Simulation of the Effects of Co-Locating Naloxone with Automated External Defibrillators

Introduction: Opioid-related overdoses have been steadily increasing over the past decade in the United States. Naloxone is used by first responders to revive overdose victims, but results may be improved by increasing access to and usage of naloxone by bystanders. Automated External Defibrillators (AEDs) are pervasive, recognizable, and publicly accessible. Co-locating naloxone kits with AEDs could increase public naloxone access and usage. However, the impact of co-locating naloxone kits with AEDs is not known. Objectives: We sought to evaluate the impact of co-locating naloxone kits with AEDs in a simulation study centered on Allegheny County, Pennsylvania. Methods: Naloxone administration frequency (N = 3,650) at the zip-code level from March 2016 to March 2017 was provided by the Allegheny County Health Department. AED point locations (N = 1,653) were obtained from the University of Pittsburgh's Resuscitation Logistics and Informatics Venture. Zip-code level geospatial analyses were conducted using QGIS and STATA to determine the correlation between AED count and naloxone administrations. AED naloxone kit (N-AED) coverage, based on a maximum walking-distance radius of 200m, was estimated at a zip-code level using the QGIS buffer tool and a custom MATLAB script. Potential impact of N-AEDs was estimated assuming uniform spatial distribution of naloxone administrations. Results: The median (IQR) AED coverage based on a 200m access radius per zip code was 4% (0-7). The median (IQR) number of naloxone administrations per zip code was 27(7-55). A total of 82 zip codes had data for both AED locations and naloxone administrations. The correlation between number of AEDs and naloxone administrations per zip code was 0.20. Overall, 16% of naloxone administrations were estimated to be covered by an N-AED. Conclusion: Using these limited methods, co-locating naloxone with AEDs is not likely to have a standalone impact on preventing overdose fatalities.