BLS 和 ALS 提供者使用纳洛酮的疗效和给药时间比较。
A Comparison of Efficacy of Treatment and Time to Administration of Naloxone by BLS and ALS Providers.
机构信息
1.Emergency Department, Christiana Care Health System,Newark, Delaware,USA.
2.Delaware Office of Emergency Medical Services,Smyrna, Delaware,USA.
出版信息
Prehosp Disaster Med. 2019 Aug;34(4):350-355. doi: 10.1017/S1049023X19004527. Epub 2019 Jul 19.
INTRODUCTION
The administration of naloxone therapy is restricted by scope of practice to Advanced Life Support (ALS) in many Emergency Medical Services (EMS) systems throughout the United States. In Delaware's two-tiered EMS system, Basic Life Support (BLS) often arrives on-scene prior to ALS, but BLS providers were not previously authorized to administer naloxone. Through a BLS naloxone pilot study, the researchers sought to evaluate BLS naloxone administration and timing compared to ALS.
HYPOTHESIS
After undergoing specialized training, BLS providers would be able to appropriately administer naloxone to opioid overdose patients in a more timely manner than ALS providers.
METHODS
This was a retrospective, observational study using data collected from February 2014 through May 2015 throughout a state BLS naloxone pilot program. A total of 14 out of 72 state BLS agencies participated in the study. Pilot BLS agencies attended a training session on the indications and administration of naloxone, and then were authorized to carry and administer naloxone. Researchers then compared vital signs and the time of BLS arrival to administration of naloxone by BLS and ALS. Data were analyzed using paired and independent sample t-tests, as well as chi-square, as appropriate.
RESULTS
A total of 131 incidents of naloxone administration were reviewed. Of those, 62 patients received naloxone by BLS (pilot group) and 69 patients received naloxone by ALS (control group). After naloxone administration, BLS patients showed improvements in heart rate (HR; P < .01), respiratory rate (RR; P < .01), and pulse oximetry (spO2; P < .01); ALS patients also showed improvement in RR (P < .01), and in spO2 (P = .005). There was no significant improvement in HR for ALS providers (P = .189).There was a significant difference in arrival time of BLS to the time of naloxone administration between the two groups, with shorter times in the BLS group compared to the ALS group (1.9 minutes versus 9.8 minutes; P < .01); BLS administration was 7.8 minutes faster when compared to ALS administration (95% CI, 6.2-9.3 minutes).
CONCLUSIONS
Patients improved similarly and received naloxone therapy sooner when treated by BLS agencies carrying naloxone than those who awaited ALS arrival. All EMS systems should consider allowing BLS to carry and administer naloxone for an effective and potentially faster naloxone administration when treating respiratory compromise related to opiate overdose.
简介
在美国许多紧急医疗服务（EMS）系统中，纳洛酮治疗的管理受到高级生命支持（ALS）范围的限制。在特拉华州的两级 EMS 系统中，基本生命支持（BLS）通常先于 ALS 到达现场，但 BLS 提供者以前未被授权给予纳洛酮。通过 BLS 纳洛酮试点研究，研究人员旨在评估 BLS 纳洛酮给药和时间与 ALS 的比较。
假设
经过专门培训，BLS 提供者将能够比 ALS 提供者更及时地向阿片类药物过量患者给予纳洛酮。
方法
这是一项回顾性观察研究，使用 2014 年 2 月至 2015 年 5 月期间在全州 BLS 纳洛酮试点计划中收集的数据。共有 72 个州 BLS 机构中的 14 个参加了这项研究。试点 BLS 机构参加了有关纳洛酮适应症和给药的培训课程，然后被授权携带和给予纳洛酮。然后，研究人员比较了 BLS 和 ALS 到达时的生命体征和纳洛酮给药时间。使用配对和独立样本 t 检验以及适当的卡方进行数据分析。
结果
共审查了 131 例纳洛酮给药事件。其中，62 名患者接受了 BLS（试点组）的纳洛酮治疗，69 名患者接受了 ALS（对照组）的纳洛酮治疗。纳洛酮给药后，BLS 患者的心率（HR；P <.01）、呼吸率（RR；P <.01）和脉搏血氧饱和度（spO2；P <.01）均有改善；ALS 患者的 RR（P <.01）和 spO2（P =.005）也有所改善。ALS 提供者的 HR 无明显改善（P =.189）。两组之间 BLS 到达纳洛酮给药时间的差异有统计学意义，BLS 组的时间明显短于 ALS 组（1.9 分钟与 9.8 分钟；P <.01）；BLS 给药比 ALS 给药快 7.8 分钟（95%CI，6.2-9.3 分钟）。
结论
当接受携带纳洛酮的 BLS 机构治疗时，患者改善情况相似，并且比等待 ALS 到达的患者更快地接受纳洛酮治疗。所有 EMS 系统都应考虑允许 BLS 携带和给予纳洛酮，以在治疗与阿片类药物过量相关的呼吸功能障碍时实现更有效和潜在更快的纳洛酮给药。
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