Emergency medical services (EMS) are a critical touchpoint for people experiencing an overdose, withdrawal, or substance use crisis. Paramedics are trained to provide a number of lifesaving procedures on scene, including administering naloxone to reverse an opioid overdose within minutes.
Given the essential role EMS play in providing immediate, on-scene care, there’s a major opportunity for patients to be linked to ongoing care via their EMS encounter as well.
Funded by the National Institutes of Health (NIH) and led by Yale University, a new study will evaluate implementation of buprenorphine (bup) by EMS in the field, exploring its feasibility, acceptability, and safety.
Bup is a highly effective treatment for opioid use disorder (OUD), proven to not only reduce pain from withdrawal but significantly reduce overdose risk. There is, however, no standard of care for EMS initiation of bup.
Earlier this year, the National Association of EMS Physicians (NAEMSP) published a landmark position statement outlining a blueprint for EMS agencies and community leaders to build comprehensive services addressing OUD. The core components of the blueprint include leave-behind naloxone, EMS-initiated bup, collaboration with EDs who provide bup, and follow-up patient navigation support — also fundamental elements of the EMS Bridge model.
Results of the EMS-bup study will inform revisions of the EMS clinical protocol, education around and roll-out of EMS-bup around the country, and national EMS-bup recommendations.
The study will take place at three clinical sites that all initiate bup in the field, including Cooper University Hospital in Camden, New Jersey; Hennepin Healthcare in Minneapolis, Minnesota; and Alameda Health System in Oakland, California.
Using a phased approach, the study will explore how patients and EMS personnel respond to bup being offered or used, and the impacts of that use. The study will explore such outcomes as the number of patients remaining on bup following their EMS encounter, the number of patients with subsequent emergency department (ED) visits post EMS-bup, and any adverse events following EMS-bup initiation. It will also qualitatively evaluate why some patients may refuse bup, despite being eligible to take it.
“This is a really important study because it assesses the impact of EMS starting patients on medications for opioid use disorder and having an additional role in the chain of survival for patients with opioid use disorder by preventing future overdoses,” said Kristin Bascombe, MD, EMS/Base Hospital Medical Director at Wilma Chan Highland Hospital in Oakland, CA. “It shows us how EMS-initiated buprenorphine can help connect patients to treatment, and, importantly, what barriers may prevent patients from accepting or continuing treatment.”
In California and nationally, EMS Bridge is working to implement EMS-initiated bup, supporting training programs delivered by experienced EMS providers and tailored to EMS agencies in both urban and rural communities.
Learn More
Learn more about the EMS-initiated buprenorphine study here. If your EMS agency is interested in bup training, contact EMS Bridge.