Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts.
Brigham and Women's Hospital, Department of Surgery, Boston, Massachusetts.
West J Emerg Med. 2024 May;25(3):320-324. doi: 10.5811/westjem.60409.
Bystander provision of naloxone is a key modality to reduce opioid overdose-related death. Naloxone training courses are available, but no standardized program exists. As part of a bystander empowerment course, we created and evaluated a brief naloxone training module.
This was a retrospective evaluation of a naloxone training course, which was paired with Stop the Bleed training for hemorrhage control and was offered to administrative staff in an office building. Participants worked in an organization related to healthcare, but none were clinicians. The curriculum included the following topics: 1) background about the opioid epidemic; 2) how to recognize the signs of an opioid overdose; 3) actions not to take when encountering an overdose victim; 4) the correct steps to take when encountering an overdose victim; 5) an overview of naloxone products; and 6) Good Samaritan protection laws. The 20-minute didactic section was followed by a hands-on session with nasal naloxone kits and a simulation mannequin. The course was evaluated with the Opioid Overdose Knowledge (OOKS) and Opioid Overdose Attitudes (OOAS) scales for take-home naloxone training evaluation. We used the paired Wilcoxon signed-rank test to compare scores pre- and post-course.
Twenty-eight participants completed the course. The OOKS, measuring objective knowledge about opioid overdose and naloxone, had improved scores from a median of 73.2% (interquartile range [IQR] 68.3%-79.9%) to 91.5% (IQR 85.4%-95.1%), < 0.001. The three domains on the OOAS score also showed statistically significant results. Competency to manage an overdose improved on a five-point scale from a median of 2.5 (IQR 2.4-2.9) to a median of 3.7 (IQR 3.5-4.1), < 0.001. Concerns about managing an overdose decreased (improved) from a median of 2.3 (IQR 1.9-2.6) to median 1.8 (IQR 1.5-2.1), < 0.001. Readiness to intervene in an opioid overdose improved from a median of 4 (IQR 3.8-4.2) to a median of 4.2 (IQR 4-4.2), < 0.001.
A brief course designed to teach bystanders about opioid overdose and naloxone was feasible and effective. We encourage hospitals and other organizations to use and promulgate this model. Furthermore, we suggest the convening of a national consortium to achieve consensus on program content and delivery.
旁观者提供纳洛酮是减少阿片类药物过量相关死亡的关键方式。纳洛酮培训课程已经提供，但没有标准化的课程。作为旁观者赋权课程的一部分，我们创建并评估了一个简短的纳洛酮培训模块。
这是对纳洛酮培训课程的回顾性评估，该课程与控制出血的“停止出血”培训配对，并提供给办公楼内的行政人员。参与者在与医疗保健相关的组织中工作，但没有临床医生。课程包括以下主题：1）阿片类药物流行的背景；2）如何识别阿片类药物过量的迹象；3）遇到过量用药受害者时不应采取的行动；4）遇到过量用药受害者时应采取的正确步骤；5）纳洛酮产品概述；6）好撒玛利亚人保护法。20 分钟的讲座部分之后是鼻腔纳洛酮试剂盒和模拟人体模型的实践环节。该课程使用阿片类药物过量知识（OOKS）和阿片类药物过量态度（OOAS）量表进行带纳洛酮回家培训评估。我们使用配对的 Wilcoxon 符号秩检验比较课前和课后的分数。
28 名参与者完成了该课程。OOKS 衡量关于阿片类药物过量和纳洛酮的客观知识，得分从中位数 73.2%（四分位距 [IQR] 68.3%-79.9%）提高到 91.5%（IQR 85.4%-95.1%），<0.001。OOAS 评分的三个域也显示出统计学上的显著结果。管理过量用药的能力从五分制的中位数 2.5（IQR 2.4-2.9）提高到中位数 3.7（IQR 3.5-4.1），<0.001。管理过量用药的担忧减少（改善）从中位数 2.3（IQR 1.9-2.6）到中位数 1.8（IQR 1.5-2.1），<0.001。干预阿片类药物过量的意愿从中位数 4（IQR 3.8-4.2）提高到中位数 4.2（IQR 4-4.2），<0.001。
设计用于教授旁观者阿片类药物过量和纳洛酮的简短课程是可行且有效的。我们鼓励医院和其他组织使用并推广这种模式。此外，我们建议成立一个国家联盟，就课程内容和交付达成共识。
