Circumstances associated with fatality from opioid overdose at the time of contact with emergency medical services.

OBJECTIVE

This study examined correlates of fatality as of the time of contact with Emergency Medical Services (EMS) in a nationwide sample of opioid overdose EMS activations, with the aim of identifying salient points of intervention to reduce deaths.

METHODS

We analyzed data from the 2023 National Emergency Medical Services Information System (NEMSIS) Public Release Research Data Set for 373,153 opioid overdose EMS activations (4865 identified as fatal as of the time of EMS contact). Bivariate and multivariable logistic regression models tested potential correlates of fatality, including characteristics of the patient, setting, and emergency response.

RESULTS

Approximately 70.8% of fatal (versus 50.7% of nonfatal) opioid overdose EMS activations occurred in a private home. Pre-EMS bystander naloxone administration was reported in 2.3% of fatal, and 3.6% of nonfatal, cases. Adjusted odds of fatality were significantly higher for EMS opioid overdose activations in older patients (Adjusted Odds Ratio [AOR] 1.23; 95% Confidence Interval [CI] 1.11-1.37 in ages 65 + relative to ages 35-44) and in rural/wilderness (AOR 1.73; 95% CI 1.55-1.94) or suburban (AOR 1.45; 95% CI 1.28-1.63) areas versus urban areas, but significantly lower when naloxone was administered by a bystander prior to EMS arrival (AOR 0.58; 95% CI 0.48-0.70). The complaint reported to dispatch, US Census Division, and EMS unit level of care were also correlates of fatality.

CONCLUSIONS

Results support the association between pre-EMS-bystander naloxone administration and lower fatality. Results also suggest the need for interventions informed by risks associated with older age, rural settings, and drug use at home.