia, and suggests bystander-administered naloxone is safe and effective for opioid overdose reversal. Data suggests an emphasis on titration during bystander naloxone training in situations where the person experiencing overdose can be adequately ventilated may help avoid severe withdrawal symptoms. We identified a decreasing trend in the likelihood of moderate or severe withdrawal over the study period.

Use of Naloxone in 9-1-1 Patients without Respiratory Depression in Los Angeles County, California (USA)

Introduction:Along with an increase in opioid deaths, there has been a desire to increase the accessibility of naloxone. However, in the absence of respiratory depression, naloxone is unlikely to be beneficial and may be deleterious if it precipitates withdrawal in individuals with central nervous system (CNS) depression due to non-opioid etiologies.Objective:The aim of this study was to evaluate how effective prehospital providers were in administering naloxone.Methods:This is a retrospective study of naloxone administration in two large urban Emergency Medical Service (EMS) systems. The proportion of patients who had a respiratory rate of at least 12 breaths per minute at the time of naloxone administration by prehospital providers was determined.Results:During the two-year study period, 2,580 patients who received naloxone by prehospital providers were identified. The median (interquartile range) respiratory rate prior to naloxone administration was 12 (6-16) breaths per minute. Using an a priori respiratory rate of under 12 breaths per minute to define respiratory depression, only 1,232 (47.8%; 95% CI, 50.3%-54.2%) subjects who received naloxone by prehospital providers had respiratory depression.Conclusion:This study showed that EMS providers in Los Angeles County, California (USA) frequently administered naloxone to individuals without respiratory depression.

02 Leveraging paramedic data to investigate the effect of COVID-19 on community opioid overdoses

BackgroundOpioid overdoses in Canada have shown dramatic increases over recent years, despite significant investments in harm reduction. Most community monitoring currently relies on emergency department and coroner data. Our team has previously shown that paramedic data can be a useful addition to the current metrics as paramedics regularly interact with opioid overdose patients. This study examines paramedic data to investigate the changes to community opioid overdoses in the era of COVID-19 to better support our strategic partners in their battle against the opioid crisis.MethodsThe electronic ambulance call report database of Peterborough Paramedics (Ontario, Canada) was examined. De-identified records for patients from 2017-2020 with documented problem codes of ‘Opioid Overdose’ were extracted. Patients receiving paramedic naloxone were also included. The data was cleaned and analysed, and incomplete records were removed. Statistical models including chi-squared tests of goodness-of-fit and post hoc pairwise t-tests were applied to the data. Ethics approval for this study was granted by the Trent University’s Research Ethics Board.Results788 opioid overdoses were identified out of 72,737 patients. There were 263 opioid overdoses found in 2020 representing 1.4% patients, a significant increase from 2017-2019 (p value: 0.006). The proportion of patients receiving paramedic naloxone was significantly increased from previous years (p value: 0.005) while bystander naloxone administration was significantly decreased (p value 0.002). Age, gender, and pick-up location types were not significantly different between 2020 and previous years.ConclusionDespite reduced overall call volumes in 2020, paramedics observed an increase in opioid overdoses. The increase in paramedic naloxone administration and decrease in bystander naloxone administration may indicate changes in usage practices of community opioid users or an instability in the drug supply. These factors must be considered in future opioid harm reduction strategies and public health COVID-19 containment measures.

Pediatric Tizanidine Toxicity Reversed with Naloxone a case report

BackgroundTizanidine, an α-2 adrenoreceptor agonist, is widely prescribed for the management of spasticity in adults. Case reports for pediatric tizanidine overdose are limited. Here, we report a case of pediatric tizanidine toxicity that was reversed with naloxone.Case presentationA three year-old male presented to the emergency department with lethargy, bradycardia, and bradypnea after accidental ingestion of multiple tizanidine tablets. Improvements in the level of consciousness, respiratory and heart rates were observed post intravenous naloxone administration of 0.05 and 0.1 mg/kg respectively.ConclusionsThis case report provides additional epidemiologic data on childhood tizanidine poisoning and further documentation on the use of naloxone as a viable antidote for centrally acting α-2 receptor agonists.