EMS data sharing to combat the opioid epidemic

By Zachary Louderback, MD; Jerry Escajeda, MD; Ryan Marino, MD

The ongoing public health crisis of overdose deaths has profoundly affected most communities throughout the country, regardless of demographics or geography. First responders, including EMTs and paramedics, law enforcement officers and firefighters, are on the front lines of the crisis and have insight into its challenges.

EMS providers have a unique perspective regarding the successes and shortcomings of various approaches aimed at mitigating the crisis. There is no doubt that progress will only occur with an impartial and multifaceted approach that includes teamwork and cooperation across different EMS boundaries. The rapid acquisition, organization and dissemination of data related to opioid use has been gaining traction in EMS and law enforcement communities as a real-time harm reduction method to improve morbidity and mortality.

Data sharing helps fight against the opioid epidemic

As one example, the Governor of Pennsylvania announced the launch of an overdose information network (ODIN). ODIN is a centralized database that will collect information regarding specific overdose location, basic demographics of individuals who overdosed, naloxone administration, drug characteristics and packaging. This data will be available to health care professionals, EMS organizations and law enforcement to allow for information sharing across agencies.

This type of data has various interesting applications worth exploring, though they should be approached with thoughtful consideration. In the United States, there is a history of reflexive punitive action towards illicit drug trends, despite the fact that these strategies have never produced effective results.

Instead, a multifaceted strategy of open data-sharing among EMS and public health organizations has the potential for true morbidity and mortality reduction. Such a strategy would encourage the development of unbiased and data-driven public health measures that allow for individuals to survive and pursue recovery.

Law enforcement does play a role in this crisis and will have access to this data to monitor lethal opioid trends and areas of increased opioid consumption with the intent to interrupt dissemination and reduce opioid related deaths. However, we must remain vigilant to prevent a purely punitive strategy and, instead, focus on a comprehensive approach to help those at risk.

EMS organizations will benefit from access to real-time data to focus resource allocation, rehabilitation options and harm reduction measures where they are needed the most. There are various examples of developing programs that would benefit from this type of EMS data sharing.

Data sharing improves resource allocation programs

“Leave Behind Naloxone” programs are one example of improved resource allocation to reduce deaths. Naloxone is the opioid reversal medication – an effective antidote to overdose – that acts to reverse the respiratory depression of opioid toxicity. Naloxone can be safely and effectively administered by any bystander with a review of simple instructions.

It is worth noting that community naloxone distribution has been repeatedly shown to reduce opioid-related deaths and does not increase opioid use or consumption. Many EMS organizations currently have naloxone leave-behind programs, where patients who refuse transport to the emergency department following an opioid-related call can still receive a medical intervention in the form of a naloxone kit to prevent future overdose harms.

Data sharing regarding increased opioid-related deaths or overdoses in a particular area could allow for targeted EMS naloxone distribution or education, and has the potential to unfold rapidly as clear trends are recognized, rather than relying on anecdotal information and delayed action.

Fire departments in New Hampshire have implemented an innovative program to encourage addiction treatment and harm reduction among opioid users. Safe Stations are a model for broadened access to recovery resources that would substantially benefit from EMS data sharing.

Individuals seeking information regarding opioid use and rehabilitation can speak with a trained professional at a designated fire station, 24 hours a day. These EMS personnel can provide resources regarding addiction treatment and harm reduction, and can facilitate prompt emergent medical screening or treatment within their scope if needed.

The stations are equipped to collect needles or paraphernalia, and turn illegal substances over to the police for disposal without penalization. The goal is to increase recovery for opioid users by making it more available and fostering a nonthreatening, and approachable, environment that can guide individuals towards long-term success. Programs like this can both accumulate data to share with other EMS organizations and adapt to community data in order to best allocate resources and staff. If EMS providers in communities had access to real time information about opioid related trends, they could funnel resources or add trained providers in high-risk areas.

Community paramedicine programs benefit from data sharing

Another growing field – community paramedicine and mobile-integrated healthcare – has the potential for significant impact among high-risk opioid-use populations, and would benefit from data sharing. Multiple cities are developing community paramedicine programs, where EMS providers will visit patients in their homes non-emergently and provide various services. Demonstrated outcomes of model programs include decreased 911 and emergency department utilization, decreased readmission rates, better outpatient follow up, medication compliance and more.

Such programs can easily be adapted to address the opioid crisis and are uniquely designed to respond to real-time data trends and mitigate further harm. For instance, if an area has a sharp increase in opioid-related overdoses and EMS utilization, community paramedicine providers could conduct return visits to patients for assessment and distribution of resources.

These resources could include information on addiction management and rehabilitation or detoxification, as well as harm-reduction methods, such as safe needle use, safer opioid use strategies and others. They would provide naloxone leave-behind kits and, most importantly, be able to spend time with these individuals and assess their specific needs. These providers are uniquely positioned to gather information and understand motivations concerning opioid trends. Community paramedicine programs have significant potential in combating opioid-use disorder and would distinctly benefit from access to up-to-date data.

While there is no single intervention or solution to this exceptionally complex issue facing our country, EMS is best positioned to interface with at-risk individuals in the communities where they live and work. Different communities will require varied, unique resources, and local EMS data-sharing programs can help facilitate this type of targeted approach.

Data collection and sharing among EMS organizations will allow for continuous research and critical evaluation regarding the effectiveness of these various public health interventions and harm reduction strategies. This will, in turn, further revision strategies and additional innovative approaches. There are many promising applications of increased access to EMS opioid data that deserve attention in the context of a balanced, multifaceted approach to the opioid crisis.

About the authors
Zach Louderback, MD, is a chief resident at UPMC emergency medicine residency and is a prehospital physician.

Jeremiah Escajeda, MD, FACEP, FAEMS, is an emergency department physician at the University of Pittsburgh/UPMC and is an EMS medical director and prehospital physician.

Ryan Marino, MD, is an emergency department physician and medical toxicologist at the University of Pittsburgh/UPMC