Disparity in Naloxone Administration by Emergency Medical Service Providers and the Burden of Drug Overdose in US Rural Communities
Disparity in Naloxone Administration by Emergency Medical Service Providers and the Burden of Drug Overdose in US Rural Communities
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DOI：
10.2105/ajph.2014.302520
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发表时间：
2015-07-01
影响因子：
12.7
通讯作者：
Paulozzi, Len J.
中科院分区：
文献类型：
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作者：
Faul, Mark;Dailey, Michael W.;Paulozzi, Len J.
目标。我们确定了药物过量中影响纳洛酮（Narcan）给药的因素，包括紧急医疗技术人员（EMT）的认证水平。方法。 2012年，42个州向国家紧急医疗服务信息系统贡献了全部或部分流动数据。我们使用逻辑回归模型来衡量纳洛酮给药与紧急医疗服务认证水平、年龄、性别、地理位置和患者主要症状之间的关联。结果。 EMT 中间体中纳洛酮给药的几率远高于 EMT 基础者（调整后的比值比 [AOR] = 5.4；95% 置信区间 [CI] = 4.5, 6.5）。郊区纳洛酮的使用率高于城市地区（AOR = 1.41；95% CI = 1.3, 1.5），其次是农村地区（AOR = 1.23；95% CI = 1.1, 1.3）。尽管农村地区纳洛酮用药的几率比城市地区高23%，但农村社区阿片类药物过量使用率却高出45%。结论。纳洛酮很少由急救人员使用，而急救人员在农村地区更为常见。在大多数州，实践范围模型禁止基本急救人员使用纳洛酮。减少这一障碍可能有助于防止药物过量死亡。
Objectives. 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.