Abstract：
Background: The aim of this study was to investigate the safety of the management of non-fatal heroin overdose in the out-of-hospital environment; irrespective of whether or not naloxone had been administered. Heroin toxicity-related deaths as well as heroin intoxication-related traumatic deaths following patient-initiated refusal of transport were investigated. Methods: Heroin-related deaths in the state of Victoria, Australia between 1 January 2012 and 31 December 2013 were investigated and data linkage to pre-hospital Emergency Medical Services performed, in order to identify whether the death was related to the last episode of care by paramedics. The number of non-fatal heroin overdose events over the study period were also examined. Results and discussion: There were a total of 3921 heroin-related attendances by paramedics during the study period, including 2455 cases that involved treatment but where the patient was not transported to hospital. There were also 243 heroin-related deaths identified over the study period and 93% (n = 225) of those cases were matched with Ambulance Victoria electronic patient care records. Data linkage revealed 31 heroin-related deaths where there had been a recent presentation with a non-fatal heroin overdose to paramedics; however, none of these deaths were related to that episode of care, including for 11 individuals that were treated on scene by paramedics but not transported to the hospital. Conclusions: This study demonstrated that the treatment of uncomplicated heroin overdose in the out-of-hospital environment was safe in terms of mortality, irrespective of whether or not naloxone had been administered. In all of the non-fatal heroin toxicity cases attended by paramedics, whether or not transported to hospital, death occurred as a result of a subsequent and unrelated heroin overdose.
摘要：
背景：这项研究的目的是调查院外环境中非致命性海洛因过量管理的安全性；无论是否使用了纳洛酮。调查了患者主动拒绝运输后与海洛因毒性相关的死亡以及与海洛因中毒相关的创伤性死亡。方法：维多利亚州与海洛因相关的死亡，澳大利亚在2012年1月1日至2013年12月31日期间进行了调查，并将数据与院前急救医疗服务联系起来。为了确定死亡是否与护理人员的最后一次护理有关。还检查了研究期间非致命性海洛因过量事件的数量。结果与讨论:研究期间护理人员共有3921名与海洛因有关的就诊,包括2455例涉及治疗但患者未被送往医院的病例。在研究期间，还发现了243例与海洛因相关的死亡，其中93％（n=225）的病例与救护车维多利亚电子患者护理记录相匹配。数据关联显示，31例与海洛因有关的死亡，最近向护理人员报告了非致命海洛因过量的情况；然而，这些死亡都不与那次护理有关，包括11名在现场接受护理人员治疗但未被送往医院的人。结论：这项研究表明，在院外环境中治疗无并发症的海洛因过量在死亡率方面是安全的，无论是否服用了纳洛酮。在所有由医护人员接诊的非致命海洛因中毒个案中，无论是否被送往医院，由于随后的和无关的海洛因过量而导致死亡。
