• Gary M Vilke, Christian Sloane, Alan M Smith, and Theodore C Chan.
• Department of Emergency Medicine, University of California-San Diego Medical Center, 200 West Arbor Drive, Mailcode #8676, San Diego, CA 92103, USA. gmvilke@ucsd.edu
• Acad Emerg Med. 2003 Aug 1;10(8):893-6.

UnlabelledNaloxone frequently is used to treat suspected heroin and opioid overdoses in the out-of-hospital setting. The authors' emergency medical services system has operated a policy of allowing these patients, when successfully treated, to sign out against medical advice (AMA) in the field.ObjectivesTo evaluate the safety of this AMA policy.MethodsThis is a retrospective review of out-of-hospital and medical examiner (ME) databases over a five-year period. The authors reviewed all ME cases in which opioid overdoses were listed as contributing to the cause of death. These cases were cross-compared with all patients who received naloxone by field paramedics and then refused transport. The charts were reviewed by dates, times, age, sex, location, and ethnicity when available.ResultsThere were 998 out-of-hospital patients who received naloxone and refused further treatment and 601 ME cases of opioid overdose deaths. When compared by age, time, date, sex, location, and ethnicity, there were no cases in which a patient was treated by paramedics with naloxone within 12 hours of being found dead of an opioid overdose.ConclusionsGiving naloxone to patients with heroin overdoses in the field and then allowing them to sign out AMA resulted in no identifiable deaths within this study population.

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