Emergency Medical Services (EMS) is frequently called in cases of drug overdose or withdrawal.

EMS Project

When an ambulance responds to a 911 call for overdose, paramedics administer treatment to prevent the patient from dying but do not provide medication to address the underlying addiction. This is a critical missed opportunity because 20% of patients treated for a non-fatal overdose will die within the next year. To save lives and improve patient outcomes, CA Bridge is engaging EMS agencies and personnel in the treatment of opioid use disorder (OUD) and the prevention of opioid overdose.

Project Leads

This project is led by Gene Hern, MD (emergentt@gmail.com), EMS Project Director, and Vanessa Lara (vlara@cabridge.org), EMS Project Manager.

Project Impact

Proving Feasibility

In a pilot project, EMS-initiated buprenorphine, incorporating data sharing and linkage with treatment, appears to be a safe intervention with a high rate of ongoing outpatient treatment. EMS-initiated buprenorphine is feasible, demonstrating the important role that EMS can play in reducing the risk of fatal opioid overdose.

Investing in Overdose Receiving Centers

While EMS systems have defined specialty centers for the treatment of many significant life-threatening diseases (trauma, stroke, myocardial infarction), the implementation of OUD systems of care that integrate EMS are uncommon. A study exploring the importance of identifying these systems of care hopes to decrease mortality for patients with OUD by transporting patients to ‘Overdose Receiving Centers’ that have established systems for early intervention and treatment for patients with OUD.

Expanding Access to Treatment

Many patients who may be at high risk for overdose deaths may never engage in treatment because they frequently refuse transport. 3 preliminary cases using a novel intervention of EMS-initiated buprenorphine for symptoms of opioid withdrawal paired with a tracking system to follow patients through additional services is a part of an integrated approach to combating the overdose crisis through EMS-focused interventions.

Project Activities

This work is funded by the CARESTAR Foundation.

Contra Costa Pilot Evaluation

Contra Costa County is piloting a novel approach to EMS engagement in preventing overdose and reducing opioid use disorder (OUD). This pilot includes four components:

  1. Equipping all ambulances with naloxone to distribute to patients, friends, and family to use in the case of future overdoses.
  2. Starting treatment for OUD with buprenorphine in the ambulance.
  3. Providing follow-up from the public health department to all patients with OUD after a 911 call to offer them linkages to treatment.
  4. Designating hospitals implementing the CA Bridge model as “overdose receiving centers” to direct ambulances to these facilities for patients with OUD.

CA Bridge is working with Contra Costa County and UCLA to conduct an evaluation of the effectiveness of starting buprenorphine on the ambulance and connecting patients with follow-up care.

EMS Toolkit

CA Bridge provides resources to help EMS agencies launch their own pilots to prevent overdose and treat OUD. Our toolkit contains resources covering three topics:

  1. Naloxone Distribution
  2. Treating OUD with Buprenorphine in the Field
  3. Engaging Patients Who Use Drugs through Motivational Interviewing

Review the resources below to learn more. To request assistance for your county or agency, contact us.

1. Naloxone Distribution 

Distributing naloxone is one of the easiest steps an EMS agency can take to prevent overdose. The following tools can help you implement this program in your agency:

2. Treating OUD with Buprenorphine in the Field

Treatment of OUD with buprenorphine (bup) has been demonstrated to reduce relapse and overdose. California is moving towards making the initiation of bup treatment the standard of care in all hospital emergency departments. Starting bup in the field during a 911 call is a further innovation that has the potential to bring more patients into care at a critical moment. OUD treatment can be started in the field through a pilot project based on a scope of practice waiver. Currently, Contra Costa County has obtained this waiver, and CA Bridge is looking to support other EMS agencies to join this pilot. Get started with these tools:

3. Engaging Patients Through Motivational Interviewing

EMS personnel encounter many people who use drugs, and these interactions can be challenging. By learning the techniques of “motivational interviewing,” first responders can greatly improve their effectiveness in turning these interactions into positive opportunities to build trust, practice harm reduction, and, in some cases, engage patients in treatment. Download this Motivational Interviewing Techniques Training and watch the video below to learn some basic techniques.

This project was supported by the CARESTAR Foundation. © 2021, California Department of Health Care Services.