Background: Increasing naloxone access has been identified as a primary strategy to reduce opioid overdose deaths. To supplement community naloxone training and distribution access points, EMS systems have instituted public safety-based naloxone leave behind (NLB) programs that allow emergency medical responders to distribute "leave behind" naloxone kits on the scene of an overdose. This model presents an opportunity to expand naloxone access for individuals at high risk for future overdoses. Objectives: To evaluate the preliminary outcomes of a novel EMS-based NLB program in Howard County, Maryland. Methods: This exploratory study involved analysis of data from the Howard County NLB Program. Basic statistical analysis of program performance metrics and participant demographic characteristics were performed. Results: From June 2018 to June 2019, Howard County Department of Fire and Rescue Services responded to 239 overdose calls and distributed 120 naloxone kits to individuals on the scene of an overdose, a 50.21% distribution rate. The HCNLB program connected 143 patients (59.83%) to peer recovery A c c e p t e d M a n u s c r i p tspecialists. Among the 143 patients linked to peer recovery support specialist services, 87 (60.84%) had accepted an NLB kit from EMS. The fully adjusted logistic regression model revealed that those whose kit was left with a family member on the scene were 5.16 times more likely to be connected to peer support specialists (OR = 5.16, p=0.000) while those whose kit was left with a friend or given directly to the patient were 3.69 times (OR=3.69, CI= 1.13 -12.06, p<0.05) and 2.37 times (OR=2.37, CI= 1.10 -5.14, p<0.05) more likely, respectively, to be connected to follow up services as compared to those who did not accept a kit, controlling for other variables in the model. Conclusion: This study highlights the importance of engaging an individual's family and social network when offering connections to treatment and recovery resources. NLB initiatives can potentially augment existing community-based naloxone training structures, thus widening the scope of the life-saving drug and reaching those most at risk of dying from an opioid overdose.
Background: Patient lifting injuries remain a significant hazard to Emergency Medical Services (EMS) providers despite preventative and mitigative strategies. Objective: To better characterize the nature of occupational injury involving patient and stretcher handling. Methods: A retrospective review of existing de-identified claims data was performed for the study period of January 1, 1999, through December 31, 2017. Independent reviewers analyzed each claim to determine if the claim was related to lifting or moving a patient. Any discrepancies between the two reviewers were analyzed by a third reviewer. Results: Eighty-two claims were identified as resulting from lifting or maneuvering patients. Fifty-two of these injuries (63.4%) resulted in at least one lost workday (LWD). Strains and sprains accounted for the majority of injuries with 63.4% (n=52) and 18.3% (n=15) respectively. Forty-two (51.2%) of these reports occurred when the provider was moving a patient, not involving a stretcher, while 37.8% (n=31) occurred due to lifting or maneuvering a stretcher with or without a patient. Conclusion: While the overall incidence of lifting injuries was less than reported in other occupational health data series, these injuries continue to occur, and cause significant operational and fiscal impact for EMS systems. This occurrence is despite advances in engineering controls and the organizational embracement of a culture of safety that focuses on risk identification and mitigation. Understanding the types of lifting/moving injuries, circumstances surrounding the injury, and contributing factors will help to maintain a heightened awareness of potential injuries associated with EMS work, and opportunities to reduce them.
IntroductionFrequent calls to 911 and requests for emergency services by individuals place a costly burden on emergency response systems and emergency departments (EDs) in the United States. Many of the calls by these individuals are non-emergent exacerbations of chronic conditions and could be treated more effectively and cost efficiently through another health care service. Mobile integrated community health (MICH) programs present a possible partial solution to the over-utilization of emergency services by addressing factors which contribute to a patient’s likelihood of frequent Emergency Medical Services (EMS) use. To provide effective care to eligible individuals, MICH providers must have a working understanding of the common conditions they will encounter.ObjectiveThe purpose of this descriptive study was to evaluate the diagnosis prevalence and comorbidity among participants in the Queen Anne’s County (Maryland USA) MICH Program. This fundamental knowledge of the most common medical conditions within the MICH Program will inform future mobile integrated health programs and providers.MethodsThis study examined preliminary data from the MICH Program, as well as 2017 Maryland census data. It involved secondary analysis of de-identified patient records and descriptive statistical analysis of the disease prevalence, degree of comorbidity, insurance coverage, and demographic characteristics among 97 program participants. Diagnoses were grouped by their ICD-9 classification codes to determine the most common categories of medical conditions. Multiple linear regression models and chi-squared tests were used to assess the association between age, sex, race, ICD-9 diagnosis groups, and comorbidity among program enrollees.ResultsResults indicated the most prevalent diagnoses included hypertension, high cholesterol, esophageal reflux, and diabetes mellitus. Additionally, 94.85% of MICH patients were comorbid; the number of comorbidities per patient ranged from one to 13 conditions, with a mean of 5.88 diagnoses per patient (SD=2.74).ConclusionOverall, patients in the MICH Program are decidedly medically complex and may be well-suited to additional community intervention to better manage their many conditions. The potential for MICH programs to simultaneously improve patient outcomes and reduce health care costs by expanding into larger public health and addressing the needs of the most vulnerable citizens warrants further study.ScharfBM, BissellRA, TrevittJL, JenkinsJL.Diagnosis prevalence and comorbidity in a population of mobile integrated community health care patients.Prehosp Disaster Med. 2019;34(1):46–55.
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