Davis Corey S, Southwell Jessica K, Niehaus Virginia Radford, Walley Alexander Y, Dailey Michael W
The Network for Public Health Law-Southeastern Region, Carrboro, NC.
Acad Emerg Med. 2014 Oct;21(10):1173-7. doi: 10.1111/acem.12485.
Fatal opioid overdose in the United States is at epidemic levels. Naloxone, an effective opioid antidote, is commonly administered by advanced emergency medical services (EMS) personnel in the prehospital setting. While states are rapidly moving to increase access to naloxone for community bystanders, the EMS system remains the primary source for out-of-hospital naloxone access. Many communities have limited advanced EMS response capability and therefore may not have prehospital access to the medication indicated for opioid overdose reversal. The goal of this research was to determine the authority of different levels of EMS personnel to administer naloxone for the reversal of opioid overdose in the United States, Guam, and Puerto Rico.
The authors systematically reviewed the scope of practice of EMS personnel regarding administration of naloxone for the reversal of opioid overdose. All relevant laws, regulations, and policies from the 50 U. S. states, the District of Columbia, Guam, and Puerto Rico in effect in November 2013 were identified, reviewed, and coded to determine the authority of EMS personnel at four levels (in increasing order of training: emergency medical responders [EMRs], emergency medical technicians [EMTs], intermediate/advanced EMTs, and paramedics) to administer naloxone. Where available, protocols governing route and dose of administration were also identified and analyzed.
All 53 jurisdictions license or certify EMS personnel at the paramedic level, and all permit paramedics to administer naloxone. Of the 48 jurisdictions with intermediate-level EMS personnel, all but one authorized those personnel to administer naloxone as of November 2013. Twelve jurisdictions explicitly permitted EMTs and two permitted EMRs to administer naloxone. At least five jurisdictions modified law or policy to expand EMT access to naloxone in 2013. There is wide variation between states regarding EMS naloxone dosing protocol and route of administration.
Naloxone administration is standard for paramedic and intermediate-level EMS personnel, but most states do not allow basic life support (BLS) personnel to administer this medication. Standards consistent with available medical evidence for naloxone administration, dosing, and route of administration should be implemented at each EMS level of certification.
美国致命性阿片类药物过量使用已达到流行程度。纳洛酮是一种有效的阿片类解毒剂，在院前环境中通常由高级急救医疗服务（EMS）人员给药。虽然各州正在迅速采取行动，增加社区旁观者获取纳洛酮的机会，但EMS系统仍然是院外获取纳洛酮的主要来源。许多社区的高级EMS响应能力有限，因此可能无法在院前获得用于逆转阿片类药物过量的药物。本研究的目的是确定在美国、关岛和波多黎各，不同级别的EMS人员给予纳洛酮以逆转阿片类药物过量的权限。
作者系统回顾了EMS人员给予纳洛酮以逆转阿片类药物过量的实践范围。确定、审查并编码了2013年11月生效的美国50个州、哥伦比亚特区、关岛和波多黎各的所有相关法律、法规和政策，以确定四个级别（按培训程度递增顺序：急救医疗响应人员[EMR]、急救医疗技术员[EMT]、中级/高级急救医疗技术员和护理人员）的EMS人员给予纳洛酮的权限。在可行的情况下，还确定并分析了有关给药途径和剂量的方案。
所有53个司法管辖区都对护理人员级别进行了EMS人员许可或认证，并且都允许护理人员给予纳洛酮。在有中级EMS人员的48个司法管辖区中，截至2013年11月，除一个外，所有辖区都授权这些人员给予纳洛酮。12个司法管辖区明确允许急救医疗技术员给予纳洛酮，2个司法管辖区允许急救医疗响应人员给予纳洛酮。2013年，至少有5个司法管辖区修改了法律或政策，以扩大急救医疗技术员获取纳洛酮的机会。各州在EMS纳洛酮给药方案和给药途径方面存在很大差异。
给予纳洛酮是护理人员和中级EMS人员的标准操作，但大多数州不允许基础生命支持（BLS）人员使用这种药物。应在每个EMS认证级别实施与纳洛酮给药、剂量和给药途径的现有医学证据一致的标准。
