Emergency Medical Services Naloxone Access: A National Systematic Legal Review
Objectives Fatal opioid overdose in the United States is at epidemic levels. Naloxone, an effective opioid antidote, is commonly administered by advanced emergency medical services (EMS) personnel in the prehospital setting. While states are rapidly moving to increase access to naloxone for communit...
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| Veröffentlicht in: | Academic emergency medicine 2014-10, Vol.21 (10), p.1173-1177 |
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| creator | Davis, Corey S. Southwell, Jessica K. Niehaus, Virginia Radford Walley, Alexander Y. Dailey, Michael W. Gaddis, Gary M. |
| description | Objectives
Fatal opioid overdose in the United States is at epidemic levels. Naloxone, an effective opioid antidote, is commonly administered by advanced emergency medical services (EMS) personnel in the prehospital setting. While states are rapidly moving to increase access to naloxone for community bystanders, the EMS system remains the primary source for out‐of‐hospital naloxone access. Many communities have limited advanced EMS response capability and therefore may not have prehospital access to the medication indicated for opioid overdose reversal. The goal of this research was to determine the authority of different levels of EMS personnel to administer naloxone for the reversal of opioid overdose in the United States, Guam, and Puerto Rico.
Methods
The authors systematically reviewed the scope of practice of EMS personnel regarding administration of naloxone for the reversal of opioid overdose. All relevant laws, regulations, and policies from the 50 U. S. states, the District of Columbia, Guam, and Puerto Rico in effect in November 2013 were identified, reviewed, and coded to determine the authority of EMS personnel at four levels (in increasing order of training: emergency medical responders [EMRs], emergency medical technicians [EMTs], intermediate/advanced EMTs, and paramedics) to administer naloxone. Where available, protocols governing route and dose of administration were also identified and analyzed.
Results
All 53 jurisdictions license or certify EMS personnel at the paramedic level, and all permit paramedics to administer naloxone. Of the 48 jurisdictions with intermediate‐level EMS personnel, all but one authorized those personnel to administer naloxone as of November 2013. Twelve jurisdictions explicitly permitted EMTs and two permitted EMRs to administer naloxone. At least five jurisdictions modified law or policy to expand EMT access to naloxone in 2013. There is wide variation between states regarding EMS naloxone dosing protocol and route of administration.
Conclusions
Naloxone administration is standard for paramedic and intermediate‐level EMS personnel, but most states do not allow basic life support (BLS) personnel to administer this medication. Standards consistent with available medical evidence for naloxone administration, dosing, and route of administration should be implemented at each EMS level of certification.
Resumen
Objetivos
La sobredosis fatal por opiáceos en Estados Unidos tiene aspectos de epidemia. La naloxona, un a |
| doi_str_mv | 10.1111/acem.12485 |
| format | Article |
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Fatal opioid overdose in the United States is at epidemic levels. Naloxone, an effective opioid antidote, is commonly administered by advanced emergency medical services (EMS) personnel in the prehospital setting. While states are rapidly moving to increase access to naloxone for community bystanders, the EMS system remains the primary source for out‐of‐hospital naloxone access. Many communities have limited advanced EMS response capability and therefore may not have prehospital access to the medication indicated for opioid overdose reversal. The goal of this research was to determine the authority of different levels of EMS personnel to administer naloxone for the reversal of opioid overdose in the United States, Guam, and Puerto Rico.
Methods
The authors systematically reviewed the scope of practice of EMS personnel regarding administration of naloxone for the reversal of opioid overdose. All relevant laws, regulations, and policies from the 50 U. S. states, the District of Columbia, Guam, and Puerto Rico in effect in November 2013 were identified, reviewed, and coded to determine the authority of EMS personnel at four levels (in increasing order of training: emergency medical responders [EMRs], emergency medical technicians [EMTs], intermediate/advanced EMTs, and paramedics) to administer naloxone. Where available, protocols governing route and dose of administration were also identified and analyzed.
Results
All 53 jurisdictions license or certify EMS personnel at the paramedic level, and all permit paramedics to administer naloxone. Of the 48 jurisdictions with intermediate‐level EMS personnel, all but one authorized those personnel to administer naloxone as of November 2013. Twelve jurisdictions explicitly permitted EMTs and two permitted EMRs to administer naloxone. At least five jurisdictions modified law or policy to expand EMT access to naloxone in 2013. There is wide variation between states regarding EMS naloxone dosing protocol and route of administration.
Conclusions
Naloxone administration is standard for paramedic and intermediate‐level EMS personnel, but most states do not allow basic life support (BLS) personnel to administer this medication. Standards consistent with available medical evidence for naloxone administration, dosing, and route of administration should be implemented at each EMS level of certification.
Resumen
Objetivos
La sobredosis fatal por opiáceos en Estados Unidos tiene aspectos de epidemia. La naloxona, un antídoto opioide efectivo, es frecuentemente administrado por el personal de los servicios de emergencias médicos (SEM) avanzados en el escenario extrahospitalario. Mientras que los estados se están moviendo rápidamente para incrementar el acceso a la naloxona por parte de población comunitaria, el SEM sigue siendo la principal fuente de acceso a la naloxona fuera del hospital. Muchas comunidades tienen acceso limitado a un SEM avanzado, y por tanto no pueden tener acceso extrahospitalario a la medicación indicada para revertir la sobredosis de opiáceos. El objetivo de esta investigación fue determinar la autoridad de los diferentes niveles del personal del SEM para administrar naloxona para revertir la sobredosis de opiáceos en Estados Unidos, Guam y Puerto Rico.
Metodología
Los autores revisaron sistemáticamente el ámbito de práctica clínica del personal del SEM acerca de la administración de naloxona para la reversión de una sobredosis de opiáceos. Se identificaron, revisaron y codificaron todas las leyes, regulaciones y políticas relevantes de los 50 estados americanos, el Distrito de Columbia, Guam y Puerto Rico en vigor en noviembre de 2013 para determinar la autoridad del personal del SEM en cuatro niveles (en creciente orden de formación: respondedores médicos de emergencias [RME], técnicos de emergencias médicas [TEM], TEM intermedios/avanzados y paramédicos) para administrar naloxona. Donde están disponibles, se identificaron y analizaron los protocolos relativos a la vía y dosis de administración.
Resultados
De las 53 jurisdicciones con personal del SEM con licencia o certificado a nivel de paramédicos, todas permiten administrar naloxona a los paramédicos. De las 48 jurisdicciones con TEM intermedios/avanzados, todas menos una autorizaron al personal a administrar naloxona a fecha de noviembre de 2013. Doce jurisdicciones explícitamente permitieron administrar naloxona a los TEM y dos a los REM. Al menos cinco jurisdicciones modificaron la ley o la política para expandir a los TEM el acceso a la naloxona en 2013. Existe una amplia variación entre los estados en los protocolos del SEM sobre la ruta y dosis de administración de la naloxona.
Conclusiones
La administración de la naloxona es el estándar de atención para los paramédicos y TEM intermedios/avanzados. Existen actualmente pocas dudas acerca de que los TEM, REM y voluntarios formados puedan administrar de forma efectiva y segura la medicación de forma intramuscular e intranasal. El fracaso del SEM a nivel nacional en cuanto al modelo de práctica y protocolos estatales que permitan a los TEM y REM EMR administrar naloxona bajo la dirección médica representa un vacío en la trasladación del conocimiento entre la evidencia y la práctica. Los estándares acorde con la evidencia médica disponible médica para el acceso a la naloxona, dosificación y vía de administración deberían ser implementados para cada nivel de certificación de los SEM.</description><identifier>ISSN: 1069-6563</identifier><identifier>EISSN: 1553-2712</identifier><identifier>DOI: 10.1111/acem.12485</identifier><identifier>PMID: 25308142</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Certification ; Drug overdose ; Drug Overdose - drug therapy ; Emergency medical care ; Emergency Medical Services - legislation & jurisprudence ; Female ; Guam ; Humans ; Male ; Naloxone - supply & distribution ; Naloxone - therapeutic use ; Narcotic Antagonists - supply & distribution ; Narcotic Antagonists - therapeutic use ; Prescription drugs ; Puerto Rico ; United States</subject><ispartof>Academic emergency medicine, 2014-10, Vol.21 (10), p.1173-1177</ispartof><rights>2014 by the Society for Academic Emergency Medicine</rights><rights>2014 by the Society for Academic Emergency Medicine.</rights><rights>Copyright Wiley Subscription Services, Inc. Oct 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3935-c4a23b7739ed8201b5feb34a04f363f495870d486230afe34284c724758d8c713</citedby><cites>FETCH-LOGICAL-c3935-c4a23b7739ed8201b5feb34a04f363f495870d486230afe34284c724758d8c713</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1411,1427,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25308142$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Gaddis, Gary M.</contributor><creatorcontrib>Davis, Corey S.</creatorcontrib><creatorcontrib>Southwell, Jessica K.</creatorcontrib><creatorcontrib>Niehaus, Virginia Radford</creatorcontrib><creatorcontrib>Walley, Alexander Y.</creatorcontrib><creatorcontrib>Dailey, Michael W.</creatorcontrib><creatorcontrib>Gaddis, Gary M.</creatorcontrib><title>Emergency Medical Services Naloxone Access: A National Systematic Legal Review</title><title>Academic emergency medicine</title><addtitle>Acad Emerg Med</addtitle><description>Objectives
Fatal opioid overdose in the United States is at epidemic levels. Naloxone, an effective opioid antidote, is commonly administered by advanced emergency medical services (EMS) personnel in the prehospital setting. While states are rapidly moving to increase access to naloxone for community bystanders, the EMS system remains the primary source for out‐of‐hospital naloxone access. Many communities have limited advanced EMS response capability and therefore may not have prehospital access to the medication indicated for opioid overdose reversal. The goal of this research was to determine the authority of different levels of EMS personnel to administer naloxone for the reversal of opioid overdose in the United States, Guam, and Puerto Rico.
Methods
The authors systematically reviewed the scope of practice of EMS personnel regarding administration of naloxone for the reversal of opioid overdose. All relevant laws, regulations, and policies from the 50 U. S. states, the District of Columbia, Guam, and Puerto Rico in effect in November 2013 were identified, reviewed, and coded to determine the authority of EMS personnel at four levels (in increasing order of training: emergency medical responders [EMRs], emergency medical technicians [EMTs], intermediate/advanced EMTs, and paramedics) to administer naloxone. Where available, protocols governing route and dose of administration were also identified and analyzed.
Results
All 53 jurisdictions license or certify EMS personnel at the paramedic level, and all permit paramedics to administer naloxone. Of the 48 jurisdictions with intermediate‐level EMS personnel, all but one authorized those personnel to administer naloxone as of November 2013. Twelve jurisdictions explicitly permitted EMTs and two permitted EMRs to administer naloxone. At least five jurisdictions modified law or policy to expand EMT access to naloxone in 2013. There is wide variation between states regarding EMS naloxone dosing protocol and route of administration.
Conclusions
Naloxone administration is standard for paramedic and intermediate‐level EMS personnel, but most states do not allow basic life support (BLS) personnel to administer this medication. Standards consistent with available medical evidence for naloxone administration, dosing, and route of administration should be implemented at each EMS level of certification.
Resumen
Objetivos
La sobredosis fatal por opiáceos en Estados Unidos tiene aspectos de epidemia. La naloxona, un antídoto opioide efectivo, es frecuentemente administrado por el personal de los servicios de emergencias médicos (SEM) avanzados en el escenario extrahospitalario. Mientras que los estados se están moviendo rápidamente para incrementar el acceso a la naloxona por parte de población comunitaria, el SEM sigue siendo la principal fuente de acceso a la naloxona fuera del hospital. Muchas comunidades tienen acceso limitado a un SEM avanzado, y por tanto no pueden tener acceso extrahospitalario a la medicación indicada para revertir la sobredosis de opiáceos. El objetivo de esta investigación fue determinar la autoridad de los diferentes niveles del personal del SEM para administrar naloxona para revertir la sobredosis de opiáceos en Estados Unidos, Guam y Puerto Rico.
Metodología
Los autores revisaron sistemáticamente el ámbito de práctica clínica del personal del SEM acerca de la administración de naloxona para la reversión de una sobredosis de opiáceos. Se identificaron, revisaron y codificaron todas las leyes, regulaciones y políticas relevantes de los 50 estados americanos, el Distrito de Columbia, Guam y Puerto Rico en vigor en noviembre de 2013 para determinar la autoridad del personal del SEM en cuatro niveles (en creciente orden de formación: respondedores médicos de emergencias [RME], técnicos de emergencias médicas [TEM], TEM intermedios/avanzados y paramédicos) para administrar naloxona. Donde están disponibles, se identificaron y analizaron los protocolos relativos a la vía y dosis de administración.
Resultados
De las 53 jurisdicciones con personal del SEM con licencia o certificado a nivel de paramédicos, todas permiten administrar naloxona a los paramédicos. De las 48 jurisdicciones con TEM intermedios/avanzados, todas menos una autorizaron al personal a administrar naloxona a fecha de noviembre de 2013. Doce jurisdicciones explícitamente permitieron administrar naloxona a los TEM y dos a los REM. Al menos cinco jurisdicciones modificaron la ley o la política para expandir a los TEM el acceso a la naloxona en 2013. Existe una amplia variación entre los estados en los protocolos del SEM sobre la ruta y dosis de administración de la naloxona.
Conclusiones
La administración de la naloxona es el estándar de atención para los paramédicos y TEM intermedios/avanzados. Existen actualmente pocas dudas acerca de que los TEM, REM y voluntarios formados puedan administrar de forma efectiva y segura la medicación de forma intramuscular e intranasal. El fracaso del SEM a nivel nacional en cuanto al modelo de práctica y protocolos estatales que permitan a los TEM y REM EMR administrar naloxona bajo la dirección médica representa un vacío en la trasladación del conocimiento entre la evidencia y la práctica. Los estándares acorde con la evidencia médica disponible médica para el acceso a la naloxona, dosificación y vía de administración deberían ser implementados para cada nivel de certificación de los SEM.</description><subject>Certification</subject><subject>Drug overdose</subject><subject>Drug Overdose - drug therapy</subject><subject>Emergency medical care</subject><subject>Emergency Medical Services - legislation & jurisprudence</subject><subject>Female</subject><subject>Guam</subject><subject>Humans</subject><subject>Male</subject><subject>Naloxone - supply & distribution</subject><subject>Naloxone - therapeutic use</subject><subject>Narcotic Antagonists - supply & distribution</subject><subject>Narcotic Antagonists - therapeutic use</subject><subject>Prescription drugs</subject><subject>Puerto Rico</subject><subject>United States</subject><issn>1069-6563</issn><issn>1553-2712</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90E1LwzAYB_AgipvTix9ACl5EqOa1SbyNMV9gm-DLuWTp09HRrjNZN_vtzdz04MFckufhxx_yR-ic4BsSzq2xUN0QypU4QF0iBIupJPQwvHGi40QkrINOvJ9jjIXU8hh1qGBYEU67aDKswM1gYdtoDFlhTRm9glsXFnw0MWX9WS8g6tsw-ruoH1arol5sUetXUIXJRiOYhcULrAvYnKKj3JQezvZ3D73fD98Gj_Ho-eFp0B_FlmkmYssNZVMpmYZMUUymIocp4wbznCUs51ooiTOuEsqwyYFxqriVlEuhMmUlYT10tctduvqjAb9Kq8JbKEuzgLrxKUmoZizRGgd6-YfO68aFP2wVkZpIRlRQ1ztlXe29gzxduqIyrk0JTrctp9uW0--WA77YRzbTCrJf-lNrAGQHNkUJ7T9RaX8wHO9CvwCYj4Rn</recordid><startdate>201410</startdate><enddate>201410</enddate><creator>Davis, Corey S.</creator><creator>Southwell, Jessica K.</creator><creator>Niehaus, Virginia Radford</creator><creator>Walley, Alexander Y.</creator><creator>Dailey, Michael W.</creator><creator>Gaddis, Gary M.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>201410</creationdate><title>Emergency Medical Services Naloxone Access: A National Systematic Legal Review</title><author>Davis, Corey S. ; Southwell, Jessica K. ; Niehaus, Virginia Radford ; Walley, Alexander Y. ; Dailey, Michael W. ; Gaddis, Gary M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3935-c4a23b7739ed8201b5feb34a04f363f495870d486230afe34284c724758d8c713</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Certification</topic><topic>Drug overdose</topic><topic>Drug Overdose - drug therapy</topic><topic>Emergency medical care</topic><topic>Emergency Medical Services - legislation & jurisprudence</topic><topic>Female</topic><topic>Guam</topic><topic>Humans</topic><topic>Male</topic><topic>Naloxone - supply & distribution</topic><topic>Naloxone - therapeutic use</topic><topic>Narcotic Antagonists - supply & distribution</topic><topic>Narcotic Antagonists - therapeutic use</topic><topic>Prescription drugs</topic><topic>Puerto Rico</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Davis, Corey S.</creatorcontrib><creatorcontrib>Southwell, Jessica K.</creatorcontrib><creatorcontrib>Niehaus, Virginia Radford</creatorcontrib><creatorcontrib>Walley, Alexander Y.</creatorcontrib><creatorcontrib>Dailey, Michael W.</creatorcontrib><creatorcontrib>Gaddis, Gary M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Academic emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Davis, Corey S.</au><au>Southwell, Jessica K.</au><au>Niehaus, Virginia Radford</au><au>Walley, Alexander Y.</au><au>Dailey, Michael W.</au><au>Gaddis, Gary M.</au><au>Gaddis, Gary M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Emergency Medical Services Naloxone Access: A National Systematic Legal Review</atitle><jtitle>Academic emergency medicine</jtitle><addtitle>Acad Emerg Med</addtitle><date>2014-10</date><risdate>2014</risdate><volume>21</volume><issue>10</issue><spage>1173</spage><epage>1177</epage><pages>1173-1177</pages><issn>1069-6563</issn><eissn>1553-2712</eissn><abstract>Objectives
Fatal opioid overdose in the United States is at epidemic levels. Naloxone, an effective opioid antidote, is commonly administered by advanced emergency medical services (EMS) personnel in the prehospital setting. While states are rapidly moving to increase access to naloxone for community bystanders, the EMS system remains the primary source for out‐of‐hospital naloxone access. Many communities have limited advanced EMS response capability and therefore may not have prehospital access to the medication indicated for opioid overdose reversal. The goal of this research was to determine the authority of different levels of EMS personnel to administer naloxone for the reversal of opioid overdose in the United States, Guam, and Puerto Rico.
Methods
The authors systematically reviewed the scope of practice of EMS personnel regarding administration of naloxone for the reversal of opioid overdose. All relevant laws, regulations, and policies from the 50 U. S. states, the District of Columbia, Guam, and Puerto Rico in effect in November 2013 were identified, reviewed, and coded to determine the authority of EMS personnel at four levels (in increasing order of training: emergency medical responders [EMRs], emergency medical technicians [EMTs], intermediate/advanced EMTs, and paramedics) to administer naloxone. Where available, protocols governing route and dose of administration were also identified and analyzed.
Results
All 53 jurisdictions license or certify EMS personnel at the paramedic level, and all permit paramedics to administer naloxone. Of the 48 jurisdictions with intermediate‐level EMS personnel, all but one authorized those personnel to administer naloxone as of November 2013. Twelve jurisdictions explicitly permitted EMTs and two permitted EMRs to administer naloxone. At least five jurisdictions modified law or policy to expand EMT access to naloxone in 2013. There is wide variation between states regarding EMS naloxone dosing protocol and route of administration.
Conclusions
Naloxone administration is standard for paramedic and intermediate‐level EMS personnel, but most states do not allow basic life support (BLS) personnel to administer this medication. Standards consistent with available medical evidence for naloxone administration, dosing, and route of administration should be implemented at each EMS level of certification.
Resumen
Objetivos
La sobredosis fatal por opiáceos en Estados Unidos tiene aspectos de epidemia. La naloxona, un antídoto opioide efectivo, es frecuentemente administrado por el personal de los servicios de emergencias médicos (SEM) avanzados en el escenario extrahospitalario. Mientras que los estados se están moviendo rápidamente para incrementar el acceso a la naloxona por parte de población comunitaria, el SEM sigue siendo la principal fuente de acceso a la naloxona fuera del hospital. Muchas comunidades tienen acceso limitado a un SEM avanzado, y por tanto no pueden tener acceso extrahospitalario a la medicación indicada para revertir la sobredosis de opiáceos. El objetivo de esta investigación fue determinar la autoridad de los diferentes niveles del personal del SEM para administrar naloxona para revertir la sobredosis de opiáceos en Estados Unidos, Guam y Puerto Rico.
Metodología
Los autores revisaron sistemáticamente el ámbito de práctica clínica del personal del SEM acerca de la administración de naloxona para la reversión de una sobredosis de opiáceos. Se identificaron, revisaron y codificaron todas las leyes, regulaciones y políticas relevantes de los 50 estados americanos, el Distrito de Columbia, Guam y Puerto Rico en vigor en noviembre de 2013 para determinar la autoridad del personal del SEM en cuatro niveles (en creciente orden de formación: respondedores médicos de emergencias [RME], técnicos de emergencias médicas [TEM], TEM intermedios/avanzados y paramédicos) para administrar naloxona. Donde están disponibles, se identificaron y analizaron los protocolos relativos a la vía y dosis de administración.
Resultados
De las 53 jurisdicciones con personal del SEM con licencia o certificado a nivel de paramédicos, todas permiten administrar naloxona a los paramédicos. De las 48 jurisdicciones con TEM intermedios/avanzados, todas menos una autorizaron al personal a administrar naloxona a fecha de noviembre de 2013. Doce jurisdicciones explícitamente permitieron administrar naloxona a los TEM y dos a los REM. Al menos cinco jurisdicciones modificaron la ley o la política para expandir a los TEM el acceso a la naloxona en 2013. Existe una amplia variación entre los estados en los protocolos del SEM sobre la ruta y dosis de administración de la naloxona.
Conclusiones
La administración de la naloxona es el estándar de atención para los paramédicos y TEM intermedios/avanzados. Existen actualmente pocas dudas acerca de que los TEM, REM y voluntarios formados puedan administrar de forma efectiva y segura la medicación de forma intramuscular e intranasal. El fracaso del SEM a nivel nacional en cuanto al modelo de práctica y protocolos estatales que permitan a los TEM y REM EMR administrar naloxona bajo la dirección médica representa un vacío en la trasladación del conocimiento entre la evidencia y la práctica. Los estándares acorde con la evidencia médica disponible médica para el acceso a la naloxona, dosificación y vía de administración deberían ser implementados para cada nivel de certificación de los SEM.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>25308142</pmid><doi>10.1111/acem.12485</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1069-6563 |
| ispartof | Academic emergency medicine, 2014-10, Vol.21 (10), p.1173-1177 |
| issn | 1069-6563 1553-2712 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1629336990 |
| source | MEDLINE; Wiley Online Library Free Content; Wiley-Blackwell Full Collection; EZB Electronic Journals Library |
| subjects | Certification Drug overdose Drug Overdose - drug therapy Emergency medical care Emergency Medical Services - legislation & jurisprudence Female Guam Humans Male Naloxone - supply & distribution Naloxone - therapeutic use Narcotic Antagonists - supply & distribution Narcotic Antagonists - therapeutic use Prescription drugs Puerto Rico United States |
| title | Emergency Medical Services Naloxone Access: A National Systematic Legal Review |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-24T19%3A28%3A52IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Emergency%20Medical%20Services%20Naloxone%20Access:%20A%20National%20Systematic%20Legal%20Review&rft.jtitle=Academic%20emergency%20medicine&rft.au=Davis,%20Corey%20S.&rft.date=2014-10&rft.volume=21&rft.issue=10&rft.spage=1173&rft.epage=1177&rft.pages=1173-1177&rft.issn=1069-6563&rft.eissn=1553-2712&rft_id=info:doi/10.1111/acem.12485&rft_dat=%3Cproquest_cross%3E3474260591%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1617917318&rft_id=info:pmid/25308142&rfr_iscdi=true |