<b>Bystander Naloxone Administration and Refusal for Transport in Emergency Medical Care</b>

This study aims to determine whether bystander administration of naloxone is associated with increased refusal for transport to the emergency department by utilizing Connecticut’s Statewide Opioid Reporting Directive (SWORD) database. The Connecticut Statewide Opioid Reporting Directive (SWORD) requires first responders to report opioid overdoses to the Connecticut Poison Control Center (CPCC). The period between January 1, 2020 and September 31, 2023 was retrospectively examined to determine the quarterly number of patients who first received naloxone from bystanders, those who received it from first responders, and whether they were transported to the hospital. A chi squared test was performed to establish an association between bystander naloxone administration and patient refusal for transport. During the study period, there were 13,258 reported nonfatal opioid overdoses involving persons who received naloxone. Among them, 2,419 (18.2%) first received naloxone from bystanders and 10,839 (81.8%) first received naloxone from non-bystander. In the bystander administration group, 358 (14.8%) refused transport to the hospital. In the non-bystander administration group, 665 (6.1%) refused transport to the hospital. Bystander first naloxone administration increased from 16.1% in 2020 to 22.6% in 2023. The rate of refusals of transport from all naloxone administrations increased from 6.3% in 2020 to 10.6% in 2023. The rate of refusals from bystander administrations increased from 13.3% in 2020 to 17.4% in 2023. A chi squared test revealed a value of 208.490 with one degree of freedom. The p value was <0.001, indicating a significant correlation between bystander administration of naloxone and patient refusal of Emergency Medical Services (EMS) transport. Patients who receive naloxone first from bystanders are more likely to refuse transport to the hospital than those who receive naloxone from first responders. Bystander administration of naloxone also increased from June 1, 2019 and September 30, 2023. This trend supports first responders’ providing harm reduction services typically provided in emergency departments such as take-home naloxone.