Taylor Jirka, Bandara Sachini, Thomas Cindy Parks, Saloner Brendan, Fredericks Peter James, Shen Karen
Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD 21205, United States.
Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States.
Health Aff Sch. 2025 May 20;3(5):qxaf101. doi: 10.1093/haschl/qxaf101. eCollection 2025 May.
Emergency medical services (EMS) response to nonfatal overdoses represents an opportunity to provide linkage to services. However, patients may decline follow-on transportation. This paper examined predictors associated with non-transport after nonfatal opioid overdoses.
We undertook a cross-sectional analysis of 2021-2022 data from the National EMS Information System. The outcome was a binary measure of declined transport. Predictors included age, gender, race/ethnicity, response time, EMS level of care, naloxone does, setting, urbanicity, region, time, and day.
We identified 710 263 nonfatal opioid overdose events, of which 12.4% ended in non-transport. Men were more likely to decline transport (average marginal effect [AME] 0.020 [95% CI, 0.019-0.022]), and Black patients were less likely to decline (AME -0.022 [95% CI, -0.024 to -0.021]). Compared with events involving an EMS-administered limited first dose (<2 mg), non-transports were more likely in events without naloxone administration (AME 0.075 [95% CI, 0.073-0.078]), with administration only by laypersons (AME 0.101 [95% CI, 0.096-0.107]), and when EMS administered higher first doses (2-4 mg AME 0.039 [95% CI, 0.037-0.041]; 4 mg+ AME 0.053 [95% CI, 0.049-0.056]).
Efforts to improve post-overdose care should focus on groups who are more likely to decline transport and on appropriate naloxone dosing.
紧急医疗服务（EMS）对非致命性药物过量的响应为提供服务联系创造了机会。然而，患者可能会拒绝后续转运。本文研究了非致命性阿片类药物过量后与拒绝转运相关的预测因素。
我们对2021 - 2022年国家紧急医疗服务信息系统的数据进行了横断面分析。结果是拒绝转运的二元指标。预测因素包括年龄、性别、种族/民族、响应时间、EMS护理级别、纳洛酮剂量、环境、城市化程度、地区、时间和日期。
我们识别出710263起非致命性阿片类药物过量事件，其中12.4%以拒绝转运告终。男性更有可能拒绝转运（平均边际效应[AME] 0.020 [95%置信区间，0.019 - 0.022]），而黑人患者拒绝的可能性较小（AME -0.022 [95%置信区间，-0.024至-0.021]）。与涉及EMS给予有限首剂（<2毫克）的事件相比，未给予纳洛酮的事件（AME 0.075 [95%置信区间，0.073 - 0.078]）、仅由非专业人员给予纳洛酮的事件（AME 0.101 [95%置信区间，0.096 - 0.107]）以及EMS给予较高首剂（2 - 4毫克AME 0.039 [95%置信区间，0.037 - 0.041]；4毫克以上AME 0.053 [95%置信区间，0.049 - 0.056]）中，拒绝转运的可能性更大。
改善过量用药后护理的努力应集中在更有可能拒绝转运的群体以及适当的纳洛酮剂量上。
