title: Disparity in naloxone administration by emergency medical service providers and the burden of drug overdose in US rural communities.
abstract: OBJECTIVE
  We determined the factors that affect naloxone (Narcan) administration in drug overdoses, including the certification level of emergency medical technicians (EMTs).
  
  
  METHODS
  In 2012, 42 states contributed all or a portion of their ambulatory data to the National Emergency Medical Services Information System. We used a logistic regression model to measure the association between naloxone administration and emergency medical services certification level, age, gender, geographic location, and patient primary symptom.
  
  
  RESULTS
  The odds of naloxone administration were much higher among EMT-intermediates than among EMT-basics (adjusted odds ratio [AOR] = 5.4; 95% confidence interval [CI] = 4.5, 6.5). Naloxone use was higher in suburban areas than in urban areas (AOR = 1.41; 95% CI = 1.3, 1.5), followed by rural areas (AOR = 1.23; 95% CI = 1.1, 1.3). Although the odds of naloxone administration were 23% higher in rural areas than in urban areas, the opioid drug overdose rate is 45% higher in rural communities.
  
  
  CONCLUSIONS
  Naloxone is less often administered by EMT-basics, who are more common in rural areas. In most states, the scope-of-practice model prohibits naloxone administration by basic EMTs. Reducing this barrier could help prevent drug overdose death.
authors.affiliation: Mark Faul, David E. Sugerman, Benjamin Levy, and Len J. Paulozzi are with the Centers for Disease Control and Prevention, Atlanta, GA. Michael W. Dailey is with the Department of Emergency Medicine, Albany Medical Center, NY. Scott M. Sasser is with the Department of Emergency Medicine, Greenville Health System, SC.
authors.forename: Mark
authors.initials: M
authors.lastname: Faul
authors.forename: Michael W
authors.initials: MW
authors.lastname: Dailey
authors.forename: David E
authors.initials: DE
authors.lastname: Sugerman
authors.forename: Scott M
authors.initials: SM
authors.lastname: Sasser
authors.forename: Benjamin
authors.initials: B
authors.lastname: Levy
authors.forename: Len J
authors.initials: LJ
authors.lastname: Paulozzi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062787:Drug Overdose / Q000188:drug therapy* / Q000453:epidemiology; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage*; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D012307:Risk Factors; D019035:Rural Health Services; D012424:Rural Population; D014481:United States / Q000453:epidemiology
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone