Evidence-Based Guidelines for EMS Administration of Naloxone

Abstract

The opioid crisis is a growing concern for Americans, and it has become the leading cause of injury-related death in the United States. An adjunct to respiratory support that can reduce this high mortality rate is the administration of naloxone by Emergency Medical Services (EMS) practitioners for patients with suspected opioid overdose. However, clear evidence-based guidelines to direct EMS use of naloxone for opioid overdose have not been developed. Leveraging the recent Agency for Healthcare Research and Quality (AHRQ) systematic review on the EMS administration of naloxone for opioid poisonings, federal partners determined the need for a clinical practice guideline for EMS practitioners faced with suspected opioid poisoning. Project funding was provided by the National Highway Traffic Safety Administration, Office of EMS, (NHTSA OEMS), and the Health Resources and Services Administration, Maternal and Child Health Bureau's EMS for Children Program (EMSC). The objectives of this project were to develop and disseminate an evidence-based guideline and model protocol for administration of naloxone by EMS practitioners to persons with suspected opioid overdose.We have four

Naloxone Use by Emergency Medical Services During the COVID-19 Pandemic: A National Survey

“…Current EMS guidelines and systematic reviews support the use of either intranasal or intramuscular naloxone. 7 , 8 Intranasal use has been recommended by some because it decreases risk of needlestick injuries and is less likely to lead to patient agitation and refusal of services. 7 The proportion of EMS naloxone reversals conducted with intranasal formulations nationally is not known.…”

“… 7 , 8 Intranasal use has been recommended by some because it decreases risk of needlestick injuries and is less likely to lead to patient agitation and refusal of services. 7 The proportion of EMS naloxone reversals conducted with intranasal formulations nationally is not known. Additionally, while intramuscular administration is an option for clinicians certified to provide advanced life support, it is typically not an option for the majority of EMS clinicians who are certified to provide basic life support services.…”

“…Additionally, while intramuscular administration is an option for clinicians certified to provide advanced life support, it is typically not an option for the majority of EMS clinicians who are certified to provide basic life support services. 9 Despite the advantages of intranasal naloxone and its endorsement in current guidelines, 7 a recent clinical trial conducted in a supervised injection facility demonstrated greater efficacy of intramuscular naloxone over intranasal when the 2 medications were provided at equal doses in the same concentration. 10 …”

“…3 – 5 Notably, some law enforcement jurisdictions have banned the administration of intranasal naloxone to avoid potential exposure of their personnel to SARS-CoV-2. 6 Current guidelines for EMS clinicians recommend the use of intranasal over intramuscular naloxone 7 whereas recent guidance from the Substance Abuse Mental Health and Services Administration (SAMHSA) favors intramuscular use if sufficient personal protective equipment is not available. 5 In the midst of the COVID-19 pandemic and to provide information on one aspect of the effect of the pandemic on frontline EMS practices, we sought to determine the effect of COVID-19 on the perceived prevalence of opioid overdoses and the use of intranasal naloxone by EMS in the US.…”

Take-Home Naloxone Programs for Suspected Opioid Overdose in Community Settings: A Scoping Umbrella Review

“…As it relates to the use of naloxone, the ASAM addressed naloxone administration in cases of opioid overdose (including for pregnant women), naloxone provision for patients being treated for opioid use disorder (OUD) and their families, and administration of naloxone by first responders. In 2019, Williams et al published evidence-based guidelines for Emergency Medical Service (EMS) administration of naloxone (70), including route of administration.…”