Background: Naloxone is well known to effectively reverse the effects of unintentional opiate overdose and reduce mortality from opiate overdose (12, 18). Despite activation of emergency medical services (EMS) after an overdose, many patients choose against transport to a hospital for further treatment and initiation of support services. These patients were previously left on scene without any additional support or services, despite encountering emergency medical personnel. To supplement the state's naloxone distribution efforts, Vermont initiated an EMS protocol allowing all levels of providers to provide naloxone leave-behind kits to patients and/or their family or friends when a patient is identified as high-risk for opiate overdose and is not transported to a hospital by the responding EMS agency. Objectives: To evaluate the preliminary outcomes of Vermont's EMS naloxone leave-behind program. Methods: De-identified data was obtained from Vermont’s pre-hospital incident reporting tool, SIREN, containing incidents in which patients who were not transported to a hospital were identified by EMS as high-risk for future opiate overdose. The data was divided into two data sets. The first represented a retrospective time period of the 12 months leading up to the naloxone leave behind protocol initiation on 10/01/2020. The prospective data set includes all encounters in the 12-month period after the protocol was started. This analysis includes only the preliminary analysis of the first six months of the protocol. Results: In the retrospective time period between October 2019 and September 2020 (prior to starting the naloxone leave-behind program), Vermont EMS agencies responded to 195 incidents where a patient that was subsequently not transported to a hospital met criteria for being high-risk for future opioid overdose. In the preliminary prospective data period, from October 2020 through March 2021 (six months of naloxone leave-behind program), 119 patients were not transported to a hospital and were identified as high-risk for future opiate overdose. Of the 119 patients, 69 patients were offered a naloxone leave-behind kit by the responding EMS agency, representing 58% of the target population of high-risk individuals. Of these 69 patients, 59 patients accepted a kit, representing an overall naloxone leave-behind kit distribution rate of 50.0%, and a kit acceptance rate of 85.5%. The high-risk patients who were not transported to a hospital were most often ages 30-39 (48.7%), and 61.7% were male gender.
Bissonette, Samantha J., "Preliminary Analysis of Vermont's EMS Naloxone Leave-Behind Program" (2021). Larner College of Medicine Fourth Year Advanced Integration Teaching/Scholarly Projects. 17.
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