Activated Charcoal
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
I
|
Supportive (Green)
|
Plasma paracetamol level
|
Patient
|
ED-MD
|
Underhill TJ., Greene MK., Dove AF. A comparison of the efficacy of gastric lavage, ipecacuanha and activated charcoal in the emergency management of paracetamol overdose. Arch Emerg Med 1990; 7(3):148-154. Medline
|
II
|
Supportive (Green)
|
Complications
|
Patient
|
PH-Paramedic
|
Villarreal J., Kahn CA., Dunford JV., Patel E., Clark RF. A retrospective review of the prehospital use of activated charcoal. Am J Emerg Med 2015; 33(1):56-59. Medline
|
II
|
Neutral (Yellow)
|
Time to administration
|
Process
|
PH-Paramedic
|
Crockett R., Krishel SJ., Manoguerra A., et al. Prehospital use of activated charcoal: A pilot study. J Emerg Med 1996; 14(3):335-8. Medline
|
III
|
Supportive (Green)
|
Compliance with treatment guidelines
|
Patient
|
PH-Paramedic
|
Thakore S., Murphy N. The potential role of prehospital administration of activated charcoal. Emerg Med J 2002; 19(1):63-65. Medline
|
III
|
Neutral (Yellow)
|
Feasibility
|
Process
|
PH-Paramedic
|
Alaspaa Ari O., Markku J. Kulsma, Kalle Hoppu, Pertti J. Neuvonen. Out of Hospital Administration of Activated Charcoal by Emergency Medical Services. Ann Emerg Med 2005; 45(2):207-12. Medline
|
III
|
Opposes (Red)
|
1) Feasibility - time from ingestion to ambulance arrival 2) potential aspiration risk
|
Process
|
PH-Paramedic
|
Isbister GK., Dawson AH., Whyte IM. Feasibility of prehospital treatment with activated charcoal: Who could we treat, who should we treat? Emerg Med J 2003; 20(4):375-8. Medline
|
Benzodiazepine antagonist (Benzo OD)
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
I
|
Supportive (Green)
|
Improvement in CGIS score
|
Patient
|
ED-MD
|
Spivey WH., Roberts JR., Derlet RW. A clinical trial of escalating doses of flumazenil for reversal of suspected benzodiazepine overdose in the emergency department. Ann Emerg Med 1993; 22(12):1813-1821. Medline
|
I
|
Supportive (Green)
|
Improvement in the CGIS Score
|
Patient
|
ED-MD
|
The Flumazenil Study Group. Treatment of benzodiazepine overdose with flumazenil. the flumazenil in benzodiazepine intoxication multicenter study group. Clin Ther 1992; 14(6):978-995. Medline
|
I
|
Neutral (Yellow)
|
Adverse events
|
Patient
|
ED-MD
|
Barnett R., Grace M., Boothe P., et al. Flumazenil in drug overdose: Randomized, placebo-controlled study to assess cost effectiveness. Crit Care Med 1999; 27(1):78-81. Medline
|
I
|
Opposes (Red)
|
Adverse events
|
Patient
|
ED-MD
|
Penninga EI., Graudal N., Ladekarl MB., et al. Adverse events associated with flumazenil treatment for the management of suspected benzodiazepine intoxication: a systematic review with meta-analyses of randomised trials. Basic Clin Pharmacol Toxicol 2016; 118:37-44. Medline
|
II
|
Opposes (Red)
|
Change in LOC
|
Patient
|
ED-MD
|
Gueye PN., Hoffman JR., Taboulet P., et al. Empiric use of flumazenil in comatose patients: Limited applicability of criteria to define low risk. Ann Emerg Med 1996; 27(6):730735. Medline
|
III
|
Supportive (Green)
|
Prevalence of adverse events
|
Patient
|
ED-MD
|
Nguyen HB., Troendle M., Cumpston K., Rutherfoord Rose S., Wills BK. Lack of adverse effects from flumazenil administration: an ED observational study Tammy T. Am J of Emerg Med 2015; 33:1677–9. Medline
|
Glucagon (Beta-Blocker OD)
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
III
|
Supportive (Green)
|
Reversal of cardiovascular depression
|
Patient
|
ED-MD
|
Peterson CD., Leeder JS., Sterner S. Glucagon therapy for beta-blocker overdose. Drug Intell Clin Pharm 1984; 18(5):394-8. Medline
|
III
|
Supportive (Green)
|
Survival
|
Patient
|
ED-MD
|
Tai YT., Lo CW., Chow WH., Cheng CH. Successful resuscitation and survival following massive overdose of metoprolol. Br J Clin Pract 1990; 44(12):746-747. Medline
|
III
|
Supportive (Green)
|
Survival
|
Patient
|
ED-MD
|
Weinstein RS., Cole S., Knaster HB., Dahlbert T. Beta blocker overdose with propranolol and with atenolol. Ann Emerg Med 1985; 14(2):161-163. Medline
|
III
|
Neutral (Yellow)
|
Mortality
|
Patient
|
ED-MD
|
Bailey B. Glucagon in beta-blocker and calcium channel blocker overdoses: A systematic review. J Toxicol Clin Toxicol 2003; 41(5):595-602. Medline
|
III
|
Neutral (Yellow)
|
Mortality
|
Patient
|
ED-MD
|
Barton CA., Johnson NB., Mah ND., Beauchamp G., Hendrickson R. Successful treatment of a massive metoprolol overdose using intravenous lipid emulsion and hyperinsulinemia/euglycemia therapy. Pharmacotherapy 2015; 35(5):e56-60. Medline
|
III
|
Neutral (Yellow)
|
Survival
|
Patient
|
PH-Paramedic
|
Lewis M., Kallenbach J., Germond C., Zaltzman M., Muller F., Steyn J., et al. Survival following massive overdose of adrenergic blocking agents (acebutolol and labetalol). Eur Heart J 1983; 4(5):328-32. Medline
|
III
|
Neutral (Yellow)
|
Mortality
|
Patient
|
ED-MD
|
O'Mahony D., O'Leary P., Molloy MG. Severe oxprenolol poisoning: the importance of glucagon infusion. Hum Exp Toxicol 1990; 9(2):101-3. Medline
|
Naloxone-IM (Opiate OD)
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
I
|
Supportive (Green)
|
Time to regain RR>10
|
Patient
|
PH-Paramedic
|
Kelly AM., Kerr D., Patrick I., Walker T., Koutsogiannis Z. Randomised trial of intranasal vs intramuscular naloxone in prehospital treatment for suspected opiod overdose. Med J Aus 2005; 182:24-7. Medline
|
I
|
Supportive (Green)
|
Response within 10 minutes of naloxone treatment
|
Patient
|
PH-Paramedic
|
Kerr D., Kelly AM., Dietze P., Jolley D., Barger B. Randomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdose. Addiction 2009; 104(12):2067-74. Medline
|
I
|
Supportive (Green)
|
Return of spontaneous respiration within 10 minutes
|
Patient
|
PH-Paramedic
|
Skulberg AK, Tylleskär I, Valberg M, AC B, Dale J, Heyerdahl F, et al. Comparison of intranasal and intramuscular naloxone in opioid overdoses managed by ambulance staff: a double-dummy, randomised, controlled trial. Addiction 2022. Medline
|
I
|
Supportive (Green)
|
Restoration of spont RR to >= to 10 at 10 minutes following drug administration.
|
Patient
|
PH-Paramedic & MD
|
Skulberg AK, Tylleskär I, Valberg M, AC B, Dale J, Heyerdahl F, et al. Comparison of intranasal and intramuscular naloxone in opioid overdoses managed by ambulance staff: a double-dummy, randomised, controlled trial. Addiction 2022. Medline
|
II
|
Supportive (Green)
|
Adequate response
|
Patient
|
PH-Paramedic
|
Chou R, Korthuis PT, McCarty D, Coffin PO, Griffin JC, Davis-O'Reilly C, et al. Management of Suspected Opioid Overdose With Naloxone in Out-of-Hospital Settings: A Systematic Review. Ann Intern Med 2017; 167(12) 867-75. Medline
|
II
|
Supportive (Green)
|
Safety and efficacy
|
Patient
|
Other
|
Harris K, Page CB, Samantray S, Parker L, Brier AJ, Isoardi KZ. One single large intramuscular dose of naloxone is effective and safe in suspected heroin poisoning. EMA 2019. Medline
|
II
|
Supportive (Green)
|
Agitation post naloxone
|
Patient
|
PH-Paramedic
|
Isoardi KZ, Parker L, Harris K, Rashford S, Isbister GK. Acute Opioid Withdrawal Following Intramuscular Administration of Naloxone 1.6 mg: A Prospective Out-Of-Hospital Series. Ann Emerg Med 2022;80(2):120–6. Medline
|
II
|
Supportive (Green)
|
Safety
|
Process
|
PH-Paramedic
|
Tylleskar I, Gjersing L, Bjørnsen LP, Braarud A, Heyerdahl F, Dale O, et al. Prehospital naloxone administration - What influences choice of dose and route of administration? BMC Emerg Med 2020; 20(1). Medline
|
II
|
Neutral (Yellow)
|
Dose required to increase LOC and RR
|
Process
|
PH-Paramedic
|
Cantwell K., Dietze P., Flander L. The relationship between naloxone dose and key patient variables in the treatment of non-fatal heroin overdose in the prehospital setting. Resuscitation 2005; 65: 315-9. Medline
|
III
|
Supportive (Green)
|
Adverse events in the ED
|
Process
|
PH-Paramedic
|
Maloney LM, Alptunaer T, Coleman G, Ismael S, McKenna PJ, Marshall RT, et al. Prehospital Naloxone and Emergency Department Adverse Events: A Dose-Dependent Relationship. J Emerg Med 2020; 59(6):872-83. Medline
|
III
|
Supportive (Green)
|
Response within 5 minutes of naloxone treatment
|
Patient
|
ED-MD
|
Sporer KA., Firestone J., Isaacs M. Out-of-hospital treatment of opioid overdoses in an urban setting. Acad Emerg Med 1996; 3(7):660-667. Medline
|
III
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Vilke GM., Sloane C., Smith AM., Chan TC. Assessment for deaths in out-of-hospital heroin overdose patients treated with naloxone who refuse transport. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine 2003; 10(8):893-896. Medline
|
III
|
Neutral (Yellow)
|
Adverse events following Naloxone
|
Process
|
PH-Paramedic
|
Buajordet I., Naess AC., Jacobsen D., Brors O. Adverse events after naloxone treatment of episodes of suspected acute opioid overdose. Eur J Emerg Med 2004; 11:19-23. Medline
|
III
|
Neutral (Yellow)
|
Response to D50W, appropriate diagnosis
|
Patient
|
PH-Paramedic
|
Hoffman JR., Schriger DL., Votey SR., Luo JS. The empiric use of hypertonic dextrose in patients with altered mental status: A reappraisal. Ann Emerg Med 1992; 21(1):20-4. Medline
|
Naloxone-IN (Opiate OD)
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
I
|
Supportive (Green)
|
Response within 10 minutes of naloxone treatment
|
Patient
|
PH-Paramedic
|
Kerr D., Kelly AM., Dietze P., Jolley D., Barger B. Randomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdose. Addiction 2009; 104(12):2067-74. Medline
|
I
|
Supportive (Green)
|
Return of spontaneous respiration within 10 minutes
|
Patient
|
PH-Paramedic
|
Skulberg AK, Tylleskär I, Valberg M, AC B, Dale J, Heyerdahl F, et al. Comparison of intranasal and intramuscular naloxone in opioid overdoses managed by ambulance staff: a double-dummy, randomised, controlled trial. Addiction 2022. Medline
|
I
|
Neutral (Yellow)
|
Time to regain RR>10
|
Patient
|
PH-Paramedic
|
Kelly AM., Kerr D., Patrick I., Walker T., Koutsogiannis Z. Randomised trial of intranasal vs intramuscular naloxone in prehospital treatment for suspected opiod overdose. Med J Aus 2005; 182:24-7. Medline
|
II
|
Supportive (Green)
|
Time to positive clinical response
|
Patient
|
PH-Paramedic
|
Barton ED., et al. Efficacy of IN naloxone as a needleless alternative treatment of opioid overdose in the prehospital setting. J Emerg Med 2005; 29:265-71. Medline
|
II
|
Supportive (Green)
|
Adequate response
|
Patient
|
PH-Paramedic
|
Chou R, Korthuis PT, McCarty D, Coffin PO, Griffin JC, Davis-O'Reilly C, et al. Management of Suspected Opioid Overdose With Naloxone in Out-of-Hospital Settings: A Systematic Review. Ann Intern Med 2017; 167(12) 867-75. Medline
|
II
|
Supportive (Green)
|
Adverse events.
|
Patient
|
PH-Bystander
|
Du Pont D, Fenderson R, Hunter K, Kuc A, Carroll G. Adverse Effects After Prehospital Administration of Naloxone by Bystanders: A Preliminary Study. Prehosp Disaster Med. March 2024; 1-6. Medline
|
II
|
Supportive (Green)
|
Need for susbsequent doses
|
Patient
|
PH-Paramedic
|
Fidacaro GA, Patel P, Carroll G, Bartimus H, Hunter K, Hong R. Do Patients Require Emergency Department Interventions After Prehospital Naloxone? J of addiction medicine 2019. Medline
|
II
|
Supportive (Green)
|
Phyisiologic response
|
Patient
|
PH-Paramedic & CCT
|
Liu A, Nelson AR, Shapiro M, Boyd J, et al. Prehospital Naloxone Administration Patterns During the Era of Synthetic Opioids. Prehosp Emerg Care 2023; 1-13. Medline
|
II
|
Supportive (Green)
|
GCS
|
Patient
|
PH-Paramedic
|
Merlin MA., Saybolt M., Kapitanyan R., et al. Intranasal naloxone delivery is an alternative to intravenous naloxone for opioid overdoses. Am J Emerg Med 2010; 28(3):296-303. Medline
|
II
|
Supportive (Green)
|
Improved vital signs
|
Patient
|
PH-Paramedic
|
Nugent K, Matthews P, Gissendaner J, Papas M, Occident D, Patel A, et al. A Comparison of Efficacy of Treatment and Time to Administration of Naloxone by BLS and ALS Providers. Prehosp Disaster Med 2019; 34(4) 350-5. Medline
|
II
|
Supportive (Green)
|
Time to positive clinical response
|
Patient
|
PH-Paramedic
|
Robertson TM., et al. Intranasal Naloxone is a Viable Alternative to Intravenous Naloxone for Prehospital Narcotic Overdoses. Prehospital Emergency Care 2009; 13(4):512-5. Medline
|
II
|
Supportive (Green)
|
Response to initial IN dose
|
Patient
|
PH-Paramedic & MD
|
Thompson J, Salter J, Bui P, Herbert L, Mills D, Wagner D, et al. Safety, Efficacy, and Cost of 0.4-mg Versus 2-mg Intranasal Naloxone for Treatment of Prehospital Opioid Overdose. Ann Pharmacother 2021; 10600280211030918. Medline
|
II
|
Supportive (Green)
|
Safety
|
Process
|
PH-Paramedic
|
Tylleskar I, Gjersing L, Bjørnsen LP, Braarud A, Heyerdahl F, Dale O, et al. Prehospital naloxone administration - What influences choice of dose and route of administration? BMC Emerg Med 2020; 20(1). Medline
|
III
|
Supportive (Green)
|
Time to positive clinical response
|
Process
|
PH-Paramedic
|
Barton E., Ramos J., Colwell C., Benson J., Baily J., Dunn W. Intranasal Administration of Naloxone by Paramedics. Prehospital Emergency Care 2002; 6(1):54-8. Medline
|
III
|
Supportive (Green)
|
Effective antidote response (EAR)
|
Patient
|
ED-MD
|
Friedman M., Manini A. Validation of Criteria to Guide Prehospital Naloxone Administration for Drug-Related Altered Mental Status. Med Toxicol 2016; 12(2016):270–5. Medline
|
III
|
Supportive (Green)
|
Change in vitals
|
Patient
|
PH-Paramedic
|
Loimer N., Hofmann P., Chaudhry HR. Nasal administration of naloxone is as effective as the intravenous route in opiate addicts. Int J Addict 1994; 29(6):819-827. Medline
|
III
|
Supportive (Green)
|
Adverse events in the ED
|
Process
|
PH-Paramedic
|
Maloney LM, Alptunaer T, Coleman G, Ismael S, McKenna PJ, Marshall RT, et al. Prehospital Naloxone and Emergency Department Adverse Events: A Dose-Dependent Relationship. J Emerg Med 2020; 59(6):872-83. Medline
|
III
|
Supportive (Green)
|
Efficacy
|
Patient
|
ED-Paramedic & CCP
|
Weiner SG, Mitchell PM, Temin ES, Langlois BK, Dyer KS. Use of Intranasal Naloxone by Basic Life Support Providers. Prehospital emergency care 2016; 21(3) 322-6. Medline
|
III
|
Neutral (Yellow)
|
Survival to discharge
|
Patient
|
ED-MD
|
Kummer RL, Kempainen RR, Olives TD, Leatherman JW, Prekker ME. Naloxone-associated pulmonary edema following recreational opioid overdose: A case series. Am J Emerg Med 2021; 41–3. Medline
|
III
|
Neutral (Yellow)
|
Resolution of Symptoms
|
Patient
|
PH-Paramedic
|
Zuckerman M., Weisberg SN., Boyer EW. Pitfalls of intranasal naloxone. Prehosp Emerg Care 2014; 18(4):550-554. Medline
|
Naloxone-IV (Opiate OD)
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
II
|
Supportive (Green)
|
Time to positive clinical response
|
Patient
|
PH-Paramedic
|
Robertson TM., et al. Intranasal Naloxone is a Viable Alternative to Intravenous Naloxone for Prehospital Narcotic Overdoses. Prehospital Emergency Care 2009; 13(4):512-5. Medline
|
II
|
Supportive (Green)
|
Route of administration
|
Process
|
PH-Paramedic
|
Tylleskar I, Gjersing L, Bjørnsen LP, Braarud A, Heyerdahl F, Dale O, et al. Prehospital naloxone administration - What influences choice of dose and route of administration? BMC Emerg Med 2020; 20(1). Medline
|
II
|
Supportive (Green)
|
Time to regain RR ≥10
|
Patient
|
PH-Paramedic
|
Wanger K., Brough L., MacMillan I., et al. Intravenous vs subcutaneous naloxone for out-of-hospital management of presumed opioid overdose. Acad Emerg Med 1998; 5(4):293-9. Medline
|
II
|
Neutral (Yellow)
|
Time to re-dose
|
Patient
|
ED-MD
|
Wong F, Edwards CJ, Jarrell DH, Patanwala AE. Comparison of lower-dose versus higher-dose intravenous naloxone on time to recurrence of opioid toxicity in the emergency department. Clinical toxicology (Philadelphia, Pa) 2019; 57(1) 19-24. Medline
|
III
|
Supportive (Green)
|
Patient response to treatment LOC and RR
|
Process
|
PH-Paramedic
|
Belz D., Lieb J., Rea T., Eisenberg M. Narcan use in a tiered-EMS system. Prehosp Emerg Care 2006; 10:468-71. Medline
|
III
|
Supportive (Green)
|
Mortality rate
|
Patient
|
PH-Paramedic
|
Bertini G., Russo L., Cricelli F., et al. Role of a prehospital medical system in reducing heroin-related deaths. Crit Care Measures 1992; 20(4):493-8. Medline
|
III
|
Supportive (Green)
|
Resolution of symptoms
|
Patient
|
PH-Paramedic
|
Gonzva J., Prunet B., Deniel C., Benner P., Toppin F., Brun PM. Early antidote use associated with noninvasive ventilation in prehospital treatment of methadone intoxication. Am J Emerg Med 2013; 31(2):e5-6. Medline
|
III
|
Supportive (Green)
|
Change in vitals
|
Patient
|
PH-Paramedic
|
Loimer N., Hofmann P., Chaudhry HR. Nasal administration of naloxone is as effective as the intravenous route in opiate addicts. Int J Addict 1994; 29(6):819-827. Medline
|
III
|
Supportive (Green)
|
Adverse events in the ED
|
Process
|
PH-Paramedic
|
Maloney LM, Alptunaer T, Coleman G, Ismael S, McKenna PJ, Marshall RT, et al. Prehospital Naloxone and Emergency Department Adverse Events: A Dose-Dependent Relationship. J Emerg Med 2020; 59(6):872-83. Medline
|
III
|
Supportive (Green)
|
Change in cardiac rhythm.
|
Patient
|
PH-Paramedic
|
Saybolt MD., Alter SM., Dos Santos F., et al. Naloxone in cardiac arrest with suspected opioid overdoses. Resuscitation 2010; 81(1):42-6. Medline
|
III
|
Supportive (Green)
|
GCS
|
Patient
|
ED-MD
|
Solhi H., Mostafazadeh B., Vishteh HR., Ghezavati AR., Shooshtarizadeh A. Benefit effect of naloxone in benzodiazepines intoxication: Findings of a preliminary study. Hum Exp Toxicol 2011; 30(7):535-540. Medline
|
III
|
Supportive (Green)
|
Response within 5 minutes of naloxone treatment
|
Patient
|
ED-MD
|
Sporer KA., Firestone J., Isaacs M. Out-of-hospital treatment of opioid overdoses in an urban setting. Acad Emerg Med 1996; 3(7):660-667. Medline
|
III
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Vilke GM., Sloane C., Smith AM., Chan TC. Assessment for deaths in out-of-hospital heroin overdose patients treated with naloxone who refuse transport. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine 2003; 10(8):893-896. Medline
|
III
|
Neutral (Yellow)
|
Adverse events following Naloxone
|
Process
|
PH-Paramedic
|
Buajordet I., Naess AC., Jacobsen D., Brors O. Adverse events after naloxone treatment of episodes of suspected acute opioid overdose. Eur J Emerg Med 2004; 11:19-23. Medline
|
III
|
Neutral (Yellow)
|
Survival to discharge
|
Patient
|
ED-MD
|
Kummer RL, Kempainen RR, Olives TD, Leatherman JW, Prekker ME. Naloxone-associated pulmonary edema following recreational opioid overdose: A case series. Am J Emerg Med 2021; 41–3. Medline
|
III
|
Neutral (Yellow)
|
Adverse events following Naloxone
|
Patient
|
PH-Paramedic
|
Osterwalder, JJ. Naloxone-For intoxications with intravenous heroin and heroin mixtures-harmless or hazardous? A prospective clinical study. Clinical Toxicology 1996; 34(4):409-16. Medline
|
III
|
Opposes (Red)
|
Pulmonary complications
|
Patient
|
PH-Paramedic
|
Farkas A, Lynch MJ, Westover R, Giles J, Siripong N, Nalatwad A, et al. Pulmonary Complications of Opioid Overdose Treated With Naloxone. Ann Emerg Med 2019. Medline
|
Treat & Release (Opiate OD)
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
II
|
Supportive (Green)
|
48 hour mortality
|
Patient
|
ED-Paramedic & MD
|
Greene JA, Deveau BJ, Dol JS, Butler MB.Incidence of mortality due to rebound toxicity after 'treat and release' practices in prehospital opioid overdose care: a systematic review. Emerg Med J 2019; 36(4):219-224. Medline
|
II
|
Supportive (Green)
|
Repeat encounter
|
Patient
|
PH-Paramedic
|
Zozula A, Neth MR, Hogan AN, Stolz U, McMullan J. Non-transport after Prehospital Naloxone Administration Is Associated with Higher Risk of Subsequent Non-fatal Overdose. Prehosp Emerg Care 2021:1-11. Medline
|
II
|
Neutral (Yellow)
|
Rate of refusal of transport
|
Process
|
PH-Paramedic
|
Glenn MJ, Rice AD, Primeau K, Hollen A, Jado I, Hannan P, et al. Refusals after prehospital administration of naloxone during the COVID-19 pandemic. PEC 2020:1-15. Medline
|
II
|
Neutral (Yellow)
|
One-week mortality after pre-hospital discharge
|
Patient
|
PH-Paramedic
|
Heyerdahl F., Hovda KE., Bjornaas MA., Nore AK., Figueiredo JC., Ekeberg O., Jacobsen D. Pre-hospital treatment of acute poisonings in oslo. BMC Emergency Medicine 2008; 8:15-227X-8-15. Medline
|
II
|
Neutral (Yellow)
|
Mortality
|
Process
|
PH-Paramedic
|
McLeod KE, Slaunwhite AK, Zhao B, Moe J, Purssell R, Gan W, et al. Comparing mortality and healthcare utilization in the year following a paramedic-attended non-fatal overdose among people who were and were not transported to hospital: A prospective cohort study using linked administrative health data. Drug Alcohol Depend 2020:108381. Medline
|
II
|
Neutral (Yellow)
|
Repeat EMS encounter
|
Patient
|
PH-Paramedic
|
Zozula A, Neth MR, Hogan AN, Stolz U, McMullan J. Non-transport after Prehospital Naloxone Administration Is Associated with Higher Risk of Subsequent Non-fatal Overdose. Prehosp Emerg Care 2021:1-11. Medline
|
III
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Boyd JJ., Kuisma MJ., Alaspaa AO., Vuori E., Repo JV., Randell TT. Recurrent opioid toxicity after pre-hospital care of presumed heroin overdose patients. Acta Anaesthesiol Scand 2006; 50: 1266-70. Medline
|
III
|
Supportive (Green)
|
Safety
|
Patient
|
PH-Paramedic
|
Levine M., Sanko S., Eckstein M. Assessing the risk of prehospital administration of naloxone with subsequent refusal of care. Prehosp Emerg Care 2016; 20:566–9. Medline
|
III
|
Supportive (Green)
|
Death and/or readmission
|
Patient
|
PH-Paramedic
|
Seidler D., Stuhlinger GH., Fischer G., et al. After antagonization of acute opiate overdose: A survey at hospitals in Vienna. Addiction 1996; 91(10):1479-1487. Medline
|
III
|
Supportive (Green)
|
Safety
|
Process
|
PH-Paramedic
|
Vilke G., Buhanan J., Dunford J., Chan T. Are Heroin Overdose Deaths Related to Patient Release After Prehospital Treatment with Naloxone? Prehospital Emergency Care 1999; 3(3):183-186. Medline
|
III
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Vilke GM., Sloane C., Smith AM., Chan TC. Assessment for deaths in out-of-hospital heroin overdose patients treated with naloxone who refuse transport. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine 2003; 10(8):893-896. Medline
|
III
|
Supportive (Green)
|
Survival
|
Patient
|
PH-Paramedic
|
Wampler DA., Molina DK., McManus J., Laws P., Manifold CA. No deaths associated with patient refusal of transport after naloxone-reversed opioid overdose. Prehosp Emerg Care 2011; 15(3):320-324. Medline
|
III
|
Neutral (Yellow)
|
Adverse Event
|
Patient
|
ED-MD
|
Christenson J., Etherington J., Grafstein E., et al. Early discharge of patients with presumed opioid overdose: Development of a clinical prediction rule. Acad Emerg Med 2000; 7(10):1110-8. Medline
|
III
|
Neutral (Yellow)
|
Rebound toxicity
|
Patient
|
PH-Paramedic
|
Rudolph SS., Jehu G., Nielsen SL., Nielsen K., Siersma V., Rasmussen LS. Prehospital treatment of opioid overdose in copenhagen--is it safe to discharge on-scene? Resuscitation 2011; 82(11):1414-8. Medline
|
III
|
Opposes (Red)
|
Deaths
|
Patient
|
PH-Bystander
|
Chou R, Korthuis PT, McCarty D, Coffin PO, Griffin JC, Davis-O'Reilly C, et al. Management of Suspected Opioid Overdose With Naloxone in Out-of-Hospital Settings: A Systematic Review. Ann Intern Med 2017; 167(12) 867-75. Medline
|