No Deaths Associated with Patient Refusal of Transport After Naloxone-Reversed Opioid Overdose
No Deaths Associated with Patient Refusal of Transport After Naloxone-Reversed Opioid Overdose
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DOI：
10.3109/10903127.2011.569854
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发表时间：
2011-07-01
影响因子：
2.4
通讯作者：
Manifold, Craig A.
中科院分区：
文献类型：
--
作者：
Wampler, David A.;Molina, D. Kimberley;Manifold, Craig A.
介绍。纳洛酮广泛用于阿片类药物过量的治疗和逆转。大多数紧急医疗服务（EMS）系统管理纳洛酮的长期订单，并滴定仅逆转呼吸抑制，而不是完全逆转镇静。一些EMS系统常规给予足够的纳洛酮以完全逆转阿片类药物过量的影响。病人往往拒绝进一步的医疗评估或干预，包括运送。目标。本研究的目的是评估这种做法的安全性，并确定死亡率的增加是否与阿片类药物的完全逆转有关。作为一项综合质量保证计划的组成部分，我们评估了患者接受纳洛酮逆转阿片类药物过量后48小时内的死亡率，随后患者主动拒绝运输。方法。设置是一个大型的城市消防EMS系统。调查人员向贝尔县法医办公室（MEO）提供了一份由圣安东尼奥消防局用纳洛酮治疗的患者名单，这些患者没有被转移。纳入标准为纳洛酮用药和患者主动拒绝。患者处置还包括仅援助，转介到MEO，或转介到执法部门。然后将该列表与MEO数据库进行比较。对所有接受治疗的患者进行图表审查，并在两天内提交给MEO。第二个时间段为30天。结果。该名单确定了592名接受纳洛酮治疗但未被送往急诊室的患者。552名接受纳洛酮治疗的患者拒绝运输或未运输。其余40例患者均出现心脏骤停，在复苏过程中给予纳洛酮，随后在现场终止治疗。接受纳洛酮治疗并随后出现患者主动拒绝的患者均未在为期两天的终点MEO接受检查。为期30天的评估显示，有9人接受纳洛酮治疗，随后死亡，但服务日期和死亡日期之间的最短时间间隔为4天。结论。主要结果是在48小时内没有接受纳洛酮治疗阿片类药物过量然后拒绝治疗的患者接受MEO的检查。
Introduction. Naloxone is widely used in the treatment and reversal of opioid overdose. Most emergency medical services (EMS) systems administer naloxone by standing order, and titrate only to reverse respiratory depression without fully reversing sedation. Some EMS systems routinely administer sufficient naloxone to fully reverse the effects of opioid overdose. Frequently patients refuse further medical evaluation or intervention, including transport. Objectives. The purpose of this study was to evaluate the safety of this practice and determine whether increased mortality is associated with full reversal of opioids. As a component of a comprehensive quality assurance initiative, we assessed mortality during the 48 hours after patients received naloxone to reverse opioid overdose followed by patient-initiated refusal of transportation. Methods. The setting was a large urban fire-based EMS system. Investigators provided the Bexar County Medical Examiner's Office (MEO) with a list of patients who were treated by the San Antonio Fire Department with naloxone, and not transported. Inclusion criteria were administration of naloxone and patient-initiated refusal. Patient dispositions also included aid only, referral to the MEO, or referral to law enforcement. The list was then compared with the MEO database. A chart review was completed on all patients treated and subsequently presented to the MEO within two days. A secondary time period of 30 days was also assessed. Results. The list identified 592 patients treated with naloxone and not transported to the emergency department. Five-hundred fifty-two patients received naloxone and refused transport or were not transported. The remaining 40 patients all presented to EMS in cardiac arrest, naloxone was administered during the course of resuscitation, and subsequent efforts were terminated in the field. None of the patients receiving naloxone with a subsequent patient-initiated refusal were examined at the MEO within the two-day end point. The 30-day assessment revealed that nine individuals were treated with naloxone and subsequently died, but the shortest time interval between date of service and date of death was four days. Conclusion. The primary outcome was that no patients who were treated with naloxone for opioid overdose and then refused care were examined by the MEO within a 48-hour time frame.