Emergency Medical Services
Background: Prehospital naloxone (Narcan) administration is becoming increasingly common due to the opioid misuse epidemic. While naloxone may be an effective acute life-saving intervention, the long-term outcomes of recipients are largely unknown. The objective of this study was to determine the one-year mortality rate of patients who receive prehospital naloxone from emergency medical services (EMS).
Methods: We performed a retrospective observational study querying prehospital electronic medical records from seven North Carolina (NC) county EMS agencies for naloxone administration over a twenty-six-month period (1/2015-2/2017). Patients were cross-referenced with the NC State Center for Health Statistics Vital Records to obtain date of death. Patients who presented in cardiac arrest or who died on Day 0 and had no recorded prehospital vital signs were excluded. Mortality was assessed on the day of naloxone administration (Day 0), the day after administration (Day 1), at one-month (Day 30), and at one-year. Patient response to naloxone (improvement/no improvement) was collected from EMS records. Analysis was by descriptive statistics.
Results: There were 3,099 naloxone administrations. Mean age was 46.1 years old (95%CI 45.4-46.8). Males accounted for 55.8% (n=1729) of the sample. The overall mortality on Day 0 was 0.03% (n=1), on Day 1 was 1.4% (n=44), at Day 30 was 6.2% (n=193), and at one-year was 14.8% (n=459). Of these administrations, 72.6% (n=2249) had documented improvement with naloxone. In the naloxone improvement subgroup, the mortality rate on Day 0 was 0%, on Day 1 was 0.6% (n=14), at Day 30 was 3.6% (n=80), and at one-year was 12.0% (n=269). Of the naloxone administrations, 27.4% (n=850) had no improvement documented. In the naloxone no improvement subgroup, the mortality rate on Day 0 was 0.1% (n=1), on Day 1 was 3.5% (n=30), at Day 30 was 13.3% (n=113), and at one-year was 22.4% (n=190).
Conclusion: Nearly 15% of patients are dead within one-year of receiving prehospital naloxone. This high one-year mortality rate suggests that healthcare providers, public health officials, and policymakers should engage together to develop programs that positively impact long-term survival in this high-risk population.