Pediatric Emergency Medical Services Activations Involving Naloxone Administration

Objectives: Fatal and nonfatal pediatric opioid poisonings have increased in recent years. Emergency medical services (EMS) clinicians are often the first to respond to an opioid poisoning and administer opioid reversal therapy. Currently, the epidemiology of prehospital naloxone use among children and adolescents is incompletely characterized. Thus, our study objective was to describe naloxone administrations reported by EMS clinicians during pediatric activations in the United States. Methods: We performed a cross-sectional study using the National Emergency Medical Services Information System (NEMSIS). Within NEMSIS, we identified emergency responses where children 1 day through 17 years old were documented by EMS to have received ≥1 dose of naloxone in 2022. We analyzed demographic and EMS characteristics and age-specific prevalence rates of activations where naloxone was reported. Results: In 2022, 6,215 activations involved naloxone administration to children. Most activations involved males (55.4%, 3,435 of 6,201) and occurred in urban settings (85.7%, 5,214 of 6,083). Naloxone administration prevalence per 10,000 activations was highest among the 13-17 year age group (57.5), followed by the 1 day to <1 year (17.9) age group. A dispatch complaint of an overdose or poisoning was documented in 28.9% (1,797 of 6,215) of activations and was more common among activations involving adolescents aged 13-17 years (31.5%, 1,555 of 4,937) than infants 1 day to <1 year (12.8%, 48 of 375). The first naloxone dose was documented to improve clinical status in 54.1% (3,136 of 5,793) of activations. Naloxone was documented to worsen clinical status in only 0.2% (11 of 5,793) of activations. Conclusions: In pediatric activations involving naloxone, less than one-third were dispatched as an overdose or poisoning but over half were documented to clinically improve after the first dose of naloxone. Naloxone was rarely documented to worsen clinical status. Our findings highlight the safety of prehospital naloxone use, as well as the importance of a high index of suspicion for opioid poisoning in the pediatric population. Opportunities exist to leverage linked data sources to develop interventions to improve prehospital opioid poisoning recognition and management.