COMMUNITY-BASED OVERDOSE RESPONSE NETWORKS

Improving access to Naloxone in isolated communities

Beacon Emergency Dispatch Platform

Beacon decentralizes emergency dispatching so that anyone carrying a mobile phone and some Naloxone can be alerted when an overdose happens nearby.

(…this isn’t crazy-talk, either – the FDA suggested it, too.)

BEACON DISPATCH

Mobile Phone-based Dispatch for Community Overdose Response Networks

Witnesses to opioid overdoses are often far more reluctant to call for help using official “9-1-1” emergency dispatch services in the United States than witnesses to any other emergency for fear of legal repercussions. Nobody would ever arrest you for calling 9-1-1 if a baby was drowning — but if someone were using heroin and about to die, it’s a completely different story.

As a result, opioid overdoses have substantially higher mortality rates in the United States where the criminalization of drug addiction remains constant. A clear example of this is the fact that only paramedics, police and other official public safety officers can be alerted of an overdose via 9-1-1 in most of the country. Nonetheless, evidence shows that by increasing the availability of Naloxone among the public – like we’ve done with AEDs for CPR — 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 victim, 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.”

Beacon is just that innovation

… though we can’t say that an “app” is the best way to go. Please read the FAQ.

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.

READ MORE

ARTICLES WE’VE WRITTEN ON COMMUNITY-BASED OVERDOSE RESPONSE

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Beacon Emergency Dispatch Platform

HOW IT WORKS

COMMUNITY-BASED OVERDOSE RESPONSE NETWORKS

1. WITNESSED OVERDOSE

A witness to a suspected opioid overdose knows that Naloxone is available in the community — but is too scared to call 9-1-1. No matter how much pleading we do with them, or how many Good Samaritan laws we pass, they don’t believe us and just refuse to call 9-1-1, thinking they have time to find another solution. Thank God the county public health department has an anonymous overdose hotline available.

2. EMERGENCY ALERT

A call-taker at the county overdose hotline receives a call from a witness requesting urgent Naloxone delivery. The call-taker enters their location into Beacon, and then sends it out as a text message alert to all available community members equipped with Naloxone.

3. RESPONDER DISPATCH

After receiving replies from those responders, Beacon determines the nearest and most appropriate resources and personnel as required, and instructs those responders to proceed to the incident location. For safety’s sake, at least two responders are dispatched for each incident.

4.  CONFIRM ON-SCENE

Once the responders have located the victim, they inform Beacon that they are on-scene.

5. ADMINISTER NALOXONE

Once the overdose victim has been located, the scene determined safe, and the symptoms for opioid overdose are confirmed, the responders administer Naloxone to the victim. If there is no change in the victim’s condition, the responders will recognize that this no longer (only) an opioid-related condition, and they know they can use their phone to call 9-1-1 about an “unresponsive patient”.

6. TRANSPORT OR RELEASE

If the patient is resuscitated after Naloxone administration, the responders have been trained to offer appropriate referral services, counseling and possibly transport to a facility for definitive care, and indicate the outcome to Beacon. The responders know there is little published evidence showing high-probabilities for rebound toxicity, but more importantly that treat-and-release is a better protocol than tag-and-zip.

CAN BEACON HELP YOU?

Send us an email to let us know how Beacon could help your community. All you need is a group of concerned citizens, a phone number for a hotline, and a backpack full of Naloxone to create an overdose response network.

BEACON SIGN UP

Universal Features:

  • Low-tech set-up A single internet connected-device is required to launch
  • Universal accessibility — Can be used on any mobile phone, whether smartphone or feature phone, with or without internet connectivity
  • Easy-to-use interface — Text message interactions require minimal input, are easily followed, and are predictable; Admin and Dispatch interface is intuitive and accessible on any device
  • Automated control – After creating the initial alert, all resource coordination is automated, eliminating the need for dispatchers to micromanage individual resources
  • Low-maintenance operations — No need to download apps or worry about updates; just register the Responder’s mobile phone number and they’re ready to go
  • Modular architecture for easy customization — Beacon v2.0 has been re-built using a modular architecture to enable custom changes to message content and response sequence workflow
  • Remote access or local installation — The Beacon platform is open source and freely available. However, not everyone has software programmers on staff, so we can make Beacon available to you at a nominal cost via access to our remote servers. For installation on local servers, we’re also available to discuss more