Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA 19104, USA.
Department of Emergency Medicine, Thomas Jefferson University, 1025 Walnut St, College Bldg, Suite 706, Philadelphia, PA 19107, USA.
Int J Drug Policy. 2021 Sep;95:103250. doi: 10.1016/j.drugpo.2021.103250. Epub 2021 Apr 20.
Targeted naloxone distribution to potential lay responders increases the timeliness of overdose response and reduces mortality. Little is known, however, about the patterns of decision-making among overdose lay responders. This study explored heuristic decision-making among laypersons equipped with an emergency response smartphone app.
UnityPhilly, a smartphone app that connects lay responders equipped with naloxone to overdose victims, was piloted in Philadelphia from March 2019 to February 2020. Participants used the app to signal overdose alerts to peer app users and emergency medical services, or respond to alerts by arriving at overdose emergency sites. This study utilised in-depth interviews, background information, and app use data from a sample of 18 participants with varying histories of opioid use and levels of app use activity.
The sample included 8 people who used opioids non-medically in the past 30 days and 10 people reporting no opioid misuse. Three prevailing, not mutually exclusive, heuristics were identified. The heuristic of unconditional signalling ("Always signal for help or backup") was used by 7 people who valued external assistance and used the app as a replacement for a 911 call; this group had the highest number of signalled alerts and on-scene appearances. Nine people, who expressed confidence in their ability to address an overdose themselves, followed a heuristic of conditional signalling ("Rescue, but only signal if necessary"); these participants had the highest frequency of prior naloxone administrations. Eleven participants used the heuristic of conditional responding ("Assess if I can make a difference"), addressing an alert if they carried naloxone, were nearby, or received a signal before dark hours.
The deployment of specific heuristics was influenced by prior naloxone use and situational factors. Success of overdose prevention interventions assisted by digital technologies may depend on the involvement of people with diverse overdose rescue backgrounds.
将纳洛酮靶向分发给潜在的非专业急救人员可以提高急救的及时性，降低死亡率。然而，对于非专业急救人员在急救过程中的决策模式知之甚少。本研究探讨了配备紧急响应智能手机应用程序的非专业人员的启发式决策。
UnityPhilly 是一款智能手机应用程序，它将配备纳洛酮的非专业急救人员与过量用药者联系起来，于 2019 年 3 月至 2020 年 2 月在费城进行试点。参与者使用该应用程序向同伴应用程序用户和紧急医疗服务发出过量用药警报，或响应警报，到达过量用药急救地点。本研究利用来自 18 名参与者的深入访谈、背景信息和应用程序使用数据，这些参与者的阿片类药物使用史和应用程序使用活跃度各不相同。
该样本包括 8 名过去 30 天内非医疗使用阿片类药物的人，以及 10 名报告没有阿片类药物滥用的人。确定了三种普遍存在的、非互斥的启发式方法。无条件信号的启发式方法（“始终发出帮助或支援的信号”）被 7 名重视外部援助并将应用程序作为 911 电话替代品的人使用；这组人发出的警报信号最多，出现在现场的次数也最多。9 人对自己处理过量用药的能力有信心，遵循有条件信号的启发式方法（“救援，但只有在必要时才发出信号”）；这些参与者之前使用过纳洛酮的次数最多。11 名参与者使用有条件反应的启发式方法（“评估我是否能有所作为”），如果他们携带纳洛酮、在附近或在天黑前收到信号，就会处理警报。
特定启发式方法的使用受到先前使用纳洛酮的情况和情境因素的影响。由数字技术辅助的过量预防干预措施的成功可能取决于具有不同过量救援背景的人员的参与。
