P2.E091: Naloxone Administration to Pediatric Patients During Emergency Medical Service Events

Background: The opioid epidemic is a leading cause of morbidity and mortality in the United States. In recent years, opioids have been implicated in rising injury and fatality rates among children. Early recognition and reversal of opioid poisoning can be lifesaving, and emergency medical services (EMS) clinicians are often the first healthcare providers to respond to an overdose event. Few studies have characterized the pre-hospital response to pediatric opioid poisonings. The objective of this study is to describe the patient and EMS response characteristics for children and adolescents receiving naloxone in the prehospital setting.

Methods: We acquired data from the National Emergency Medicine Service Information System (NEMSIS) on EMS activations for pediatric patients 1 day to 17 years old in 2022. Among these activations, we identified children who received ≥ 1 dose of naloxone. We analyzed patient demographics and EMS response characteristics using descriptive statistics and characterized the incidence rate of pediatric EMS activations where naloxone was administered.

Results: In 2022, 6,215 EMS activations met our inclusion criteria. Activations more commonly involved males (55.3%) and were dispatched to a home or residential setting (61.4%) (Table 1). Most responses involved adolescents 13-17 years old (79.4%), followed by children 1-5 years (10.2%) and infants < 1 year (6.0%). The incidence of naloxone administration per 10,000 activations was highest in the 13–17-year age group (57.5), followed by the < 1 year (17.9) and 1–5-year (11.1) age groups. One in five adolescents 13-17 years old were documented as receiving naloxone prior to EMS arrival (20.7%, 974/4,702) compared to fewer than one in ten infants < 1 year (8.2%, 28/341). Most EMS activations involving naloxone administration involved an advanced life support unit (91.0%) (Table 2). An initial dispatch complaint of an overdose, poisoning, or ingestion was more common among responses to adolescents 13-17 years old (31.5%, 1,555/4,937) compared to infants < 1 year (12.8%, 48/375). Approximately one third (32.7%) of pediatric patients received 2 or more naloxone doses. The first dose of naloxone led to a clinical improvement in a greater proportion of 1-5 years old (64.7%, 388/600) compared to infants < 1 year (51.3%, 184/359) and adolescents 13-17 years (54.0%, 2,474/4,580). Naloxone administration was followed by a worsening in clinical status in 11 individuals in our study population (0.2%).

Conclusion: Infants and young children administered naloxone received different EMS care compared to adolescents. EMS dispatches to infants receiving naloxone were uncommonly identified as poisonings or ingestions, and few infants received naloxone prior to EMS arrival. Notably, naloxone administration was rarely documented to worsen clinical status in pediatric patients. These findings highlight opportunities to improve community and prehospital provider identification and management of suspected pediatric opioid poisonings.