Evidence-Based Guidelines for EMS Administration of Naloxone

Area of Science:

• Emergency medicine
• Toxicology
• Public health

Background:

• The opioid crisis is a leading cause of death in the U.S.
• Naloxone administration by Emergency Medical Services (EMS) can reduce mortality.
• Evidence-based guidelines for EMS naloxone use are lacking.

Purpose of the Study:

• Develop and disseminate clinical practice guidelines for EMS naloxone administration.
• Create a model protocol for suspected opioid overdose management by EMS.

Main Methods:

• Leveraged a systematic review from the Agency for Healthcare Research and Quality (AHRQ).
• Developed evidence-based recommendations for naloxone administration routes.
• Identified areas lacking sufficient evidence for recommendations.

Main Results:

• Conditional recommendations for naloxone administration routes (intravenous, intranasal).
• Intravenous route favored for dose titration; intramuscular route disfavored.
• Intranasal and intravenous routes are equally recommended, with route choice dependent on patient variables.

Conclusions:

• Guidelines provide evidence-based direction for EMS naloxone use.
• Acknowledged limitations including novel synthetic opioids and new devices.
• Called for future research on new devices and synthetic opioid impact on naloxone efficacy.