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A Comparison of Efficacy of Treatment and Time to Administration of Naloxone by BLS and ALS Providers

  • Kenneth Nugent (a1), Patrick Matthews (a1) (a2), Jamie Gissendaner (a1), Mia Papas (a1), Deborah Occident (a1), Avkash Patel (a1), Michelle Johnson (a2), Ross E. Megargel (a1) (a2) and Jason T. Nomura (a1)...



The administration of naloxone therapy is restricted by scope of practice to Advanced Life Support (ALS) in many Emergency Medical Services (EMS) systems throughout the United States. In Delaware’s two-tiered EMS system, Basic Life Support (BLS) often arrives on-scene prior to ALS, but BLS providers were not previously authorized to administer naloxone. Through a BLS naloxone pilot study, the researchers sought to evaluate BLS naloxone administration and timing compared to ALS.


After undergoing specialized training, BLS providers would be able to appropriately administer naloxone to opioid overdose patients in a more timely manner than ALS providers.


This was a retrospective, observational study using data collected from February 2014 through May 2015 throughout a state BLS naloxone pilot program. A total of 14 out of 72 state BLS agencies participated in the study. Pilot BLS agencies attended a training session on the indications and administration of naloxone, and then were authorized to carry and administer naloxone. Researchers then compared vital signs and the time of BLS arrival to administration of naloxone by BLS and ALS. Data were analyzed using paired and independent sample t-tests, as well as chi-square, as appropriate.


A total of 131 incidents of naloxone administration were reviewed. Of those, 62 patients received naloxone by BLS (pilot group) and 69 patients received naloxone by ALS (control group). After naloxone administration, BLS patients showed improvements in heart rate (HR; P < .01), respiratory rate (RR; P < .01), and pulse oximetry (spO2; P < .01); ALS patients also showed improvement in RR (P < .01), and in spO2 (P = .005). There was no significant improvement in HR for ALS providers (P = .189).

There was a significant difference in arrival time of BLS to the time of naloxone administration between the two groups, with shorter times in the BLS group compared to the ALS group (1.9 minutes versus 9.8 minutes; P < .01); BLS administration was 7.8 minutes faster when compared to ALS administration (95% CI, 6.2-9.3 minutes).


Patients improved similarly and received naloxone therapy sooner when treated by BLS agencies carrying naloxone than those who awaited ALS arrival. All EMS systems should consider allowing BLS to carry and administer naloxone for an effective and potentially faster naloxone administration when treating respiratory compromise related to opiate overdose.


Corresponding author

Correspondence: Kenneth Nugent, MD 633 S. St. Mary’s St. Unit 5405 San Antonio, Texas 78205 USA E-mail:


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1. Hedegaard, H, Warner, M, Miniño, AM. Drug overdose deaths in the United States, 1999–2016. NCHS Data Brief, No 294. Hyattsville, Maryland USA: National Center for Health Statistics; 2017.
2. Center for Disease Control, National Center for Health Statistics. Wide-ranging online data for epidemiologic research. Published 2017. Accessed July 30, 2018.
3. Dean, R, Bilsky, EJ, Negus, SS. Opiate Receptors and Antagonists: From Bench to Clinic. Berlin, Germany: Springer Science & Business Media; 2009:514.
4. Tintinalli, JE, Stapczynski, JS, Ma, OJ, Yealy, DM, Meckler, GD, Cline, D. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. (Eighth edition). New York USA: McGraw-Hill Education; 2016:12081209.
5. National EMS Advisory Council. The Recommendation of the National EMS Advisory Council (NEMSAC) in response to: National Highway Traffic Safety Administration’s (NHTSA) questions regarding Naloxone and National EMS Scope of Practice Model that were submitted to NEMSAC on March 10, 2016. Accessed July 30, 2018.
6. Office of Emergency Medical Services. National Highway Traffic Safety Administration. 2007 National EMS Scope of Practice Model, Change Notice. Washington, DC, USA: OEMS; 2017.
7. Davis, CS, Southwell, JK, Niehaus, VR, Walley, AY, Dailey, MW. Emergency Medical Services naloxone access: a national systematic review. Acad Emerg Med. 2014;21(10):11731177.
8. Gulec, N, Lahey, J, Suozzi, JC, Sholl, M, MacLean, CD, Wolfson, DL. Basic and advanced EMS providers are equally effective in naloxone administration for opioid overdose in northern New England. Prehosp Emerg Care. 2018;22(2):163169.
9. Weiner, SG, Mitchell, PM, Temin, ES, Langlois, BK, Dyer, KS. Use of intranasal naloxone by Basic Life Support providers. Prehosp Emerg Care. 2017;21(3):322326.
10. Belz, D, Lieb, J, Rea, T, Eisenberg, MS. Naloxone use in a tiered-response Emergency Medical Services system. Prehosp Emerg Care. 2006;10(4):468471.
11. US Census Bureau. QuickFacts Delaware 2017. Published 2017. Accessed July 30, 2018.


A Comparison of Efficacy of Treatment and Time to Administration of Naloxone by BLS and ALS Providers

  • Kenneth Nugent (a1), Patrick Matthews (a1) (a2), Jamie Gissendaner (a1), Mia Papas (a1), Deborah Occident (a1), Avkash Patel (a1), Michelle Johnson (a2), Ross E. Megargel (a1) (a2) and Jason T. Nomura (a1)...


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