Objectives To optimize healthcare utilization, health outcomes, and costs, research is needed to improve an understanding of frequent users of emergency health services. Frequent use of emergency services is associated with high costs of healthcare and may be indicative of challenges accessing, or poor outcomes of, healthcare. We identified patient demographics and health factors related to frequent use of the emergency medical services (EMS) system of a mid-sized city. Study findings will aid in the development of targeted interventions to improve population health. Methods We reviewed 9-1-1 call dispatch data and Baltimore City Fire Department EMS records in 2008–10. Frequent use was defined as six or more EMS incidents in the 23 month period. Analyses used census data to compare demographics of EMS users to their population distribution; and examined differences in demographics and health problems of frequent EMS users compared to non-frequent users. Results Frequent EMS users (n=1,969) had a range of 6–199 EMS incidents (mean 11.2) during the observation period; and though they accounted for only 1.5% of EMS users, they were involved in 12.0% of incidents. Frequent users, as compared to non-frequent users and to the population, were more likely to be male, African American, or 45 years or older. Of frequent users, the modal age group was 45–54 years, accounting for 29.7% of frequent users, which represented twice this age group’s population distribution. Furthermore, this age group had the greatest overrepresentation of males (63.0% of frequent users), and was the peak age group for substance abuse related incidents (28.0% of frequent users’ incidents in this age group). Frequent users compared to non-frequent users had lower levels of trauma related incidents (5.1% versus 16.7%) and higher levels of medical incidents (94.8% versus 82.9%). As proportions of EMS incidents among frequent versus non-frequent users, respiratory, mental health, and seizure related incidents were highest in the youngest age groups; and substance abuse related incidents were highest in those middle aged (35–44 years and 45–54 years). Of health problems, behavioral health (mental health or substance use) problems most contributed to frequent EMS use (23.4% of frequent users’ incidents). Across all incidents, 65.8% of frequent users had an indication of behavioral health problems, representing a 6.6-fold higher odds than non-frequent users (22.5%). Frequent compared to non-frequent users also had higher levels of select chronic conditions (diabetes: 39.9% vs. 14.6%, respectively; asthma: 40.9% vs. 13.4%; and HIV: 9.1% vs. 2.4%), with unadjusted odds almost 4 to 7 times higher. Conclusions The study findings revealed the major role of chronic somatic and behavioral health problems in frequent EMS use; and that rates of frequent use were highest among those middle aged, African American, and male. The results suggest the need for coordination of EMS with community-based, integrated medical and behavioral health services to impro...

The role of incarceration and community reentry after incarceration has been studied extensively for individual and community health; however, little attention has been given to the experiences of individuals who provide support to those in reentry. Through a community-academic partnership, seven focus groups were conducted with 39 individuals supporting a family member in reentry in the summer of 2012. The primary objectives of the focus groups were to explore community experiences and perspectives regarding providing support during a family member's reentry from a period of incarceration and any desired support for themselves during this time. Five themes emerged under a metatheme of stress, indicating that family members experience acute stress as a result of family reentry that adds to the chronic stress they already endure. Programs that acknowledge the difficult role of family members as supporters during an individual's reentry and provide support to them are desperately needed.

Objective Opioid (including prescription opiate) abuse and overdose rates in the US have surged in the past decade. The dearth and limitations of opioid abuse and overdose surveillance systems impede the development of interventions to address this epidemic. We explored evidence to support the validity of emergency medical services (EMS) data on naloxone administration as a possible proxy for estimating incidence of opioid overdose. Methods We reviewed data from Baltimore City Fire Department EMS patient records matched with dispatch records over a thirteen month time period (2008-2009), and census 2008 data. We calculated incidence rates and patient demographic and temporal patterns of naloxone administration, and examined patient evaluation data associated with naloxone administration. Results were compared to the demographic distributions of the EMS patient and city population and to prior study findings. Results Of 116,910 EMS incidents during the study period for patients 15 years and older, EMS providers administered naloxone 1,297 times (1.1% of incidents), an average of 100 administrations per month. Overall incidence was 1.87 administrations per 1,000 population per year. Findings indicated naloxone administration peaked in summer months (31% of administrations), weekends (32%), and late afternoon (4-5:00pm [8%]); and there was a trend toward peaking in the first week of the month. The incidence of suspected opioid overdose was highest among males, whites, and those in the 45-54 year age group. Findings on temporal patterns were comparable to findings from prior studies. Demographic patterns of suspected opioid overdose were similar to medical examiner reports of demographic patterns of fatal drug or alcohol related overdoses in Baltimore in 2008-9 (88% of which involved opioids). The findings on patient evaluation data suggest some inconsistencies with previously recommended clinical indications of opioid overdose. Conclusions While our findings suggest limitations of EMS naloxone administration data as a proxy indicator of opioid overdose, the results provide partial support of the data for estimating opioid overdose incidence and suggest ways to improve such data. The study findings have implications for an EMS role in conducting real-time surveillance and treatment and prevention of opioid abuse and overdose.