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Pinnacle Conference Quick Take: EMS data can solve the opioid overdose epidemic, not naloxone

EMS leaders at Pinnacle conference learn how CAD and ePCR data, not naloxone, might be EMS's greatest contribution to resolving opioid overdose epidemic


SAN ANTONIO — Mortality from opioid overdose, steadily worsening since 2000, and the critical role of EMS to address this epidemic was presented by Alex Garza, MD, MPH at the Pinnacle EMS conference.

The multi-dimensional solution to the epidemic will be prevention through education and other interventions at the national, local and individual levels. EMS, with data on where overdoses are occurring and who is experiencing them, has a critical role in resolving this public health crisis.

Memorable quotes
Here are four memorable quotes from Garza's presentation.

"Opioid epidemic kills so many people, but it still seems to fly under the radar."

"There were more deaths in 2014 from opioid overdose which is more than any year in recorded history."

Treating an opioid overdose with naloxone "is like taking a loaded gun away from a suicidal patient, then handing it back as you say don't do that again."

"We can't naloxone our way out of this problem."

Key takeaways on role of EMS data
Garza reviewed the history of the opium trade and the rise of the legal and illegal pharmaceutical trade. Garza then described the role of EMS leaders and EMS data. Here are the key takeaways from Garza's presentation.

  • Opioid abuse pathway: For individual patients an overdose results in a predictable pathway of EMS care, bystander naloxone delivery or death. The patient's path depends on how their overdose is recognized or treated, but for most patients the path ends with a return to the community without rehab or recovery. 
  • Opioid overdose data: EMS has the best data on opioid overdoses, but public health interventions are most reliant on difficult to access hospital data and death certificates. EMS data can give a nearly instantaneous view of opioid use within a community that can show usage rates and location of usage. Data can be culled from CAD and ePCR data fields.
  • Best EMS data field: Garza analyzed ePCRs to determine which fields in an ePCR best indicate an opioid overdose. Free text search and use of naloxone were significant in his analysis. Other fields — dispatch info, primary impression, secondary impression and pre- or post-GCS — were not predictive of opioid overdose.
  • Data informs effectiveness of interventions: Garza described how Trinity EMS is using data and clinical indicators to determine effectiveness of law enforcement and public health interventions.
  • Rapid response model for opioid overdoses: More people die from opioid deaths than motor vehicle collisions. Major trauma patients receive a dramatic, rapid team response upon arrival at the hospital. Overdose patients, if they are transported to the hospital, receive a minimal response from a triage nurse and a security officer. Garza proposed a rapid response recovery model with an addiction specialist, initiating patient contact in the hospital, to steer patients towards rehabilitation services and resources.

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