Feasibility of bystander-administered naloxone delivered by drone to opioid overdose victims



      Currently, ≤5% of bystanders witnessing an opioid overdose (OD) in the US administer antidote to the victim. A possible model to mitigate this crisis would be a system that enables 9-1-1 dispatchers to both rapidly deliver naloxone by drone to bystanders at a suspected opioid OD and direct them to administer it while awaiting EMS arrival.


      A simulated 9-1-1 dispatcher directed thirty subjects via 2-way radio to retrieve naloxone nasal spray from atop a drone located outside the simulation building and then administer it using scripted instructions. The primary outcome measure was time from first contact with the dispatcher to administration of the medication.


      All subjects administered the medication successfully. The mean time interval from 9 -1-1 contact until antidote administration was 122 [95%CI 109–134] sec. There was a significant reduction in time interval if subjects had prior medical training (p = 0.045) or had prior experience with use of a nasal spray device (p = 0.030). Five subjects had difficulty using the nasal spray and four subjects had minor physical impairments, but these barriers did not result in a significant difference in time to administration (p = 0.467, p = 0.30). A significant number of subjects (29/30 [97%], p = 0.044) indicated that they felt confident they could administer intranasal naloxone to an opioid OD victim after participating in the simulation.


      Our results suggest that bystanders can carry out 9-1-1 dispatcher instructions to fetch drone-delivered naloxone and potentially decrease the time interval to intranasal administration which supports further development and testing of a such a system.


      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • CDC/NCHS
        Services UDoHaH Opioid overdose mortality. CDC WONDER, Atlanta, GA2018
      1. The opioid epidemic and emerging public health policy priorities.
        in: Giroir B.P. AMA National Advocacy Conference. 2019
        • Pathan H.
        • Williams J.
        Basic opioid pharmacology: an update.
        Br J Pain. 2012; 6: 11-16
        • Valenzuela T.D.
        • Roe D.J.
        • Nichol G.
        • Clark L.L.
        • Spaite D.W.
        • Hardman R.G.
        Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos.
        N Engl J Med. 2000; 343: 1206-1209
        • Kudenchuk P.J.
        • Brown S.P.
        • Daya M.
        • Rea T.
        • Nichol G.
        • Morrison L.J.
        • et al.
        Amiodarone, lidocaine, or placebo in out-of-hospital cardiac arrest.
        N Engl J Med. 2016; 374: 1711-1722
        • Perkins G.D.
        • Ji C.
        • Deakin C.D.
        • Quinn T.
        • Nolan J.P.
        • Scomparin C.
        • et al.
        A randomized trial of epinephrine in out-of-hospital cardiac arrest.
        N Engl J Med. 2018; 379: 711-721
        • Balasingam M.
        Drones in medicine-the rise of the machines.
        Int J Clin Pract. 2017; 71
        • Bhatt K.
        • Pourmand A.
        • Sikka N.
        Targeted applications of unmanned aerial vehicles (drones) in telemedicine.
        Telemed J E Health. 2018; 24: 833-838
        • Boutilier J.J.
        • Brooks S.C.
        • Janmohamed A.
        • Byers A.
        • Buick J.E.
        • Zhan C.
        • et al.
        Optimizing a drone network to deliver automated external defibrillators.
        Circulation. 2017; 135: 2454-2465
        • Claesson A.
        • Backman A.
        • Ringh M.
        • Svensson L.
        • Nordberg P.
        • Djarv T.
        • et al.
        Time to delivery of an automated external defibrillator using a drone for simulated out-of-hospital cardiac arrests vs emergency medical Services.
        JAMA. 2017; 317: 2332-2334
        • Claesson A.
        • Fredman D.
        • Svensson L.
        • Ringh M.
        • Hollenberg J.
        • Nordberg P.
        • et al.
        Unmanned aerial vehicles (drones) in out-of-hospital-cardiac-arrest.
        Scand J Trauma Resusc Emerg Med. 2016; 24: 124
      2. Operation of small unmanned aircraft systems over people, 14 CFR part. vol. 107. 2019
        • Pulver A.
        • Wei R.
        • Mann C.
        Locating AED enabled medical drones to enhance cardiac arrest response times.
        Prehosp Emerg Care. 2016; 20: 378-389
        • Sanfridsson J.
        • Sparrevik J.
        • Hollenberg J.
        • Nordberg P.
        • Djarv T.
        • Ringh M.
        • et al.
        Drone delivery of an automated external defibrillator - a mixed method simulation study of bystander experience.
        Scand J Trauma Resusc Emerg Med. 2019; 27: 40
        • National Public Radio
        FAA certifies Google's wing drone delivery company to operate as an airline.
        (Available from)
        • Hogg R.V.
        • Tanis E.A.
        • Zimmerman D.L.
        Probability and statistical inference.
        Pearson, 2019