Department of Emergency Medicine, Virginia Commonwealth University Health, Richmond, Virginia.
Richmond Ambulance Authority, Richmond, Virginia.
Prehosp Emerg Care. 2023;27(7):927-933. doi: 10.1080/10903127.2022.2107124. Epub 2022 Aug 12.
Although most US emergency medical services (EMS) systems collect time-to-treatment data in their electronic prehospital patient care reports (PCRs), analysis of these data seldom appears in publications. We believe EMS agencies should routinely analyze the initial time-to-treatment data for various potentially life-threatening conditions. This not only assures that protocol-required treatments have been provided but can discover avoidable delays and drive protocol/treatment priority change. Our study purpose was to analyze the interval from 9-1-1 call receipt until the first administration of naloxone to adult opioid overdose victims to demonstrate the quality assurance importance of analyzing time-to-treatment data.
Retrospective analysis of intervals from 9-1-1 call receipt to initial naloxone treatment in adult opioid overdose victims. We excluded victims <18 years of age and cases where a bystander, police, or a health care worker gave naloxone before EMS arrival. We compared data collected before and during the COVID-19 pandemic to determine its effect on the analysis.
The mean patient age of 582 opioid overdose victims was 40.7 years [95% CI 39.6, 41.8] with 405 males (69.6%). EMS units' scene arrival was 6.7 minutes from the 9-1-1 call receipt. It took 1.8 minutes to reach the victim, and 8.6 additional minutes to administer the first naloxone regardless of administration route (70.4% intravenous, 26.1% intranasal, 2.7% intraosseous, 0.7% intramuscular). EMS personnel administered the first naloxone 17.1 minutes after the 9-1-1 call receipt, with 50.3% of the delay occurring after patient contact. There was no statistically significant difference in the times-to-treatment before vs. during the pandemic.
The prepandemic interval from 9-1-1 call receipt until initial EMS administration of naloxone was substantial and did not change significantly during COVID-19. Our findings exemplify why EMS agencies should analyze initial time-to-treatment data, especially for life-threatening conditions, beyond assuring that protocol-required treatments have been provided. Based on our analysis, fire department crews now carry intranasal naloxone, and intranasal naloxone is given to "impaired" opioid overdose victims the first-arriving fire department or EMS personnel. We continue to collect data on intervals-to-treatment prospectively and monitor our critical process/treatment intervals using the plan-do-study-act model to improve our process/carry out change, and publish our results in a future publication.
尽管大多数美国急救医疗服务（EMS）系统在其电子院前患者护理报告（PCR）中收集治疗时间数据，但这些数据的分析很少出现在出版物中。我们认为 EMS 机构应该定期分析各种潜在危及生命的情况的初始治疗时间。这不仅可以确保已提供协议规定的治疗，还可以发现可避免的延迟并推动协议/治疗优先级的改变。我们的研究目的是分析从 9-1-1 电话接听至成人阿片类药物过量受害者首次给予纳洛酮的间隔时间，以展示分析治疗时间数据的质量保证重要性。
对成人阿片类药物过量受害者从 9-1-1 电话接听至首次给予纳洛酮的间隔时间进行回顾性分析。我们排除了年龄<18 岁的受害者和在 EMS 到达之前由旁观者、警察或医疗保健工作者给予纳洛酮的病例。我们比较了 COVID-19 大流行前后收集的数据，以确定其对分析的影响。
582 名阿片类药物过量受害者的平均患者年龄为 40.7 岁[95%置信区间（CI）39.6，41.8]，其中 405 名男性（69.6%）。EMS 单位从 9-1-1 电话接听至现场到达用时 6.7 分钟。到达受害者需要 1.8 分钟，无论给药途径如何，给予首剂纳洛酮都需要额外 8.6 分钟（70.4%静脉内，26.1%鼻内，2.7%骨内，0.7%肌内）。EMS 人员在接到 9-1-1 电话后 17.1 分钟给予首剂纳洛酮，其中 50.3%的延迟发生在与患者接触之后。在大流行前后，治疗时间无统计学显著差异。
从 9-1-1 电话接听至最初 EMS 给予纳洛酮的时间在大流行前就已经很长，并且在 COVID-19 期间没有显著变化。我们的研究结果证明了为什么 EMS 机构应该分析初始治疗时间数据，尤其是对于危及生命的情况，而不仅仅是确保提供了协议规定的治疗。根据我们的分析，消防部门人员现在携带鼻内纳洛酮，并且对“意识不清”的阿片类药物过量受害者，第一到达的消防部门或 EMS 人员给予鼻内纳洛酮。我们继续前瞻性地收集治疗时间间隔数据，并使用计划-执行-研究-行动模型监测我们的关键流程/治疗间隔，以改进我们的流程/实施变更，并在未来的出版物中发布我们的结果。
