Excellence in Clinical Practice 'Leave behind Naloxone' by St John WA Ambulance Officers/Paramedics

St John WA

Team: Rudi Brits, Curtis Naylor, Lauren Davis

St John Western Australia (SJWA)’s joint initiative with the WA Naloxone Program and WA Mental Health Commission (MHC) to reduce overdose (OD) deaths in the community is a nation-leading clinical model for patient-centred care as it provides a greater safety net to a vulnerable cohort of patients who refuse transportation to hospital due to opioid overdose. SJWA’s remodelled Take Home Naloxone (THN) program, known as ‘Leave Behind Naloxone’, allows ambulance clinicians to dispense lifesaving THN to patients and/ or their social network on scene when patients refuse transport, to be used if patients experience relapse due to residual opioid toxicity.

Opioids are a significant contributor to death and disability in Australia, with as many as three people per day dying from an opioid OD in 2018. Naloxone has been used by hospitals and ambulance services for decades to rapidly and safely reverse opioid OD.

MHC delivers the state-wide WA Naloxone Program using Commonwealth THN funding including purchase of THN for the SJWA ‘Leave Behind Naloxone’ project. SJWA’s aim is to decrease the incidence of overdoserelated harms and mortality, and to combat the serious issue of opioid misuse in WA communities.

In working with the MHC, SJWA has adapted its State Operations Centre (SOC) call taking processes, frontline clinical guidance, internal system protocols, which led to SJWA petitioning of the Poisons Regulator to allow ambulance clinicians to dispense THN in a first for Australia and possibly the southern hemisphere.

The joint initiative has resulted in a significant increase in the number of cases being administered THN by bystanders prior to emergency ambulance attendance, as well as a reduction in transportation to Emergency Departments (EDs) at peak times, which has aided a return in SJWA’s community response hours. Additionally, incidences requiring WA Police Force (WAPOL) support at OD-related cases has decreased, which has further supported emergency service response capabilities.

The ‘Leave Behind Naloxone (THN)’ project is well received by patients and their peers, and it has contributed to positive relationships between SJWA and people at risk of OD. In taking a patient-centred harm reduction approach to opioid overdose, SJWA is building on community resilience.