Abstract
Background
The U.S. and worldwide death toll from opioids and other drugs has accelerated, rivaling
all other causes of premature death. Emergency medical services (EMS) now has an evolving
role in providing solutions.
Methods
EMS medical directors from the majority of the largest U.S. cities and global counterparts
met to share/compile an inventory of best practices derived from their respective
high-volume experiences in jurisdictions with >114 million residents combined. In
turn, they created a consensus guideline document for the purposes of information-sharing
among themselves and other interested parties.
Results
The group concluded that EMS personnel have evolving training needs with respect to
new medical care challenges, but they also recommended that agencies have a special
place within the collective of those hoping to provide solutions to the public health
crisis of addiction and drug-related epidemics. In addition to intervening in real-time
overdose events, it was recommended that they partner with other key stakeholders
to develop mechanisms to end the repetitive cycle of emergency rescue followed by
an almost immediate return to addictive behaviors. EMS providers should be trained
to optimally communicate, refer, and direct the affected individuals to appropriate
resources that will provide viable and evidence-based pathways directed toward long-term
recovery.
Conclusions
Beyond a need to update acute medical rescue practices and improved assessment techniques,
EMS providers should also learn to optimally communicate, encourage, and even participate
in facilitating management continuity for the affected individuals by identifying
and using the appropriate resources that will provide viable, evidence-based pathways
toward sustained recovery.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Drug overdose deaths in the United States 1999-2016.NCHS Data Brief. 2017; 294: 1-8
- Overdose deaths involving opioids, cocaine, and psychostimulants—United States, 2015–2016.MMWR Morb Mortal Wkly Rep. 2018; 67: 349-358
- Contribution of opioid-involved poisoning to the change in life expectancy in the United States, 2000-2015.JAMA. 2017; 318: 1065-1067
- The burden of opioid-related mortality in the United States.JAMA Netw Open. 2018; 1: e180217
- Insurance institute for highway safety highway loss data institute website. General statistics 2016.(Available at:)http://www.iihs.org/iihs/topics/t/general-statistics/topicoverviewDate accessed: June 21, 2018
- Deaths: final data for 2015.Natl Vital Stat Rep. 2017; 66: 1-75
- Gun-related deaths in America keep going up. Time, Nov 6, 2017.(Available at:)http://time.com/5011599/gun-deaths-rate-america-cdc-data/Date accessed: June 21, 2018
- Assessment of changes in the geographical distribution of opioid-related mortality across the United States by opioid type, 1999-2016.JAMA Netw Open. 2019; 2: e190040
- Advanced management opioid overdose in the emergency department.Emerg Med Rep. 2018; 39: 61-74
- CDC health advisory: increases in fentanyl drug confiscations and fentanyl-related overdose fatalities.(Available at:)
- The effect of heroin and multiple drug abuse on the electrocardiogram.Am Heart J. 1973; 86: 663-668
- Drug-induced prolongation of the QT interval.N Engl J Med. 2004; 350: 1013-1022
- FDA warns about serious heart problems with high doses of the antidiarrheal medicine loperamide (Imodium), including from abuse and misuse. January 30, 2018.(Available at:)https://www.fda.gov/Drugs/DrugSafety/ucm504617.htmDate accessed: June 23, 2018
- Unusual consequences of heroin overdose: rhabdomyolysis, acute renal failure, paraplegia and hypercalcaemia.Br J Anaesth. 1999; 83: 496-498
- Rhabdomyolysis secondary to drug overdose and prolonged coma.South Med J. 1980; 73: 990-994
- Evaluation of amphetamine-related hospitalizations and associated clinical outcomes and costs in the United States.JAMA Netw Open. 2018; 1: e183758
- Violence against EMS: rolling with the punches. Emergency Physicians Monthly.(Available at:)http://epmonthly.com/article/rolling-with-the-punches/Date accessed: April 22, 2019
- Virtual reality training to prepare paramedics for violent patient encounters. EMS1.(Available at:)https://www.ems1.com/ems-products/training-products/video/202921187-Virtual-reality-training-to-prepare-paramedics-for-violent-patient-encountersDate: 2017Date accessed: April 22, 2019
- Detroit Fire Department addresses violence against EMS providers following attack.JEMS. 2017; 42: 1-10
- Reframing the opioid epidemic as a national emergency.JAMA. 2017; 318: 1539-1540
- Multiple naloxone administrations among emergency medical service providers is increasing.Prehosp Emerg Care. 2017; 21: 411-419
- Fighting the opioid crisis from the front lines. EMS World.(Available at:)https://www.emsworld.com/article/12252049/fighting-the-opioid-crisis-from-the-front-linesDate: 2016Date accessed: April 22, 2019
- OD in Chicago: fentanyl-laced heroin epidemic 2015. Presented at The Gathering of Eagles XVIII, Dallas, Texas.(Available at:)http://gatheringofeagles.us/2016/2016presentations/Saturday/WeberFentanyChicago.pdfDate: 2016Date accessed: April 22, 2019
- Anchorage is seeing a dramatic surge in heroin overdoses. Anchorage Daily News.(Available at:)https://www.adn.com/alaska-news/anchorage/2017/05/16/anchorage-is-experiencing-a-dramatic-surge-in-heroin-overdoses/Date: 2017Date accessed: May 3, 2019
- Those on the front line of heroin epidemic share frustrations, concerns. Journal-News Butler County, June 2.(Available at:)https://www.journal-news.com/news/local/those-front-line-heroin-epidemic-share-frustrations-concerns/ExFCcpgGpj6uV64E0SVPFO/Date: 2017Date accessed: June 24, 2018
- Scene safety and force protection in the era of ultra-potent opioids.Prehosp Emerg Care. 2018; 22: 157-162
- First responder PTSD: the escalating health risks for opioid crisis emergency response teams. RAVE Mobile Safety.(Available at:)https://www.ravemobilesafety.com/blog/first-responder-ptsd-during-opioid-crisisDate: 2017Date accessed: June 24, 2018
- Johns Hopkins pilots study on EMS treatment of substance abusers. John Hopkins Gazette.(Available at:)https://hub.jhu.edu/gazette/2014/september-october/focus-baltimore-city-ems/Date: 2014Date accessed: June 24, 2018
- EMS treatment referral program for opioid and heroin overdose. Efficient Government. April 6, 2018.(Available at:)https://efficientgov.com/blog/2017/04/06/ems-treatment-referral-program-heroin-overdose/Date accessed: June 24, 2018
- Reducing fatal opioid overdose: prevention, treatment and harm reduction strategies.Yale J Biol Med. 2015; 88: 235-245
- The multisite prescription opioid addiction treatment study: 18-month outcomes.J Subst Abuse Treat. 2015; 48: 62-69
- Long-term outcomes from the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study.Drug Alcohol Depend. 2015; 150: 112-119
- Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence.JAMA. 2015; 313: 1636-1644
- Emergency overdose-treatment center to open Friday. Columbus Dispatch. January 18.(Available at:)http://www.dispatch.com/news/20180118/emergency-overdose-treatment-center-to-open-fridayDate: 2018Date accessed: April 22, 2019
- Alcohol, Drug and Mental Health Board (ADAMH) of Franklin County, Ohio. Maryhavens Addiction Stabilization Center opens its doors.(Available at:)https://adamhfranklin.org/maryhavens-addiction-stabilization-center-opens-doors/Date accessed: June 29, 2018
- Heroin epidemic: as deaths rise, program a ‘glimmer of hope’ for life. Palm Beach Post. Friday, April 21.(Available at:)https://www.mypalmbeachpost.com/news/heroin-epidemic-deaths-rise-program-glimmer-hope-for-life/c8ITU5Q2lJbVFfEjSZKwpK/Date: 2017Date accessed: April 22, 2019
- Palm Beach County launches detox program aimed at lowering heroin death toll. South Florida Sun-Sentinel, January 5.(Available at:)https://www.sun-sentinel.com/local/palm-beach/fl-palm-heroin-pilot-program-20170105-story.htmlDate: 2017Date accessed: May 3, 2019
- Fentanyl.(Available at:)https://www.drugabuse.gov/drugs-abuse/fentanylDate accessed: June 21, 2018
- (Available at:)http://www.gatheringofeagles.us/2018/2018information.htmDate accessed: April 22, 2019
- The next stage of buprenorphine care for opioid use disorder.Ann Intern Med. 2018; 169: 628-635
- Time to change the way we approach opioid use disorder: a challenge to the status quo.Ann Intern Med. 2018; 169: 652-653
- Medication-assisted therapy is more than just buprenorphine, ACEP Now.(Available at:)https://www.acepnow.com/article/medication-assisted-therapy-is-more-than-just-buprenorphine/Date accessed: April 22, 2019
- ACMT statement on fentanyl exposure.(Available at:)https://www.acmt.net/cgi/page.cgi/_zine.html/The_ACMT_Connection/ACMT_Statement_on_Fentanyl_ExposureDate accessed: April 22, 2019
Article info
Publication history
Published online: May 17, 2019
Accepted:
April 9,
2019
Received in revised form:
April 4,
2019
Received:
January 7,
2019
Footnotes
Reprints are not available from the authors.
Identification
Copyright
Published by Elsevier Inc.
