New York State EMT Basic Intranasal Naloxone Demonstration Programc.ymcdn.com/sites/ · New York...
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New York State EMT Basic Intranasal Naloxone Demonstration Program Michael W. Dailey, MD FACEP Regional EMS Medical Director Associate Professor Department of Emergency Medicine
Transcript of New York State EMT Basic Intranasal Naloxone Demonstration Programc.ymcdn.com/sites/ · New York...
New York State EMT Basic Intranasal Naloxone
Demonstration Program"Michael W. Dailey, MD FACEP
Regional EMS Medical Director Associate Professor
Department of Emergency Medicine"
Conflict of Interest!! None!
Why?!! Disaster opioid overdoses in areas of New York with little
coverage by advanced EMS providers!! REMO and Albany Medical College were approached by
medical providers from rural areas to spearhead program!! Rochester, Mountain Lakes and Suffolk County EMS
were invited to participate in initial development!
REMO!
Collaboration!! Albany Medical College!! Regional EMS Organization (REMO)!! Harm Reduction Coalition!! NYS Department of Health!
• Bureau of EMS!• AIDS Institute!
Rationale for the Partnership!! The AIDS Institute’s Opioid Overdose Prevention
Program authorizes Community Naloxone program via intramuscular injection!
! As of January 2012, there are about 70 registered programs!
! Between April 2006 and September 2011, over 470 overdose reversals were reported !
! Regulations already in place, but did not include public safety!
NYS EMS Programs!! Not eligible for participation in the Community
Naloxone Program!! Local control!! County involvement!! Regional medical oversight!! State certification and systems!
Participants !
REMO!Participants
About NYS EMS Personnel!! New York recognizes five levels of EMS responders !
1. Certified First Responders!2. EMT- Basic!3. EMT- Intermediate !4. EMT- Critical Care Technician!5. EMT- Paramedic!
EMT-CCT and EMT-P are able to provide medications, including naloxone, by scope of practice!
Who are EMT- Basic? !! Lowest level of provider allowed to independently staff
an ambulance!! Have about 140 hours of training!! Often the only responders available, especially in rural
areas of the state!
With the exception of EpiPens, the scope of practice of EMT-B does not include
IV or IM administration of medications "
Intranasal Naloxone for EMT-B!! EMT-B are frequently the first to arrive at the scene!! Intranasal atomizer reduces the potential for
occupational exposure via needlestick!! Well-established off-label administration route!! No evidence suggesting negative health outcomes after
experience in other states!! No evidence of risk to personnel!! Concern for additional training if skill is not used!
Scope of Project!! Regional Emergency Medical Organization (REMO)
serves as lead agency for Opioid Overdose Prevention Program!
! Albany Medical College, AIDS Institute, and Bureau of EMS develop training for EMT-B!
! NYS AIDS Institute provides Opioid Overdose Prevention Kits, including Intranasal naloxone!
! Clearly defined study with IRB approval by NYS DOH!
Training Materials!! 90 minute training includes lecture, 25 minute video,
skills practice and Q&A!! Trainer guide prepares trainers to conduct the training!! Participant manual for all participants includes:!
• Slides!• EMS protocol!
! Pre-post test!
Some Pre and Post-test Questions !
Pretest Mean" Post-test Mean" Change"I can recognize opioid overdose!
6.7! 8.6! +1.9!
I am comfortable treating opioid overdose!
7.2! 8.7! +1.5!
I am confident administering IN!
7.3! 8.9! +1.6!
Confident in knowledge of naloxone!
6.2! 8.7! +2.5!
Should be in scope of practice for EMT-B!
8.1! 9.0! +0.9!
10 point Likert Scale!
What do we know so far…in six months!! 1,250 EMTs trained!! 66 opioid overdose reversals!
• Yearly projection: 1 reversal for every 10 EMTs trained!! No adverse events!! No hazards to EMS personnel!! Case of reduced hazard for EMS personnel!
! One interesting unplanned complication!
Law Enforcement and Naloxone !!! Law enforcement will frequently be the first on the scene!! Suffolk County Police Department was very proactive to
address problem when it was discovered!! Law enforcement policy development to assist with scope
of the NYS 911 Good Samaritan Law!• Patrol directives now in place!• No arrest in cases of simple overdose notification!• No further issues!
Conclusion!! Phenomenal success!! Training for providers should be expanded where useful"
• Law enforcement!• First response fire personnel!
! Hopefully a new addition for EMT-B scope of practice!! Must maintain close oversight to assure new
complications are quickly addressed!! Must continue to assure safety of personnel!
