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Community Dispatching for Bystander-Administered Naloxone

QUIXOTE DISPATCH

Communities Can Prevent Overdoses as Effectively as Ambulance Companies

Lack of access to basic life-saving emergency care is a major contributor to premature death and disability from preventable conditions where time is a critical determinant of patient outcomes. Historically, emergency medical services (EMS), supported by robust landline-based telecommunications systems and accessed through toll-free numbers, like 9-1-1, are relied upon to provide both urban and rural populations with expedited access to critical health services for a range of emergency medical conditions.

 

Overdoses from heroin and opioid painkillers are a primary example of when early access to basic life-saving interventions can save lives. Through delivery of the “overdose antidote” Naloxone, an easy-to-administer medication that reverses the effects of opioid overdose and saves lives, trained first responders are able to safely reverse the fatal effects of heroin and opioid painkiller overdoses.

 

It is not uncommon that witnesses to opioid overdoses will have a greater reluctance to report overdoses to official 9-1-1 emergency dispatch services for fear of legal repercussions. As a result, opioid overdoses have substantially higher mortality rates for what would otherwise be considered preventable deaths. Evidence shows that by increasing the availability of Naloxone among the public, and coordinating their response efforts through improved mobile communications systems, bystanders equipped with Naloxone can reduce the time interval between the onset of a life-threatening opioid overdose and the delivery of life-saving care to the patient, thus averting thousands of overdose-related fatalities each year. Recently, the United States federal government, through the Food and Drug Administration (FDA) and the National Institute for Drug Abuse (NIDA) sponsored a hack-a-thon competition “to spur innovation around the development of a low-cost, scalable, crowd-sourced mobile phone application that helps increase the likelihood that opioid users, their immediate personal networks, and first responders are able to identify and react to an overdose by administering naloxone.”

 

Quixote, Inc. has developed a text message-based emergency medical dispatch platform that leverages the ubiquitous use of mobile phones to create decentralized 9-1-1 dispatching systems anywhere there’s a mobile phone signal. The Quixote Dispatch platform enables mobile phone users to place requests for emergency assistance to private dispatchers, which are then relayed to a trained cadre of layperson first responders equipped with Naloxone who are able to locate and deliver the life-saving medication. We have seen that the minimal human, physical and financial resources associated with a mobile phone-based emergency medical dispatch system can make the implementation of community-based emergency response networks possible wherever mobile phones are used, providing a sustainable and cost-effective model for under-served patient demographic groups who are unable or unwilling to access formal 9-1-1 services.

 

If you are interested in implementing the Quixote Dispatch platform to support a community-based emergency response network that will prevent fatal opioid overdoses, please send your inquiry.

FAQ

Why don’t you want people calling 9-1-1 first when they witness an overdose?

We do. Calling 9-1-1 is always the best way to ensure that a victim receives the highest level of medical attention. There are also several reasons why relying solely on 9-1-1 and formal first responders is not going to save the most lives:

  1. There is an understandable reluctance among significant proportions of heroin and opioid users to call 9-1-1 for fear of legal repercussions
  2. The existence of new Good Samaritan protections has helped to decrease this reluctance, but it has not eliminated it
  3. The frequency and rate of opioid overdoses has drastically spiked, increasing the demands placed on local emergency resources
  4. New forms of Naloxone are now available that make it easy for non-medical professionals to be trained to effectively administer the medication in as little as 10 minutes

How do you propose people should call for help if they won’t call 9-1-1?

By calling a community crisis line dedicated to overdose prevention where witnesses can anonymously call and report an opioid overdose

What about requesting assistance or posting an alert through a mobile “app”?

There are certain definite advantages to requesting assistance through a mobile app, but not enough that you would want to replace traditional dispatchers and call centers.

 

Purported Advantages vs. Actual Disadvantages of App-based Alerting

  1. Advantage: Apps are easy-to-use: You can build a simple interface that makes requesting assistance very straightforward
    • Disadvantage: Apps restrict universal access to the public: Relying on an app to report emergencies requires that everyone has a smartphone, which is always connected to the internet, has a registered account with an app store, and has downloaded the app.
  2. Advantage: An app can provide the GPS location of the caller
    • Disadvantage: GPS locations can be misleading, causing significant problems in high population densities where the margin of error may extend across multiple adjacent buildings; GPS does not indicate vertical positioning, which causes problems in multi-story buildings; if the GPS location is being taken from the caller’s phone, that assumes that the witness is next to the victim, which is not always the case
  3. Advantage: Apps can streamline communication by eliminating intermediaries (i.e., dispatchers) and connecting callers and victims directly to responders
    • Disadvantage: In practice we’ve found that during true medical emergencies callers and dispatchers generally don’t want to be texting with each other; the presence of a human dispatcher provides multiple advantages that are made increasingly difficult when channeled through an app:
      • Texting often takes longer, for both communicating (typing) and delivering messages
      • Context is easily lost through texting: tone is difficult to decipher, lines of questioning are easily scrambled, and background noise can’t be heard
      • Pre-arrival instructions are difficult to both give and perform while texting — imagine trying to give CPR or administer a drug while texting with the dispatcher (vs. speakerphone, for example)
      • Texting is a distraction that requires you take your attention away from the emergency at hand
  4. Advantage: There are many apps that can re-fashioned to dispatch responders
    • Apps that rely on other third-party application functionality – e.g,. WhatsApp or Facebook – may be making data available accessible to non-authorized parties and/or inaccessible to authorized parties
    • Even when secure, the problem is scalability: A Twitter list or a WhatsApp chat group are helpful to alert multiple responders to a single emergency, but dispatching the same responders to multiple incidents in different locations at the same time is very different
  5. Advantage: A standalone app makes it easy to organize among many other apps
    • Disadvantage: Apps must be able to function across a range of devices and be regularly updated; public access numbers don’t have to change and can be accessed through any phone – mobile or otherwise
  6. Advantage: Apps can efficiently store user info and store data
    • Disadvantage: It is not uncommon for heroin and opioid users to regularly change their phones and/or phone numbers, often opting to use pre-paid feature phones as “burners” that they discard after limited use; an app would potentially create significant restrictions to access

How do you guarantee someone will show up if I call the crisis line instead of 911?

A range of strategies and tactics can be employed to ensure that sufficient responders will always be available if needed, many of which can be taken from the volunteer fire departments that cover nearly 1/3 of the U.S. population, including:

  1. Recruit the right people – Ensure that the people who are signing up are comfortable with heroin and opioid use, and can be relied upon to respond. Anecdotal evidence suggests that the most likely responders will be other opioid users, and we believe this is the best place to start recruitment activities
  2. Dispatch multiple responders – Create staffing schedules so that at least 2-3 responders will be dispatched to each incident
  3. Offer incentives – Whether it’s someone’s full-time job or a periodic volunteer, both financial and non-monetary incentives can go a long way in recruiting the right people and keeping them active
  4. Always have a safety net – While 9-1-1 may not be the preferred method for reporting overdoses, it’s essential that police and EMS professionals can be alerted in case no other responders are available

Why do you think it’s a good idea for non-medical professionals to be administering naloxone without medical supervision?

Ideally, Naloxone would be administered under the supervision of a trained medical professional, but that’s not always possible – nor is it necessarily required

  1. There aren’t enough trained medical professionals available to administer Naloxone as often and as promptly as demand requires
  2. Research has found that there are minimal risks associated with treat-and-release protocols[1],[2]
  3. There are certainly instances in which a cocktail of substances could have been ingested prior to the overdose, along with a range of other medical complications. Training exists to help layperson responders identify when Naloxone administration has not been effective, in which case they are again instructed to call 911. Bystander-administered Nalxone should not be considered a complete solution.

[1] Rudolph SS, Jehu G, Nielsen SL, Nielsen K, Siersma V, Rasmussen LS. Prehospital treatment of opioid overdose in Copenhagen: Is it safe to discharge on-scene? Resuscitation. 2011;82(11):1414–8.

[2] Wampler DA, Molina DK, McManus J, Laws P, Manifold CA. No Deaths Associated with Patient Refusal of Transport After Naloxone-Reversed Opioid Overdose. Prehosp Emerg Care. 2011;15(3):320–4.

How do you guarantee safety for the responders?

There’s no way to guarantee total safety for responders – whether for formal responders, like police and paramedics, or for community bystanders – but we believe that a number of factors can help to significantly increase safety:

  1. Recruit the right people – Specifically, individuals and organizations who are regularly exposed to heroin and opioid abuse, and who preferably have an established relationship with these populations
  2. Provide ample training – Delivering Naloxone successfully to save lives requires more than just knowing how to administer the drug; training for community responders should devote substantial time to personal safety and situational awareness
  3. Dispatch multiple responders – There’s safety in numbers, and sending multiple responders to the same incident helps increase the availability of competent and experienced assistance
  4. Make additional resources available – Give responders the ability to request additional resources if needed
  5. Always have a safety valve — While 9-1-1 may not be the preferred method for reporting overdoses, it’s essential that police and EMS professionals can be alerted in case more robust support is needed

From our experience as EMS professionals responding to countless overdoses over many years, we have good reason to believe that bystanders may be more likely to mitigate the risks to safety commonly encountered at the scene of an overdose. Overdose victims who have recently been revived through Naloxone administration can be confused and irritable leading to exacerbated behaviors in the presence of law enforcement.

NOW HIRING

Program Officer

Job description:

The Program Officer will be tasked with launching new community-based overdose response networks wherever possible. Through this position, thousands of lives will be saved and many more opportunities will be created to continue advancing Quixote’s impact. The Program Officer will be expected to be a quick study of our mission, vision and values; take the initiative; work independently; and show quick results based on the added value they bring by joining our startup venture.

Required:

  • Paramedic-level training
  • Startup and/or sales experience
  • Strong interpersonal skills
  • Empathy
  • Integrity

Highly desirable:

  • Demonstrated understanding of U.S. public health and public administration policy
  • Experience in non-affiliated rural and/or volunteer EMS systems
  • Spanish language skills

To apply:

Please send your updated resume with a 1-page cover letter describing why you want to work for Quixote, including a concise summary of what you would do in the first two months if offered the job and any salary demands. Submissions not meeting these criteria will not be considered or replied to.

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