A review of performance assessment tools for rescuer response in opioid overdose simulations and training programs

Abstract

Since the 1990s, more than 600 overdose response training and education programs have been implemented to train participants to respond to an opioid overdose in the United States. Given this substantial investment in overdose response training, valid assessment of a potential rescuers' proficiency in responding to an opioid overdose is important. The aim of this article is to review the current state of the literature on outcome measures utilized in opioid overdose response training. Thirty-one articles published between 2014 and 2020 met inclusion criteria. The reviewed articles targeted laypersons, healthcare providers, and first responders. The assessment tools included five validated questionnaires, fifteen non-validated questionnaires, and nine non-validated simulation-based checklists (e.g., completion of critical tasks and time to completion). Validated multiple choice knowledge assessment tools were commonly used to assess the outcomes of training programs. It is unknown how scores on these assessment tools may correlate with actual rescuer performance responding to an overdose. Seven studies reported ceiling effects most likely attributed to participants' background medical knowledge or experience. The inclusion of simulation-based outcome measures of performance, including the commission of critical errors and the time to naloxone administration, provides better insight into rescuer skill proficiency.

Keywords: Naloxone; Outcome measures; Overdose response training; Proficiency; Simulation.

Fig. 1

PRISMA Flow Chart of Articles Included (Aizen et al., 2018, Cash et al., 2018, Coleman, 2018, Dunn et al., 2016, Dunn et al., 2017, Dwyer et al., 2015, Espelt et al., 2017, Faul et al., 2015, Faul et al., 2017, Giglio et al., 2015, Gulec et al., 2018, Haffajee et al., 2019, Heavey et al., 2018, Hill et al., 2018, Jacobson et al., 2018, Jawa et al., 2020, Jones et al., 2014, Keane et al., 2018, Keenan et al., 2017, Kilwein et al., 2019, Kim et al., 2019, Kirane et al., 2016, Lewis et al., 2016, Madah-Amiri et al., 2017, Morris and Kleinman, 2020, Mueller et al., 2015, Nandakumar et al., 2019, Neale et al., 2019, Nielsen et al., 2016, Noveloso et al., 2020, Oliva and Bounthavong, 2017, Panther et al., 2017, Peckham and Boggs, 2016, Raffa et al., 2017, Rando et al., 2015, Ryan and Dunne, 2018, Rzasa Lynn and Galinkin, 2018, Salerno et al., 2018, Schartel et al., 2018, Sumner et al., 2016, Taylor et al., 2018, Weiner et al., 2017, Williams et al., 2019).