Abstract
IntroductionOpioids contributed to over 300,000 deaths in the United States in the past 10 years. Most research on drug use occurs in clinics or hospitals; few studies have evaluated the impact of opioid use on emergency medical services (EMS) or the EMS response to opioid use disorder (OUD). This study describes the perceived burden of disease, data collection, and interventions in California local EMS agencies (LEMSA).MethodsWe surveyed medical directors of all 33 California LEMSAs with 25 multiple-choice and free-answer questions. Results were collected in RedCap and downloaded into Excel (Microsoft Corporation, Redmond WA). This study was exempt from review by the Alameda Health System - Highland Hospital Institutional Review Board.ResultsOf the 33 California LEMSAs, 100% responded, all indicating that OUD significantly affects their patients. Most (91%) had specific protocols directing care of those patients and repeat naloxone dosing. After naloxone administration, none permitted release to law enforcement custody, 6% permitted patient refusal of care, and 45% directed base hospital contact for refusal of care. Few protocols directed screening or treatment of OUD or withdrawal symptoms. Regular data collection occurred in 76% of LEMSAs, with only 48% linking EMS data with hospital or coroner outcomes. In only 30% did the medical director oversee regular quality improvement meetings. Of respondents, 64% were aware of public health agency-based outreach programs and 42% were aware of emergency department BRIDGE programs (Medication Assisted Treatment and immediate referral). Only 9% oversaw naloxone kit distribution (all under the medical director), and 6% had EMS-based outreach programs. In almost all (94%), law enforcement officers carried naloxone and administered it anywhere from a few times a year to greater than 200 in one LEMSA.ConclusionThis study represents an important description of EMS medical directors’ approaches to the impact of OUD as well as trends in protocols and interventions to treat and prevent overdoses. Through this study, we can better understand the variable response to patients with OUD across California.
Highlights
Opioids contributed to over 300,000 deaths in the United States in the past 10 years
Most research on drug use occurs in clinics or hospitals; few studies have evaluated the impact of opioid use on emergency medical services (EMS) or the EMS response to opioid use disorder (OUD)
64% were aware of public health agency-based outreach programs and 42% were aware of emergency department BRIDGE programs (Medication Assisted Treatment and immediate referral)
Summary
Opioids contributed to over 300,000 deaths in the United States in the past 10 years. Drug overdoses have led to more than half a million deaths in the United States in the last 10 years, two-thirds of which were opioid-related.[1] Opioid-related deaths increased fivefold from 1999 to 2016,2 and became the leading cause of accidental death in the US in 2015.3 While heroin and other illicit opioids contributed to the epidemic, prescription opioids constituted the bulk of the drugs leading to overdose.[4,5,6] poorly characterized, the impact to the emergency medical services (EMS) system is significant. Local, regional, and national governments implemented laws to reduce supply, monitor use, and enhance response to overdoses.[9]
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