title: Naloxone use in a tiered-response emergency medical services system.
abstract: OBJECTIVE
  To examine the delivery and effect of naloxone for opioid overdose in a tiered-response emergency medical services (EMS) system and to ascertain how much time could be saved if the first arriving emergency medical technicians (EMTs) could have administered intranasal naloxone.
  
  
  METHODS
  This was case series of all EMS-treated overdose patients who received naloxone by paramedics in a two-tiered EMS system during 2004. The system dispatches basic life support-trained fire fighter-EMTs and/or advanced life support-trained paramedics depending on the severity of cases. Main outcomes were geographic distribution of naloxone-treated overdose, severity of cases, response to naloxone, and time interval between arrival of EMTs and arrival of paramedics at the scene.
  
  
  RESULTS
  There were 164 patients who received naloxone for suspected overdose. There were 75 patients (46%) initially unresponsive to painful stimulus. Respiratory rate was <10 breaths/min in 79 (48%). Death occurred in 36 (22%) at the scene or during transport. A full or partial response to naloxone occurred in 119 (73%). Recognized adverse reactions were limited to agitation/combativeness in 25 (15%) and emesis in six (4%). Average EMT arrival time was 5.9 minutes. Average paramedic arrival time was 11.6 minutes in most cases and 16.1 minutes in 46 cases (28%) in which paramedics were requested by EMTs at the scene.
  
  
  CONCLUSIONS
  There is potential for significantly earlier delivery of naloxone to patients in opioid overdose if EMTs could deliver intranasal naloxone. A pilot study training and authorizing EMTs to administer intranasal naloxone in suspected opioid overdose is warranted.
authors.affiliation: Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Belz
authors.forename: Jacob
authors.initials: J
authors.lastname: Lieb
authors.forename: Tom
authors.initials: T
authors.lastname: Rea
authors.forename: Mickey S
authors.initials: MS
authors.lastname: Eisenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062787:Drug Overdose; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D012720:Severity of Illness Index; D013997:Time Factors; D014861:Washington
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone