Buprenorphine Field Initiation of ReScue Treatment by Emergency Medical Services (Bupe FIRST EMS): A Case Series
Buprenorphine Field Initiation of ReScue Treatment by Emergency Medical Services (Bupe FIRST EMS): A Case Series
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DOI：
10.1080/10903127.2020.1747579
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发表时间：
2020-05-03
影响因子：
2.4
通讯作者：
Haroz, Rachel
中科院分区：
文献类型：
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作者：
Carroll, Gerard G.;Wasserman, Deena D.;Haroz, Rachel
阿片类药物流行病目前是美国的主要健康危机，有证据支持阿片类药物使用障碍（MOUD）作为最有效的治疗方法（2）。在我们的EMS系统中，我们观察到越来越多的患者，由于在纳洛酮抢救后拒绝转运，在过量时出现了通路空白。我们提出了一个病例系列，以说明一种新的治疗模式，利用一线EMS护理单位和高剂量丁丙诺啡治疗戒断症状，次日桥长期护理。所描述的三名患者是示例性病例，旨在代表完整数据收集之前的干预的总体特征。每例患者均使用纳洛酮从阿片类药物过量中苏醒。护理人员随后用16 mg丁丙诺啡治疗每位患者，以缓解和预防戒断症状。无论是否转运艾德，均对患者进行门诊随访。据我们所知，这是美国第一家EMS机构在过量用药时在院前环境中提供MOUD。这项创新计划为EMS提供教育和工具，以促进患者参与。虽然仍处于起步阶段，但这种方法利用现有的EMS资源将MOUD带到院前环境，为长期护理提供了新的途径。关键词：阿片类药物，丁丙诺啡，紧急医疗服务，药物辅助治疗，纳洛酮，过量
The opioid epidemic is currently a leading health crisis in the United States, and evidence supports Medication for Opioid Use Disorder (MOUD) as the most effective treatment (2). In our EMS system we are observing an ever increasing number of patients who, due to refusing transport after naloxone rescue, represent an access void at the point of overdose. We present a case series to illustrate a new treatment paradigm utilizing front line EMS paramedic units and high dose buprenorphine to treat withdrawal symptoms with next day bridge to long term care. The three patients described are exemplary cases, meant to represent overall characteristics of the intervention prior to complete data collection. Each patient was revived from opioid overdose with naloxone. Paramedics then treated each patient with 16 mg of buprenorphine to relieve and prevent withdrawal symptoms. Patients were provided with outpatient follow up irrespective of ED transport. To the best of our knowledge, this is the first EMS agency in the United States providing MOUD in the prehospital setting at the point of overdose. This innovative program provides EMS with education and tools to promote patient engagement. While still in its infancy, this approach utilizes existing EMS resources to bring MOUD to the prehospital setting, offering a new avenue to long term care. Keywords: Opioid, buprenorphine, emergency medical services, medication assisted therapy, naloxone, overdose