In this prehospital study, we confirmed that intranasal naloxone is effective in reversing suspected opioid toxicity. Nine percent of patients required two or more doses of naloxone to achieve clinical reversal of suspected opioid toxicity. Two percent of patients received a third dose of naloxone.

Over the last decade, opioid-related deaths in the United States have increased at an alarming rate. The use of naloxone by laypersons is a newer concept and its utilization can benefit patients by rapid administration due to it being readily available immediately after an opioid overdose. The US Food and Drug Administration approved a naloxone auto-injector on April 3, 2014 for adults and pediatrics, designed for use by anyone including patients, family members, bystanders, and medical professionals. This device (EZVIO™) is the first device of its kind available on the market. The auto-injector is a battery-operated disposable 0.4 mg/0.4 mL prefilled device for use in the lateral thigh by patients, bystanders, or health care professionals. It utilizes auditory and visual commands for ease of administration and instructs patients to seek further medical care after injection. EVZIO costs about $600 for two auto-injectors and a trainer. Additionally, in August 2013, the Substance Abuse and Mental Health Services Administration introduced the Opioid Overdose Toolkit, a federal resource promoting safety and prevention information. This extensive document provides information for medical professionals, first responders, patients, caregivers, and overdose survivors. It outlines many strategies for dealing with this health care crisis. Most importantly, it highlights the importance of rapid recognition and treatment of opioid overdoses as well as routine conversations with patients assessing the need for naloxone prescriptions. The auto-injector is a safe, portable device with limited instruction needed and should routinely be made available to anyone who has contact with an opioid user.

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Study Objective: The DSM-5 defines post-traumatic stress disorder (PTSD) as the development of certain characteristic symptoms after direct, witnessed, or secondhand "exposure to actual or threatened death, serious injury, or sexual violence." The COVID-19 pandemic has been compared to the 2003 SARS outbreak; health care workers (HCWs) during that crisis experienced increased levels of emotional distress. As of March 2021, there have been over 830,000 cases of COVID-19 and 24,000 mortalities in New Jersey (NJ). Our study aimed to identify the point prevalence of PTSD and sub-threshold PTSD in HCWs across NJ during the second wave of the pandemic.Methods: We conducted a prospective survey study that was distributed electronically to physicians (attendings, fellows, and residents) and mid-level practitioners (MLPs) working in emergency departments across NJ from December 2020 -March 2021 using a secure, online survey platform.Results: All collected participant demographics are shown by training level in Table 1. There are several provisional diagnostic determinations of PTSD currently in use (Table 2). For continuous total severity score, the mean score and standard deviation (SD) for attending physicians was 13.9 (12.6), for resident/fellow physicians it was 15.4 (18.2), and for MLPs it was 20.4 (14.9), causing a statistically significant difference between the groups (p¼0.01). Following the DSM-5 criteria, a total of 27 individuals were diagnosed with PTSD, where a significantly high proportion of those were MLPs (n (%) ¼ 20 (25); p¼0.02). DSM-5 criteria B-E (Table 2) is used to evaluate subthreshold PTSD. Regardless of whether two or three criteria were used for diagnosis, the proportion met was greatest for the MLPs, with criterion D being significantly associated with training level (p¼0.01).