As overdose deaths surge throughout America, driven by the increased presence of fentanyl in illicit opioids, public health policies turn to technology for help. One increasingly popular tool is anti-motion alarm systems, designed to help prevent overdoses in public bathrooms.

A study published in the International Journal of Drug Policy analyzes the effectiveness of anti-motion alarms, how they affect public safety personnel, and other key factors.

Anti-Motion Alarms in Public Restrooms: An Overview

Public restrooms have long been a popular location for drug users, especially intravenous drug users. A study found 48% of habitual intravenous drug users in New York City had injected in a public bathroom. It was the third most popular category behind a friend’s house and the individual’s own home.

Public restrooms are popular injection sites for several reasons:

  • Privacy with a lockable stall or lockable door.
  • Access to running water, paper towels, a trash can, and flat surfaces
  • Bright lighting

The popularity of public bathrooms as injection sites means they’re also a common location for individuals to overdose.

How Anti-Motion Alarms Helps Prevent Overdoses

Anti-motion alarm systems use a two-stage process to identify when an individual is overdosing in the bathroom. First, they use sensors on the door and elsewhere to track people entering and leaving the bathroom. Then, the system sends an alarm if any movement in the bathroom stops for four minutes, indicating the person inside is in immediate need of medical attention.  

Systems typically emit three alarms simultaneously:

  • An audible alarm accompanied by a strobe light inside the bathroom
  • An audio and visual alarm to the building’s security center
  • A remote alarm sent to public safety officials or other monitoring organization

The ability to notify public safety personnel in the immediate vicinity of the bathroom is the most critical aspect of the system.

The Role of Public Safety Personnel

Among medical emergencies, opioid overdoses have one of the shortest windows between initial symptoms and death, and it’s only grown shorter due to the prevalence of fentanyl. Responders often have five minutes or less to administer naloxone if the overdosing individual is to survive.  

An alarm is essentially worthless if no one is available to respond. The effectiveness of an anti-motion alarm relies heavily on trained public safety personnel capable of a quick response. Note that public safety personnel aren’t necessarily trained medical responders. The category can include administrative staff, security guards, and similar. 

Study Participants and Results   

The anti-motion studies focused on responses from 11 public safety personnel working at a large hospital in a major urban area. They had all responded to at least one overdose at the hospital within the past year and at least one anti-motion alarm within the previous three months.

Each interview was conducted one-on-one by a researcher. Interviews lasted about 30 minutes and consisted of semi-structured questions gauging each employee’s response to the anti-motion alarm. Topics covered include how they reacted to the alarm, how they felt administering naloxone, their opinion on the alarm system in general, and related issues.

After completing the interviews, researchers found four key themes.

Appropriate Responsibility for Employees

Do employees without a medical background, such as front desk workers and security personnel, feel a responsibility to administer aid in the event of an overdose? Survey results found that 100% of respondents felt it was an appropriate, if not downright vital, element of the job.

Respondents repeatedly expressed an understanding of the time constraints involving an overdose, and how their position resulted in them arriving first on the scene, even in a building filled with medical personnel.

Focus on Training Over Emotions

How did respondents feel upon discovering an overdose and administering treatment? Most described not reacting with emotion at all. Instead, they immediately reacted according to their training.

However, while those surveyed said they reacted without emotion during the immediate incident, they later often had strong emotional reactions. Many said they felt frustrated, especially when dealing with the same individual repeatedly overdosing, sometimes even multiple times in the same day.

Pros of Anti-Motion Systems Outweigh Cons

False alarms were fairly frequent, but survey respondents thought of them as a routine part of the job instead of a hassle or inconvenience. As one individual described it, a false alarm was far superior to finding “a cold body.”

All respondents stated false alarms in no way decreased their response time or the seriousness of their reaction. They also appreciated how the alarm would reset if movement occurred, often indicating a false positive, although even a reset didn’t slow response time.

Concern for Unintended Consequences

Although not a specific issue raised by interviewers, the subject of unintended consequences was introduced by multiple personnel surveyed.

The most common concern cited was displacement. Respondents were concerned individuals would seek out more remote locations away as injection sites. Instead of bathrooms, they might inject in abandoned buildings, underpasses, and other locations where they’ll become hard to find.

Another concern is a reluctance for security patrols to walk too far from anti-motion bathrooms. An understandable notion of staying with a reasonable running distance of the bathrooms could potentially inhibit their movement across the broader campus.   

Comparisons to Other Anti-Drug Measures in Public Bathrooms

Many other anti-drug measures have been implemented in bathrooms across the United States, such as:

  • Removing doors on stalls
  • Installing blue lighting, which makes finding a vein difficult
  • Prohibiting bathroom access to the public

One of the main recognized benefits of the anti-motion system is that it allows privacy while still allowing for a fast response in a medical emergency.

Conclusions

Studies show anti-motion alarm systems are an effective tool in the ongoing efforts to curb drug overdoses, including the rise of fentanyl-related overdoses. A significant component of their effectiveness is due to how trained public safety personnel have embraced them.

With nearly unanimous agreement, personnel find the system’s ability to save lives far outweighs any disruptions caused by false alarms. Additionally, while confident in their training regarding administering first aid to an overdosing individual, public safety personnel frequently expressed frustration at the frequency with which overdoses occurred.