I’m a new OSM editor so be patient with me.
In my region (west of Scotland) illegal narcotics are a big problem. As a result, I’ve started noticing something new available on the streets: emergency Naloxone points. These are similar to defibrillator points in form and function, but give access to a dose of Naloxone to help people suffering an overdose.
How can I have this added as a new feature type, with a dedicated icon etc.?
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Hi, and welcome to OSM!
This is a great idea for a feature to map. I don’t have a solid answer for the best way to tag these, but here’s some context and thoughts.
Looking through Taginfo for “naloxone”, “narcan” (the common term for this in the US), and “overdose”, two main approaches come to mind: vending and emergency.
amenity=vending_machine + vending=* seems most appropriate for things (keep in mind, OSM’s definition of a “vending machine” is quite broad) that make naloxone kits available, intended to give people access to the nasal spray kits which can be carried around. These machines could be used in an emergency, but that’s not their primary purpose. They also often make other harm reduction materials available.
emergency=* seems more appropriate for small defib-like “just in time” emergency supplies.
I used * for the value placeholder because I’m not sure what’s best - naloxone, naloxone_nasal_spray, or intranasal_naloxone (which all have some small amount of existing use).
So, that’s about how those should be tagged. Once that’s decided and put into some amount of practice, to have it as a feature type in the prominent editors, the developers of the various editors (iD, Rapid, JOSM, StreetComplete, Go Map!!, EveryDoor, Vespucci, etc.) or the projects they pull from (like id-tagging-schema) would have to be contacted.
To have a dedicated icon, one would need to be found or made, and then the developers of the various tools and renderers (keep in mind, the Carto (“OSM Standard”) map style used by default on osm.org is just one of many ways of consuming and/or displaying OSM data) would have to be contacted.
That’s a lot - in brief, let’s first continue discussion on what’s the best way for these to be tagged!
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Sadly I think Carto won’t be showing such useful items anytime soon. Emergency=defibrillator is a no show in Carto and there are many more of those.
I’ve no idea why they are a no show given the social expectation to be able to find one in some parts of the world.
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You’re not the first with that question see Opioid overdose reversal kit / Naloxone
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In any case, remember that openstreetmap.org is not intended for end users, but more for mappers to check their work. Map apps that use OSM data are the ones that should be showing this, and I think they tend to do it well. I just checked CoMaps, cartes.app, and osmapp.org. The first shows the icon just by zooming into the area, while all three have it as an easily searchable term. Plus there’s dedicated apps such as https://openaedmap.org or https://www.defibfinder.uk.
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There is a good reason, see Add rendering for emergency=defibrillator · Issue #1603 · openstreetmap-carto/openstreetmap-carto · GitHub
As someone else once said, “Carto’s gonna Carto”. Just use a different map style and move on.
However, the original question was about tagging, not rendering. I tend to agree with @Lumikeiju that emergency is the way to go. I’d either pick a value from taginfo or make something new up.
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Might have seemed like a good reason at the time, but this effectively offloads the problem by expecting general map users to have specialist tools when they need them in an emergency. I did mention social expectation in some parts of the world. The last posted has water wells as common items, they are not in my part of the world. Here water wells would be specialist need. Perhaps tools like Carto or their successors will allow more regional nuance, although that is probably fraught with urban/rural/developing issues too.
Icons. I think things have moved on in 4 years and the imagery seems essentially the same, apart from colour. I’d be happy with red or green. Red for public access perhaps, not show the private ones at all (or green). 170k of them now in OSM.
Carto is effectively the advert map for OSM. Like it or now, it’s not too surprising that many think Carto is OSM. It’s not great when the general solution to Carto is ‘just use something else’.
That or ‘do it yourself’ which is the least helpful answer to a non technical user. Just because one person finds it within their capability (I don’t mean easy), it does not mean most will.
Rendering helps people understand the results of their tagging. I wonder how many people OSM has lost on the way when their changes have ‘not appeared on the map’.
Of the 8 styles OSM shows, only Shortbread shows AEDs. In grey along with all icons. So much for a different map style.
I know you do your own, but how many map styles are that that display the range of features that Carto does along with more emergency features such as AEDs.
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The argument against adding AEDs was (in a nutshell) “usual rendering rules will mean that AEDs will frequently be hidden by other features, leading to people who rely on this map for an emergency to assume that there is no AED nearby when in fact there might be”.
I think this argument still holds. In order to make the standard map into an efficient emergency tool, one would have to prioritize AEDs over everything else (making the map much less useful for the “general purpose”, even more so if one used different colors as you suggested). Even then the AEDs would compete for space with other emergency features like the emergency naloxone dispenser discussed here. An AED could hide a dispenser or vice versa. Therefore specialist tools will be required to efficiently interpret the map for emergency causes.
Technology has moved on and we now have vector tiles. A vector tile map can - provided that the respective emergency features are present in the tiles - easily switch to an emergency rendering where emergency features are prominent, and could even be set to show just AEDs or just dispensers (or fire extinguishers, or …).
Stuffing them onto the general purpose map view is still a bad idea, no matter how many thousands are in OSM.
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(taking these in reverse order)
Yes - you absolutely can’t have “everything louder than everything else” at OSM Carto’s max zoom of raster 19.
… and it can also “just show everything” at higher zooms, because there’s more space to show everything. As an aside, the restriction of OSM Carto to a maximum raster zoom of 19 is an implementation rather than a software restriction. Perhaps this is for a good reason, but my experience of maintaining a small area of higher zoom raster tiles is that the space taken up by zoom levels in order is “14, 17, 16, 15, 18, 13, 12, 21, 20” (and 14 is only at the head of that list because of prerendering). Someone absolutely could create OSM Carto raster tiles at zoom levels higher than 19. They would not look nice because they have not been designed to look nice at those zoom levels, but they would show the same data with fewer overlap issues.
Pedant alert: “Shortbread” is actually a schema, and what is (in my view unhelpfully) described as “Shortbread” is actual the “Versatiles Colorful” map style which uses the Shortbread Schema.
Creating a different map style to use that schema requires a few files hosted on a web server (on the internet, or on your local PC). If you want a slightly more European style of map rather than the “advertising backdrop” of Versatiles Colorful try this one of mine - it uses the OSMF shortbread raster tiles and works anywhere in the world. Whilst the “shortbread” schema works for defibrillators, it’s a deliberately “light” schema and the vector tiles do not contain “everything”, even at the highest zoom generated vector tiles (14). It also omits quite a lot (like barriers) that perhaps could have been included even in a “light” schema.
… and that’s a key point - people don’t find their nearest defibrillator or similar by “browsing a map”, they search for it. As long as it can be found by that method, it doesn’t matter if no map icon appears at low zoom levels.
(but all of which is somewhat offtopic from the original “how to tag” question 
)
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Agreed, folks in OSMUS Slack have also pointed out these actual vending machines, resembling the ones that spit out cola or crisps. Passers-by pick up the kits to carry around just in case. While emergency=* isn’t wrong, they fit amenity=vending_machine unironically.
The more common “NaloxBoxes” probably qualify as emergency=first_aid_kit. You don’t take anything out of the box unless someone nearby is having an emergency and you’re giving them aid. We’d still need to somehow clarify what’s in the kit. I’d lean toward relegating the contents to a secondary key, because unlike AEDs, these boxes can supply more than just naloxone.
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Comparing this thread with the one linked by lumikeiju, it seems the consensus is generally that, for an on-the-spot emergency dispenser of Naloxone (or Narcan), the approach I should use is: emergency= .
Given the use of different terms for the actual medication dispensed, and based on my opinion of what people are most likely to search for under the circumstances, I’m suggesting:
emergency=overdose
This seems to be pretty region-agnostic.
I’m not sure I like the idea of diluting the meaning of the tag by using something more generic like emergency=first_aid_kit - in an emergency situation it’s better to give clarity as to what’s actually available. Given the very narrow circumstances under which a defibrillator is suitable for use, I don’t think this is setting a bad precedent. Also, not every map user will know what Naloxone or Narcan is, but overdose is more or less ubiquitous. Editors can then specify naloxone=yes or narcan=yes, or whichever is the regional variant.
The method of accessing the emergency kit seems to vary across boxes. I think the one I’m intending to add to the map requires users to call a number to receive the box’s security code. I’ll look at the access tags and see if there’s something that’s suitable.
Because I think it’s better to get something like this on the map sooner than later, I’m going to apply this suggestion now but I’ll keep an eye on this thread and if there are any objections or the consensus approves something else, I’ll go back and update my the tag accordingly.
“Overdose” isn’t much more descriptive than “first aid”. Naloxone is the generic name, applicable anywhere, while Narcan is a brand name for it. I don’t think the brand name particularly matters for this kind of feature, but the generic name does matter. Naloxone is only for opioids; if you treat someone with it but they’re suffering from an overdose of a non-opioid, you may fail to treat their condition or even worsen it.
Certainly, if you encounter a box that claims to address overdosing in general, you could use overdosing to describe it somehow. But I’d imagine any kit would specify the kinds of overdoses it addresses. Besides, I think an umbrella tag would be preferable to forcing data consumers to work with seemingly unrelated features. My suggestion was to pair emergency=first_aid_kit with a secondary tag specifying naloxone or anti-opioids, but emergency=overdose_kit with that secondary tag probably works for the most part.
NaloxBox is labeled “Opioid Rescue Kit” and is usually placed next to related supplies such as an AED or traditional first aid kit. Meanwhile, the vending machines can contain a variety of supplies, not just for overdosing. For example, this vending machine in Richmond, Virginia, is labeled “Harm Reduction Supplies”. It contains fentanyl test strips, naloxone (Narcan), and personal hygiene items.
Hmm, I don’t agree with that. An overdose is a specific type of medical emergency, with a limited range of treatments. A first aid kit, OTOH, is a container that may contain treatments for any number of medical conditions, many of them not emergencies. Typical contents of a FAK would probably be plasters, bandages, antiseptic wipes, painkillers, steri-strips, gauze etc.
From my perspective, I think it’s unlikely that a FAK would contain something as specific as an epinephrine injector or Naloxone except under specific circumstances. You seem to accept this yourself in your last paragraph when you say that NaloxBoxes are usually placed next to traditional FAKs - as opposed to being contained within them. That suggests that a separate tag for public items designed to help treat overdoses is reasonable.
Some of your comments suggest a different way of looking at tagging than mine. I’m a new editor so the importance of tagging is limited to what an end-user might search for, but I get the impression you might be considering how developers and software might use it. That’s fair, and I really can’t comment on that. There’s obviously a lot I’ve still got to learn about how OSM data is used in practice. I’m not sure how tag heirarchies work, for example.
In your last paragraph you also refer to vending machines. But I don’t think that kind of comparison is useful, as consensus seems to be that vending machines are a distinct item and seem to serve a non-emergency purpose, and I would agree with that. In my specific case, I’m referring to a dedicated box with the same visual appearance as a defib. box (for easy recognition, I would imagine) and for a single dedicated emergency purpose.
Perhaps the defib. feature should be relegated to a sub-category (sorry if I’m not using these terms correctly in relation to OSM data) and there should be a top category referring specifically to emergency use, single-function treatment boxes? Perhaps medical_emergency cabinet=yes?
I get the impression a long time could be spent debating these things. For the moment I’m going to tag the box with emergency=overdose_kit - you’re right, this works better alongside defibrillator by describing the item available, not the emergency being treated - and sub-tags overdose=opioid (as the more generic term covering heroin and fentanyl, etc.) and naloxone=yes.
But I stress I’m happy to change tags according to consensus.
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I’d lookout for bleed_control_kit s too mapped inthe same way as AEDs.
Yes, generally speaking, the most important thing is to map. Don’t let the ontological bikeshedding keep you from recording what you know and then losing it when we finally come to a decision.
Thanks for explaining your reasoning. I think your solution is pretty good. This iterative refinement allows for multiple levels of detail depending on what the mapper sees on the box and the level of detail that a data consumer might want for a particular use case. It also avoids misleading a data consumer that assumes a first aid kit is full of sundries, for example because an icon was designed before overdose kits became common.
Looking into it further, I agree that overdose response kits should not be conflated with standard first aid kits. Regulators around the world clearly distinguish them. It’s probably important to distinguish opioid overdosing from other overdosing, but I was wrong about naloxone potentially being risky to apply when other drugs are involved.
The reason I focused on a more general tagging scheme was in consideration of a first aid kit that also contains overdose supplies along with the sundries. I think that is still a possibility, but since you’ve split out overdose=* as a separate key, a mapper can combine it with another tag such as emergency=first_aid_kit if necessary.