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Background The COVID-19 pandemic has amplified the need for wide deployment of effective harm reduction strategies in preventing opioid overdose mortality. Placing naloxone in the hands of key responders, including law enforcement officers who are often first on the scene of a suspected overdose, is one such strategy. New York State (NYS) was one of the first states to implement a statewide law enforcement naloxone administration program. This article provides an overview of the law enforcement administration of naloxone in NYS between 2015 and 2020 and highlights key characteristics of over 9000 opioid overdose reversal events. Methods Data in naloxone usage report forms completed by police officers were compiled and analyzed. Data included 9133 naloxone administration reports by 5835 unique officers located in 60 counties across NYS. Descriptive statistics were used to examine attributes of the aided individuals, including differences between fatal and non-fatal incidents. Additional descriptive analyses were conducted for incidents in which law enforcement officers arrived first at the scene of suspected overdose. Comparisons were made to examine year-over-year trends in administration as naloxone formulations were changed. Quantitative analysis was supplemented by content analysis of officers’ notes ( n  = 2192). Results In 85.9% of cases, law enforcement officers arrived at the scene of a suspected overdose prior to emergency medical services (EMS) personnel. These officers assessed the likelihood of an opioid overdose having occurred based on the aided person’s breathing status and other information obtained on the scene. They administered an average of 2 doses of naloxone to aided individuals. In 36.8% of cases, they reported additional administration of naloxone by other responders including EMS, fire departments, and laypersons. Data indicated the aided survived the suspected overdose in 87.4% of cases. Conclusions With appropriate training, law enforcement personnel were able to recognize opioid overdoses and prevent fatalities by administering naloxone and carrying out time-sensitive medical interventions. These officers provided life-saving services to aided individuals alongside other responders including EMS, fire departments, and bystanders. Further expansion of law enforcement naloxone administration nationally and internationally could help decrease opioid overdose mortality.

Objectives. We determined the factors that affect naloxone (Narcan) administration in drug overdoses, including the certification level of emergency medical technicians (EMTs). Methods. In 2012, 42 states contributed all or a portion of their ambulatory data to the National Emergency Medical Services Information System. We used a logistic regression model to measure the association between naloxone administration and emergency medical services certification level, age, gender, geographic location, and patient primary symptom. Results. The odds of naloxone administration were much higher among EMT-intermediates than among EMT-basics (adjusted odds ratio [AOR] = 5.4; 95% confidence interval [CI] = 4.5, 6.5). Naloxone use was higher in suburban areas than in urban areas (AOR = 1.41; 95% CI = 1.3, 1.5), followed by rural areas (AOR = 1.23; 95% CI = 1.1, 1.3). Although the odds of naloxone administration were 23% higher in rural areas than in urban areas, the opioid drug overdose rate is 45% higher in rural communities. Conclusions. Naloxone is less often administered by EMT-basics, who are more common in rural areas. In most states, the scope-of-practice model prohibits naloxone administration by basic EMTs. Reducing this barrier could help prevent drug overdose death.

In 2021, an 8-mg intranasal naloxone product was approved by the Food and Drug Administration; however, no studies have examined outcomes among persons who receive the 8-mg naloxone product and those who receive the usual 4-mg product. During March 2022-August 2023, New York State Department of Health (NYSDOH) supplied some New York State Police (NYSP) troops with 8-mg intranasal naloxone; other troops continued to receive 4-mg intranasal naloxone to treat suspected opioid overdose. NYSP submitted detailed reports to NYSDOH when naloxone was administered. No significant differences were observed in survival, mean number of naloxone doses administered, prevalence of most postnaloxone signs and symptoms, postnaloxone anger or combativeness, or hospital transport refusal among 4-mg and 8-mg intranasal naloxone recipients; however, persons who received the 8-mg intranasal naloxone product had 2.51 times the risk for opioid withdrawal signs and symptoms, including vomiting, than did those who received the 4-mg intranasal naloxone product (95% CI = 1.51-4.18). This initial study suggests no benefits to law enforcement administration of higher-dose naloxone were identified; more research is needed to guide public health agencies in considering whether 8-mg intranasal naloxone confers additional benefits for community organizations.

At initial presentation to the emergency medical services, the patient was found obtunded with agonal respiration, a systolic blood pressure of 92 mm Hg, and an electrocardiogram revealing second-degree heart block type 2 with a 2:1 conduction, a rate of 51 beats per minute, and an ST elevation consistent with an inferolateral myocardial infarction. Paramedical personnel initiated bilateral intravenous lines in the patient's antecubital fossa, whereas the airway was more definitively protected through nasotracheal intubation. Because of the atypical presentation without hypotension, regional EMS protocol for the treatment of anaphylaxis was initially withheld while a 12-lead EKG was obtained (Fig. 2). [...]animal studies of bee venom infusion have demonstrated EKG changes [1-6].

Background. As many medical, medicolegal, andresearch interests have become more time-dependent, increased weight should be placed on the precision of time documentation andtiming devices. Studies have previously documented poor synchronization of timing devices in the medical setting. Objective. To determine whether any advancement has been made in prehospital time accuracy andto determine the timing devices used by today's emergency medical services (EMS) providers. Methods. Times recorded from the timing devices available for use during calls by local EMS providers, including watches, cellular phones, cardiac monitors/ defibrillators, ambulance clocks, andpublic safety answering points, were compared with atomic time to determine accuracy. Additionally, the preferred provider timing device, andaccuracy of said device, was obtained. Results. A total of 138 available timing devices were observed, with an accuracy of only 36.9%; cell phones had the best accuracy (67.7%). For the 53 providers surveyed, watches (64.2%) were found to be the most used timing device, followed by cell phones (24.5%) andambulance clocks (11.3%). Only 18 (34.0%) of these preferred devices were accurate when compared with atomic time. Conclusions. There is no precision or consistency in the timing devices used by EMS personnel. However, methods are available, such as those that support the cellular phone industry, that would help with consistent andprecise timekeeping. Utilization of modern technologies could increase precision in patient documentation anddecrease medical, medicolegal, andresearch issues relating to time documentation