Barefoot Elizabeth H, Cyr Julianne M, Brice Jane H, Bachman Michael W, Williams Jefferson G, Cabanas Jose G, Herbert Kyle M
Prehosp Emerg Care. 2021 Mar-Apr;25(2):182-190. doi: 10.1080/10903127.2020.1740363. Epub 2020 Apr 2.
The opioid crisis is a growing cause of mortality in the United States and may be mitigated by innovative approaches to identifying individuals at-risk of fatal opioid overdose. We examined Emergency Medical Services (EMS) utilization among a cohort of individuals who died from opioid overdose in order to identify potential opportunities for intervention. : Individuals who died of unintentional opioid overdose in a large North Carolina county between 01/01/2014 and 12/31/2016 were studied in a retrospective cohort. Death records obtained from North Carolina Vital Records were linked to EMS patient care records obtained from the county EMS System in order to describe the EMS encounters of each decedent in the year preceding their death. Patient demographics and EMS encounters were assessed to identify encounter characteristics that may be targeted for intervention. Chi-square tests and odds ratios were used to evaluate and characterize the statistical significance of differences in EMS utilization. : Of the 218 individuals who died from unintentional opioid overdose in the study interval, 30% (n = 66) utilized EMS in the year before their death and 17% (n = 38) had at least one EMS encounter with documented drug or alcohol use (i.e. "drug-related encounter"). The mean age at death was 38 (range 19-74) years, 30% were female, 89% were White, and 8% were Black/African American. Factors associated with higher incidence of EMS utilization included age (<.001), gender (=.006), and race (001). Decedents aged 56-65 had the highest EMS utilization (47%) and patients aged <25 and 25-35 had more drug-related EMS encounters (29% and 20%, respectively). The most common reasons for EMS utilization were "other medical" (27%), "non-traumatic pain" (20%), "traumatic injury" (16%), and "poisoning/drug ingestion" (14%). Drug or alcohol use was documented by EMS in 33% of all encounters and an opioid prescription was reported in 22% of encounters. Nearly one-third of individuals who died from accidental opioid overdose utilized EMS in the year before their death and nearly one-fifth had a drug-related encounter. EMS encounters may present an opportunity to identify individuals at-risk of opioid overdose and, ultimately, reduce overdose mortality.
阿片类药物危机在美国正日益成为导致死亡的一个原因，而通过创新方法识别有致命阿片类药物过量风险的个体或许可以缓解这一危机。我们研究了一组死于阿片类药物过量的个体的紧急医疗服务（EMS）使用情况，以便确定潜在的干预机会。在一个回顾性队列研究中，我们对2014年1月1日至2016年12月31日期间在北卡罗来纳州一个大县死于意外阿片类药物过量的个体进行了研究。从北卡罗来纳州生命记录处获得的死亡记录与从该县EMS系统获得的EMS患者护理记录相链接，以描述每个死者在其死亡前一年的EMS接触情况。评估患者人口统计学和EMS接触情况，以确定可能作为干预目标的接触特征。使用卡方检验和比值比来评估和描述EMS使用差异的统计学显著性。在研究期间死于意外阿片类药物过量的218名个体中，30%（n = 66）在死亡前一年使用了EMS，17%（n = 38）至少有一次记录有药物或酒精使用的EMS接触（即“与药物相关的接触”）。死亡时的平均年龄为38岁（范围19 - 74岁），30%为女性，89%为白人，8%为黑人/非裔美国人。与EMS使用发生率较高相关的因素包括年龄（<.001）、性别（=.006）和种族（=.001）。56 - 65岁的死者EMS使用率最高（47%），年龄<25岁和25 - 35岁的患者有更多与药物相关的EMS接触（分别为29%和20%）。EMS使用的最常见原因是“其他医疗”（27%）、“非创伤性疼痛”（20%）、“创伤性损伤”（16%）和“中毒/药物摄入”（14%）。在所有接触中，33%的接触有EMS记录的药物或酒精使用，22%的接触报告有阿片类药物处方。近三分之一死于意外阿片类药物过量的个体在死亡前一年使用了EMS，近五分之一有与药物相关的接触。EMS接触可能提供了一个识别有阿片类药物过量风险个体的机会，并最终降低过量死亡率。
