Emergency Medical Service (EMS)

The opioid overdose crisis has rapidly expanded in North Carolina (NC), paralleling the epidemic across the United States. The number of opioid overdose deaths in NC has increased by nearly 40% each year since 2015.1 Critical to preventing overdose deaths is increasing access to the life-saving drug naloxone, which can reverse overdose symptoms and progression. Over 700 EMS agencies across NC respond to over 1,000,000 calls each year; naloxone administration was documented in over 15,000 calls in 2017.2 Linking EMS encounters with naloxone administration to the corresponding ED visit assists in understanding the health outcomes of these patients. However, less than 66% of NC EMS records with naloxone administration in 2017 were successfully linked to an ED visit record. This study explored methods to improve EMS and ED data linkage, using a multistage process to maximize the number of correctly linked records while avoiding false linkages.

Objective: To improve linkage between North Carolina's Emergency Medical Services (EMS) and Emergency Department (ED) data using an iterative, deterministic approach.

Opioid abuse has increased exponentially in recent years throughout the United States, leading to an increase in the incidence of emergency response activities, hospitalization, and mortality related to opioid overdose. As a result, states that have been hit particularly hard during this period such as Wisconsin have allocated considerable resources to addressing this crisis via enhanced public health surveillance and outreach, procurement and administration of medical countermeasures, prescription drug monitoring programs, targeted preventive and acute treatment, first responder and hospital staff training, cross-agency collaboration, and Incident Management System activities. Central to these efforts is the identification of the primary drivers of opioid overdose and death to improve the precision and efficacy of targeted public health interventions to address the opioid crisis. The present study sought to accomplish this end by syncing rich data sources at the point of emergency response (EMS ambulance runs) to ultimate mortality outcomes (vital death records).

Objective: To identify the correlates of opioids as an underlying cause of death by linking coroner/medical examiner vital death records with emergency medical service (EMS) ambulance run data. By combining death data to EMS ambulance runs, the goal was to determine characteristics of the emergency response particularly for opioid overdose events that may connect to increased mortality.

In North America we experience the highest rate of drug related mortality in the world. In the US, overdose is now the leading cause of death among adults under 50. Each day more than 115 people in the United States die due to an opioid overdose. The opioid overdose national crisis is rapidly evolving due to changes in drug availability and the presence of adulterated fentanyl in some areas leading to a critical need for innovative methods to identify opioid overdoses for both surveillance and intervention purposes. As an effort to strengthen our understanding of the epidemic through surveillance of Emergency Medical Services (EMS) we have developed a set of clinical indicators that identify opioid overdose within the information provided by an Electronic Patient Care Reporting (ePCR), Computer Aided Dispatch (CAD), ProQA systems and Hospital Medical Records.

Objective: To develop a set of clinical indicators of opioid overdose using Emergency Medical Services (EMS) records that included data from Computer Aided Dispatch (CAD), ProQA systems, Electronic Patient Care Reporting (ePCR) and Hospital Medical Records.

In recent years, the number of deaths from illicit and prescription opioids has increased significantly resulting in a national and local public health crisis. According to the Texas Center for Health Statistics, there were 1340 opioid related deaths in 2015.1 In 2005, by comparison, there were 913 opioid related deaths. Syndromic surveillance can be used to monitor overdose trends in near real-time and provide much needed information to public health officials. Texas Syndromic Surveillance (TxS2) is the statewide syndromic surveillance system hosted by the Texas Department of State Health Services (DSHS). To enhance the capabilities of TxS2 and to better understand the opioid epidemic, DSHS is integrating both Texas Poison Center (TPC) data and Emergency Medical Services (EMS) data into the system. Much of the data collected at public health organizations can be several years old by the time it is released for public use. As a result, there have been major efforts to integrate more real-time data sources for a variety of surveillance needs and during emergency response activities.

Objective: To improve Texas Syndromic Surveillance by integrating data from the Texas Poison Center and Emergency Medical Services for opioid overdose surveillance.

As a Centers for Disease Control and Prevention Enhanced State Opioid Overdose Surveillance (ESOOS) funded state, Kentucky started utilizing Emergency Medical Services (EMS) data to increase timeliness of state data on drug overdose events in late 2016. Using developed definitions of heroin overdose for EMS emergency runs, Kentucky analyzed the patterns of refused/transported EMS runs for both statewide and local jurisdictions. Changes in EMS transportation patterns of heroin overdoses can have a dramatic impact on other surveillance systems, such as emergency department (ED) claims data or syndromic surveillance (SyS) data.

Objective: The aim of this project was to explore changing patterns in patient refusal to transport by emergency medical services for classified heroin overdoses and possible implications on heroin overdose surveillance in Kentucky.

Opioid overdoses have emerged within the last five to ten years to be a major public health concern. The high potential for fatal events, disease transmission, and addiction all contribute to negative outcomes. However, what is currently known about opioid use and overdose is generally gathered from emergency room data, public surveys, and mortality data. In addition, opioid overdoses are a non-reportable condition. As a result, state/national standardized procedures for surveillance or reporting have not been developed, and local government monitoring is frequently not specific enough to capture and track all opioid overdoses. Lastly, traditional means of data collection for conditions such as heart disease through hospital networks or insurance companies are not necessarily applicable to opioid overdoses, due to the often short disease course of addiction and lack of consistent health care visits. Overdose patients are also reluctant to follow-up or provide contact information due to law enforcement or personal reasons. Furthermore, collected data related to overdoses several months or years after the fact are useless in terms of short-term outreach. Therefore, given the potentially brief timeline of addiction or use to negative outcome, the current project set to create a near real-time surveillance and treatment/outreach system for opioid overdoses using an already existing EMS data collection framework.

Objective: To develop and implement a classifcation algorithm to identify likely acute opioid overdoses from text fields in emergency medical services (EMS) records.

Syndromic surveillance has become an integral component of public health surveillance efforts within the state of Florida. The near real-time nature of these data are critical during events such as the Zika virus outbreak in Florida in 2016 and in the aftermath of Hurricane Irma in 2017. Additionally, syndromic surveillance data are utilized to support daily reportable disease detection and other surveillance efforts. Although syndromic systems typically utilize emergency department (ED) visit data, ESSENCE-FL also includes data from non-traditional sources: urgent care center visit data, mortality data, reportable disease data, and Florida Poison Information Center Network (FPICN) data. Inclusion of these data sources within the same system enables the broad accessibility of the data to more than 400 users statewide, and allows for rapid visualization of multiple data sources in order to address public health needs. Currently, the ESSENCE-FL team is actively working to incorporate EMS data into ESSENCE-FL to further increase public health surveillance capacity and data visualization.

Objective: To describe the strategy and process used by the Florida Department of Health (FDOH) Bureau of Epidemiology to onboard emergency medical services (EMS) data into FDOH’s syndromic surveillance system, the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE-FL).

Drug overdoses are now the leading cause of accidental death in the United States, with an estimated 60,000 deaths in 2016. Nationally, EMS overdose responses with naloxone administration have nearly doubled from 2012 to 2016 from 573.6 to 1004.4 per 100,000 EMS events. Resuscitation using the opioid antagonist, naloxone is recommended in cases of suspected opioid ODs, and has been increasingly used by EMS agencies, law enforcement, healthcare providers, and Good Samaritans. While naloxone can save lives, it is not clear how often its use is appropriate; delivering the right care to the right patient at the right time. It has been suggested that community paramedic programs teamed with recovery services may help link OD patients to recovery and rehabilitation services and establish mechanisms for follow-up care. Prior to implementing community EMS programs, it is important to understand the EMS utilization patterns of the OD population. I-EMS interactions may present an opportunity for behavioral intervention and linkage to services to prevent future OD and death in the opioid-using population. Accurately documenting substances involved in drug overdose deaths has been of increasing interest to Marion County and Indiana with a recent law requiring toxicology testing 5,6. This project linked individual-level data across public health information systems to assess the appropriateness of naloxone administration, the frequency of I-EMS service utilization until final death outcome among the I-EMS OD deceased cohort, and underlying causes of death among the cohort.

Objective: To characterize the appropriateness of naloxone administration, causes of death, and history of Indianapolis Emergency Medical Services (I-EMS) service utilization among the drug overdose population in Marion County, Indiana between 2011 to 2017.