NHTSA Webinar Addresses How to Fix the Opioid Epidemic

Without a definitive solution, the opioid epidemic in America continues to worsen.

In 2014, there were more reported opioid overdose deaths in America than ever before, and the epidemic continues affecting communities at all levels across the nation. But there are ways EMS agencies can work to reduce these deaths.

In a recent webinar titled “How EMS Can Reduce Opioid Overdoses,” presented by the NHTSA’s Office of EMS as part of its EMS Focus webinar series, officials from the state, local and federal level detailed ways their organizations are trying to decrease the number of deaths.

Jeffrey Elder, director and medical director of New Orleans EMS, and Joseph Kanter, medical director for the New Orleans Health Department, spoke on how using data from EMS agencies can help find opioid-use hotspots and help agencies craft a response to these incidents.

In January 2016, Elder says his organization noticed an uptick in opioid overdoses over a four-day period and wanted to note how and where naloxone was being administered in those areas. New Orleans EMS used patient records and noticed they went from administering naloxone about twice per day to using about 10 doses per day.

Elder says they then created a “heat map” of where the doses were being administered and gave this information to the New Orleans Health Department so they could take a better look at what was happening in those sections of the community.

Kanter says they usually can get somewhat similar information from the coroner, but the reports do not have the same immediacy the information from the EMS agency. Using this information, Kanter was able to collaborate with EMS to craft a response and issued a standing order for naloxone at area pharmacies. Any resident could go into the pharmacy, ask for naloxone from the pharmacist and receive a brief training on how to use it.

The health department also implemented an education program for residents to recognize the signs of an overdose and to inform them of the steps that should be taken when someone overdoses.

Elder says there are some limitations to this model currently, and they’re still working out how to use data from both dispatch and EPCR most efficiently. Elder says they are working on getting more overarching data.

At the state level, Nick Mercuri, bureau chief of EMS for the state of New Hampshire, says collaboration with other departments was key as well.

In about 2013, Mercuri says his office began getting calls from larger services in the state presenting data that noted an increase in responses to overdose, and they decided to work with these departments to decide on a solution. The state bureau of EMS in New Hampshire houses emergency medical records, so the bureau was able to look at where and when naloxone was being given to patients, and Mercuri says they noticed there was a 15% increase in naloxone use statewide.

In response, Mercuri and the other departments began a push to get naloxone administation approved for all EMS providers. This doubled the amount of EMS personnel who were able to administer naloxone.

In collaboration with the New Hampshire Department of Health and Human Services and the New Hampshire, a task force was created, and naloxone training was given to law enforcement and community health centers.

Taking it a step further, in Manchester, a program was developed in collaboration with an already-existing MIH program to help avoid transporting patients in ambulances if it was not necessary. After a medical evaluation, stable patients were offered alternate forms of transportation. With consent, some patients were taken directly to substance abuse programs instead of to the hospital.

Similarly to New Orleans EMS, New Hampshire is looking to expand its medical data collection in an effort to better respond to the opioid epidemic as well.

“We’re in an interesting situation, and it’s only through pulling together and taking a look at this information that we can make some headway,” Mercuri says.

Jeremy Kinsman, ASPPH public health fellow with the NHTSA’s Office of EMS, says that on a federal level, the focus is on creating evidence-based guidelines for overdose patients.

Kinsman says in April, a collective effort began between a number of different agencies to create evidence-based guidelines on treating opioid overdose patients. The results will be published in 2017. Kinsman says after the guidelines are published, the work still does not stop at the federal level. Kinsman says they are researching many funding opportunities between state and local partners, and they are working on getting laws changed at the federal level to improve access to naloxone.

Similarly to the state and local level, Kinsman says data collection is another focus at the federal level, and Kinsman advocates for a collaborative EMS systems approach.

To listen to the webinar in its entirety, or to view other EMS Focus webinars, click here. For more information about the NHSTA’s Office of EMS, visit EMS.gov. 

A more detailed report on the work of New Orleans EMS will be featured in the October issue of EMS World Magazine.