Clinical paperTreatment of opioid overdose in a physician-based prehospital EMS: Frequency and long-term prognosis☆
Section snippets
Methods
The city of Copenhagen covers 97 km2, with a resident population of approximately 590 000, which increases by approximately 10% during daytime. Consistent with the European Union recommendations, Copenhagen has a single emergency number – 112 – which enables direct contact to the emergency dispatch centre. In Copenhagen, the emergency medical system (EMS) is two-tiered 24 h a day and 7 days a week. The basic life support (BLS) unit, equipped with two BLS providers is called out from eight
Results
During the 10-year investigation period, a total of 4762 emergency dispatches were related to opioid overdose. Patients were identified in 3245 of these episodes. A steady decline in numbers of overdoses was seen from 639 out of 4520 (14.1%) patients treated in 1994 to 311 out of 7263 patients treated (4.3%) in 2003, and the proportion of identification increased significantly (p < 0.0001; Table 1). In addition, the proportion of death on the scene decreased significantly (p < 0.0001) also during
Discussion
We found a highly significant decreasing number of opioid overdose episodes during the 10 years of data collection.
It is a strength of our investigation that all cases of opioid overdose in the city centre of Copenhagen were treated and recorded by one single unit – the physician-based MECU, and long-term mortality could be assessed due to the Danish Central Personal Registry. Unfortunately, we could not identify all patients, and our analysis of long-term prognosis is therefore necessarily
Conclusion
Over the 10-year period 1994–2003, a decreasing number of opioid overdose episodes were found. Long-term mortality is high in these patients and highest in those with advanced age and numerous episodes of opioid overdose.
Conflicts of interest statement
There are no conflicts of interest.
Acknowledgement
Secretary Gitte Brofeldt.
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2020, Annals of Emergency MedicineCitation Excerpt :Patterns of health care use before and after an ED visit for nonfatal poisoning can also be assessed to identify system-level opportunities for improvement. There is little information on the rates and risk factors for death after treatment for nonfatal opioid poisoning.7-15 Specific to the ED setting, 2 studies conducted in a large health care plan in the United States (records for up to 1.2 million unique patients)16,17 estimated between 7% and 9.4% all-cause mortality within 1 year after treatment in the ED for opioid poisoning.
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2019, ResuscitationCitation Excerpt :For example, documented naloxone administration has been used in several studies as an inclusion criterion for OD-OHCA.8,9,10,15 It has been estimated that this may not be a sensitive method of calculating the number of OD-OHCA victims because many who are given naloxone by EMS have not overdosed and administration was not recommended for OHCA during some study periods.8,16,17 To avoid this possible inclusion bias, we chose not to use naloxone administration, but instead to search EMS reports, hospital records, and vital statistics data for any mention of likely overdose or drug involvement.
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2017, Journal of Emergency MedicineCorrelates of overdose risk perception among illicit opioid users
2016, Drug and Alcohol DependenceCitation Excerpt :Extensive research has established an array of circumstances and behaviors that increase the likelihood of opioid overdose, which has facilitated the development of evidence-based interventions (Darke and Hall, 2003). These established risk factors include having had a prior overdose, concurrent use of alcohol, cocaine, or benzodiazepines, more frequent injecting, and HIV infection (Brugal et al., 2002; Coffin et al., 2003, 2007; Darke et al., 2011, 2007, 2005; Evans et al., 2012; Green et al., 2012; Jenkins et al., 2011; Nielsen et al., 2011; Ochoa et al., 2005; Stoove et al., 2009; Wines et al., 2007). Despite these advances, young opioid analgesic users have been shown to be unaware or misinformed regarding overdose risk factors, and heroin users have been shown to present an “optimistic bias”, or tendency to perceive a lower personal susceptibility to overdose compared to one's peers (Frank et al., 2015; McGregor et al., 1998; Neira-Leon et al., 2006).
European Resuscitation Council Guidelines for Resuscitation 2015. Section 4. Cardiac arrest in special circumstances
2015, ResuscitationCitation Excerpt :Titrate the dose until the victim is breathing adequately and has protective airway reflexes. Large opioid overdoses may require a total dose of up to 10 mg of naloxone.283–285,290–300 All patients treated with naloxone must be monitored.
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.05.027.