Protocol for prehospital management of opioid poisoning in the APH 123 project, Medellín

Abstract

The city of Medellín is facing a growing public health issue related to opioid intoxication, such as fentanyl misuse, which has been linked to an increase in cases of cardiorespiratory arrest. The intervention strategy aimed to design a prehospital protocol for managing these emergencies within the APH 123 project, prioritizing the administration of naloxone, a safe and effective antidote for reversing respiratory depression. Through a review of international literature and a self-designed survey applied to the program's healthcare personnel, the best clinical practices and necessary competencies for optimizing prehospital care were identified. The recommended initial dose of naloxone was established at 0.4 mg, adjustable based on the patient’s condition while recognizing possible mild side effects associated with withdrawal syndrome. Additionally, a protocol and flowchart were developed to facilitate the timely identification and management of opioid intoxication, helping to reduce associated morbidity and mortality. These results were shared with the Project 123 directives. This intervention strategy aims to enhance the response capacity of APH personnel by promoting standards grounded in scientific evidence. Its implementation seeks to improve patient survival and establishes a precedent for addressing this emerging issue in Colombia. Further implementation and additional studies comparing clinical outcomes in different scenarios are recommended.