Open AccessFactors Associated With Calling 911 for an Overdose: An Ethnographic Decision Tree Modeling Approach
Author(s) -
Karla D. Wagner,
Brandon Koch,
Jeanette M. Bowles,
Silvia R. Verdugo,
Robert W. Harding,
Peter Davidson
Publication year - 2021
Publication title -
american journal of public health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.284
H-Index - 264
eISSN - 1541-0048
pISSN - 0090-0036
DOI - 10.2105/ajph.2021.306261
Subject(s) - law enforcement , psychological intervention , decision tree , poison control , suicide prevention , sample (material) , human factors and ergonomics , occupational safety and health , medical emergency , psychology , enforcement , first responder , injury prevention , applied psychology , computer security , medicine , computer science , psychiatry , political science , data mining , law , chemistry , chromatography , pathology
Objectives. To identify factors that influence when people who use drugs (PWUDs) call 911 for an overdose. Methods. We conducted 45 qualitative interviews and 180 surveys with PWUDs who had recently witnessed overdoses in Southern California from 2017 to 2019. We used conditional inference tree and random forest models to generate and validate a model to predict whether 911 would be called. Results. Our model had good in- (83%) and out-of-sample (84%) predictive accuracy. Three aspects of the social and policy environment influenced calling 911 for an overdose: the effectiveness of response strategies employed, the behavior of other bystanders, and whether the responder believes it is their responsibility to call. Conclusions. Even in the presence of policies that provide some protections, PWUDs are faced with difficult decisions about calling 911 and must weigh their own safety against that of an overdose victim. Potential interventions include strengthening training and safety planning for PWUDs, bolstering protections for PWUDs when they call 911, and separating law enforcement response from emergency medical response to overdoses.