• Mark Faul, Michael W Dailey, David E Sugerman, Scott M Sasser, Benjamin Levy, and Len J Paulozzi.
• Mark Faul, David E. Sugerman, Benjamin Levy, and Len J. Paulozzi are with the Centers for Disease Control and Prevention, Atlanta, GA. Michael W. Dailey is with the Department of Emergency Medicine, Albany Medical Center, NY. Scott M. Sasser is with the Department of Emergency Medicine, Greenville Health System, SC.
• Am J Public Health. 2015 Jul 1;105 Suppl 3:e26-32.

ObjectivesWe determined the factors that affect naloxone (Narcan) administration in drug overdoses, including the certification level of emergency medical technicians (EMTs).MethodsIn 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.ResultsThe 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.ConclusionsNaloxone 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.

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