Vilke G M, Buchanan J, Dunford J V, Chan T C
Department of Emergency Medicine, University of California, San Diego Medical Center, 92103, USA.
Prehosp Emerg Care. 1999 Jul-Sep;3(3):183-6. doi: 10.1080/10903129908958933.
Naloxone is frequently used by prehospital care providers to treat suspected heroin and opioid overdoses. The authors' EMS system has operated a policy of allowing these patients, once successfully treated, to sign out against medical advice (AMA) in the field. This study was performed to evaluate the safety of this practice.
The authors retrospectively reviewed all 1996 San Diego County Medical Examiner's (ME's) cases in which opioid overdoses contributed to the cause of death. The records of all patients who were found dead in public or private residences or died in emergency departments of reasons other than natural causes or progression of disease, are forwarded to the ME office. ME cases associated with opiate use as a cause of death were cross-compared with all patients who received naloxone by field paramedics and then refused transport. The charts were reviewed by dates, times, age, sex, location, and, when available, ethnicity.
There were 117 ME cases of opiate overdose deaths and 317 prehospital patients who received naloxone and refused further treatment. When compared by age, time, date, sex, location, and ethnicity, there was no case in which a patient was treated by paramedics with naloxone within 12 hours of being found dead of an opiate overdose.
Giving naloxone to heroin overdoses in the field and then allowing the patients to sign out AMA resulted in no death in the one-year period studied. This study did not evaluate for return visits by paramedics nor whether patients were later taken to hospitals by private vehicles.
院前急救人员经常使用纳洛酮治疗疑似海洛因和阿片类药物过量中毒。作者所在的紧急医疗服务（EMS）系统实施了一项政策，允许这些患者一旦成功治疗，可在现场签署自动出院（AMA）。本研究旨在评估这种做法的安全性。
作者回顾性分析了1996年圣地亚哥县法医（ME）办公室所有因阿片类药物过量导致死亡的案例。所有在公共或私人住所被发现死亡或在急诊科因非自然原因或疾病进展以外原因死亡的患者记录都会被转至法医办公室。将与阿片类药物使用作为死因相关的法医案例与所有接受现场护理人员纳洛酮治疗后拒绝转运的患者进行交叉比较。根据日期、时间、年龄、性别、地点以及（如有）种族对病历进行审查。
有117例法医判定的阿片类药物过量死亡案例，以及317例接受纳洛酮治疗并拒绝进一步治疗的院前患者。按年龄、时间、日期、性别、地点和种族进行比较时，未发现有患者在因阿片类药物过量死亡前12小时内接受护理人员纳洛酮治疗的情况。
在本研究的一年期间，在现场给海洛因过量患者使用纳洛酮然后允许患者签署自动出院并未导致死亡。本研究未评估护理人员的回访情况，也未评估患者后来是否被私家车送往医院。
