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Objective: Emergency medical services (EMS) use of naloxone in the prehospital setting is indicated in patients who have significantly impaired breathing or level of consciousness when opioid intoxication is suspected. The present study characterised naloxone use in a nationwide sample of Aotearoa New Zealand road EMS patients to establish a baseline for surveillance of any changes in the future. Methods: A retrospective analysis of rates of patients with naloxone administrations was conducted using Hato Hone St John (2017–2021) and Wellington Free Ambulance (2018–2021) electronic patient report form datasets. Patient demographics, presenting complaints, naloxone dosing, and initial and last vital sign clinical observations were described. Results: There were 2018 patients with an equal proportion of males and females, and patient median age was 47 years. There were between 8.0 (in 2018) and 9.0 (in 2020) naloxone administrations per 100 000 population‐years, or approximately one administration per day for the whole country of 5 million people. Poisoning by unknown agent(s) was the most common presenting complaint (61%). The median dose of naloxone per patient was 0.4 mg; 85% was administered intravenously. The median observed change in Glasgow Coma Scale score was +1, and respiratory rate increased by +2 breaths/min. Conclusions: A national rate of EMS naloxone patients was established; measured clinical effects of naloxone were modest, suggesting many patients had reasons other than opioid toxicity contributing to their symptoms. Naloxone administration rates provide indirect surveillance information about suspected harmful opioid exposures but need to be interpreted with care. [ABSTRACT FROM AUTHOR]

Background: The decision for emergency medical services (EMS) personnel not to transport a patient is challenging: there is a risk of subsequent deterioration but transportation of all patients to hospital would overburden emergency departments. The aim of this large-scale EMS study was to identify factors associated with an increased likelihood of ambulance reattendance within 48 hours in low acuity patients who were not transported by ambulance. Methods: We conducted a 2-year retrospective cohort study using data from the St John New Zealand EMS between 1 July 2016 and 30 June 2018 to investigate demographic and clinical associations with ambulance reattendance. Results: In total, 83,171 low acuity patients not transported by ambulance were included, of whom 4,512 (5.4%) had an EMS ambulance reattend within 48 hours. There were significant associations between EMS reattendance and patient age, sex, ethnicity, deprivation, and event location. Patients aged 60-74 years old had the highest likelihood of ambulance recall (OR 2.87, 95% CI: 2.51-3.28). Males were more likely to have an EMS ambulance reattend within 48 hours (OR 1.17, 95% CI: 1.09-1.25). Māori and Pacific Peoples had a similar likelihood of EMS recall to European/Others; however, the Asian cohort showed a reduced likelihood of reattendance (OR 0.76, 95% CI: 0.62-0.93). There were significant associations between EMS reattendance and non-transport reason, time spent on scene, event type, clinical acuity level (status), and pain score. Shorter (<30 minutes) on scene times were associated with a decreased likelihood of ambulance reattendance, whereas longer scene times (>45 minutes) were associated with an increased likelihood. Medical events were more likely to require reattendance than accident-related events (OR 1.22, 95% CI: 1.13-1.32). Non-transported patients with a severe pain score (7-10/10) were at increased likelihood of requiring reattendance (OR 1.60, 95% CI: 1.33-1.92). Discussion: The overall low rate of EMS reattendance is encouraging. Further research is needed into the clinical presentation of patients requiring ambulance reattendance within 48 hours to determine if there are early warning signs indicative of subsequent deterioration. [ABSTRACT FROM AUTHOR]

Background: Countries with a high incidence of coronavirus 2019 (COVID-19) reported reduced hospitalisations for acute coronary syndromes (ACS) during the pandemic. This study describes the impact of a nationwide lockdown on ACS hospitalisations in New Zealand (NZ), a country with a low incidence of COVID-19., Methods: All patients admitted to a NZ Hospital with ACS who underwent coronary angiography in the All NZ ACS Quality Improvement registry during the lockdown (23 March - 26 April 2020) were compared with equivalent weeks in 2015-2019. Ambulance attendances and regional community troponin-I testing were compared for lockdown and non-lockdown (1 July 2019 to 16 February 2020) periods., Findings: Hospitalisation for ACS was lower during the 5-week lockdown (105 vs. 146 per-week, rate ratio 0•72 [95% CI 0•61-0•83], p  = 0.003). This was explained by fewer admissions for non-ST-segment elevation ACS (NSTE-ACS; p  = 0•002) but not ST-segment elevation myocardial infarction (STEMI; p  = 0•31). Patient characteristics and in-hospital mortality were similar. For STEMI, door-to-balloon times were similar (70 vs. 72 min, p  = 0•52). For NSTE-ACS, there was an increase in percutaneous revascularisation (59% vs. 49%, p <0•001) and reduction in surgical revascularisation (9% vs. 15%, p  = 0•005). There were fewer ambulance attendances for cardiac arrests (98 vs. 110 per-week, p  = 0•04) but no difference for suspected ACS (408 vs. 420 per-week, p  = 0•44). Community troponin testing was lower throughout the lockdown (182 vs. 394 per-week, p <0•001)., Interpretation: Despite the low incidence of COVID-19, there was a nationwide decrease in ACS hospitalisations during the lockdown. These findings have important implications for future pandemic planning., Funding: The ANZACS-QI registry receives funding from the New Zealand Ministry of Health., Competing Interests: DZC is supported by the A.H. Couch Research Fellowship. PDA is supported by a Heart Foundation of New Zealand Senior Fellowship (1844). YBL is supported by the Middlemore Cardiac Trust. HDW has received grant support paid to the institution and fees for serving on Steering Committees of the ODYSSEY trial from Sanofi and Regeneron Pharmaceuticals, of the STRENGTH trial from Omthera Pharmaceuticals, and of the HEART-FID study from American Regent, of the CAMELLIA study from Eisai Inc., of the DAL-GENE study from DalCor Pharma UK Inc., of the AEGIS-II study from CSL Behring, of the SCORED and SOLOIST-WHF trials from Sanofi Australia Pty Ltd., and of the CLEAR OUTCOMES study from Esperion Therapeutics Inc., and of the ACCELERATE study from Eli Lilly and Company.  He has been on an Advisory Board for Genentech, Inc. San Francisco. He has received interview fees paid at ACC2018 Cardiovascular Forum by AstraZeneca., (© 2020 The Authors. Published by Elsevier Ltd.)