McMullan Jason, Mueller Will, Brown Jennifer L, Ewing Irene, Lyons Michael S, Sprunger Joel, Winhusen John, Collins Thomas
Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Colerain Township Fire Department, Colerain, Ohio.
Prehosp Emerg Care. 2025;29(4):519-524. doi: 10.1080/10903127.2025.2451214. Epub 2025 Jan 17.
Opioid-associated fatal and non-fatal overdose rates continue to rise. Prehospital overdose education and naloxone distribution (OEND) programs are attractive harm-reduction strategies, as patients who are not transported by EMS after receiving naloxone have limited access to other interventions. This narrative summary describes our experiences with prehospital implementation of evidence-based OEND practices across Ohio as part of the HEALing Communities Study (HCS).
HCS was a parallel-group, cluster randomized, unblinded, wait-list controlled trial of 67 communities highly impacted by opioid-related overdose fatalities in four states, including Ohio. An EMS Intervention Design Team (IDT), consisting of EMS physicians, paramedics, and an EMS department Chief with an established OEND program, supported participating EMS agencies. Services of the IDT included protocol development, program training, and stigma-reduction education. HCS funding supported implementation costs and varied by county/agency.
In 12 Ohio counties, 29 agencies implemented an OEND program; agencies served rural, suburban, and urban communities. While leaving naloxone kits with patients and/or families at an EMS call was universally adopted, additional OEND approaches were undertaken. Seven EMS agencies registered with the Ohio Department of Health's Project DAWN program, allowing hub-and-spoke distribution of state-provided naloxone to smaller OEND programs. An urban EMS agency targeted mass gatherings for OEND efforts; bicycle teams providing crowd medical response distributed leave-behind naloxone kits in a process mirroring traditional 9-1-1 calls while static first aid stations offered overdose educational materials, information on local resources, and take-home naloxone kits. A rural EMS agency allowed community members to request naloxone kits from agency headquarters. To address an overdose hotspot at an interstate rest area, a rural joint ambulance district partnered with the county health department to install and maintain a public-access naloxone station. Observed facilitators included Ohio's legal and regulatory environment, creating local definitions of success, identifying and empowering local champions, and operational solutions to ease OEND for practitioners. Stigma represents the biggest barrier, with ongoing education as the best solution. Incremental program implementation was most successful.
Our OEND implementation experiences across multiple Ohio EMS agencies identified several barriers, facilitators, and creative solutions that may inform future prehospital harm-reduction programs.
与阿片类药物相关的致命和非致命过量用药率持续上升。院前过量用药教育和纳洛酮分发（OEND）项目是颇具吸引力的减少伤害策略，因为接受纳洛酮治疗后未由紧急医疗服务（EMS）转运的患者获得其他干预措施的机会有限。本叙述性总结描述了我们在俄亥俄州作为“治愈社区研究”（HCS）的一部分，院前实施循证OEND实践的经验。
HCS是一项平行组、整群随机、非盲、等待列表对照试验，涉及四个州（包括俄亥俄州）受阿片类药物相关过量用药死亡严重影响的67个社区。一个由EMS医生、护理人员和一个设有既定OEND项目的EMS部门主管组成的EMS干预设计团队（IDT）为参与的EMS机构提供支持。IDT的服务包括方案制定、项目培训和减少污名化教育。HCS资金支持实施成本，且各县/机构有所不同。
在俄亥俄州的12个县，29个机构实施了OEND项目；这些机构服务于农村、郊区和城市社区。虽然在EMS出诊时将纳洛酮试剂盒留给患者和/或家属这一做法被普遍采用，但也采取了其他OEND方法。7个EMS机构在俄亥俄州卫生部的“黎明计划”项目中注册，这使得能够将由该州提供的纳洛酮以中心辐射的方式分发给较小的OEND项目。一个城市EMS机构将OEND工作的目标对准大型集会；提供人群医疗响应的自行车队在类似传统911呼叫的过程中分发备用纳洛酮试剂盒，同时静态急救站提供过量用药教育材料、当地资源信息和可带回家的纳洛酮试剂盒。一个农村EMS机构允许社区成员从机构总部申领纳洛酮试剂盒。为解决一个州际休息区的过量用药热点问题，一个农村联合救护区与县卫生部门合作安装并维护了一个公共可及的纳洛酮站。观察到的促进因素包括俄亥俄州的法律和监管环境、制定当地的成功定义、识别并赋予当地倡导者权力以及为从业者简化OEND的操作解决方案。污名化是最大的障碍，持续教育是最佳解决方案。逐步实施项目最为成功。
我们在俄亥俄州多个EMS机构实施OEND的经验确定了几个障碍、促进因素和创造性解决方案，这些可能为未来的院前减少伤害项目提供参考。
