Characteristics of EMS Transport Refusal Following Glucose or Naloxone Administration

Introduction—EMS responses resulting in transport refusal are of interest due to clinical outcome, liability, and financial risks. Treat-and-release protocols are being increasingly developed for hypoglycemia and opioid overdose. Scant literature exists comparing the characteristics of refusals between patients given naloxone, glucose, or neither medication.

Objective—To describe the characteristics of transport refusal among patients who received glucose, naloxone, or neither medication.

Methods—Using 2017 data from the ESO Solutions national database, a retrospective analysis of all 9-1-1 responses with patient contact was conducted. The outcome was transport refusal. Patients were classified as having received naloxone, glucose, or neither. Multivariable logistic regression was used to control for other covariates including response characteristics (time of day, day of week), agency characteristics (type, volunteer status), and patient characteristics (age, gender, race/ethnicity). Adjusted odds ratios and 95% confidence intervals are reported.

Results—There were 1,219 patients excluded because they received naloxone and glucose, leaving 2,778,921 records. Overall, 399,766 (14%) resulted in transport refusal; 2,838 (7%) of those given naloxone refused, 16,548 (39%) given glucose refused, and 380,380 (14%) given neither drug refused (p<0.001). Of patients given naloxone, 60% were male, compared to 53% for glucose and 46% for neither (p<0.001). More patients receiving naloxone were white, non-Hispanic (80%) compared to those given glucose (67%) or neither (71%) (p<0.001). About half (47%) of those given naloxone were 18–39 years old, compared to 14% of those given glucose and 22% of those given neither. After controlling for patient, agency, and response characteristics, odds of nontransport for patients given glucose were more than fourfold higher (aOR 4.67; 95% CI, 4.57–4.77) and odds of nontransport for patients given naloxone were 54% lower (aOR 0.46; 95% CI, 0.44–0.48) compared to patients given neither.

Conclusion—In this large multiagency sample of EMS patient contacts, transport refusal rates were higher for those given glucose and lower for those given naloxone compared with those given neither. Patients given naloxone tended to be younger, male, and white, non-Hispanic. Limitations include retrospective analysis and use of data from a single ePCR vendor.