Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-19T17:57:57.223Z Has data issue: false hasContentIssue false
  • English
  • Français

Challenges and Opportunities to Engaging Emergency Medical Service Providers in Substance Use Research: A Qualitative Study

Published online by Cambridge University Press:  26 January 2017

Allysha C. Maragh-Bass ,
Julie C. Fields ,
Junette McWilliams  and
Amy R. Knowlton
Allysha C. Maragh-Bass*
Affiliation:
Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Schools of Medicine and Public Health, Boston, Massachusetts USA
Julie C. Fields
Affiliation:
Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, Maryland USA
Junette McWilliams
Affiliation:
Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, Maryland USA
Amy R. Knowlton
Affiliation:
Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, Maryland USA
*
Correspondence: Allysha Maragh-Bass, PhD, MPH The Lighthouse Studies at Peer Point Department of Health, Behavior, Society Johns Hopkins Bloomberg School of Public Health 2213 McElderry Street, 2nd floor Baltimore, Maryland 21205 USA E-mail: arobin52@jhu.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Research suggests Emergency Medical Services (EMS) over-use in urban cities is partly due to substance users with limited access to medical/social services. Recent efforts to deliver brief, motivational messages to encourage these individuals to enter treatment have not considered EMS providers.

Problem

Little research has been done with EMS providers who serve substance-using patients. The EMS providers were interviewed about participating in a pilot program where they would be trained to screen their patients for substance abuse and encourage them to enter drug treatment.

Methods

Qualitative interviews were conducted with Baltimore City Fire Department (BCFD; Baltimore, Maryland USA) EMS providers (N=22). Topics included EMS misuse, work demands, and views on participating in the pilot program. Interviews were transcribed and analyzed using grounded theory and constant-comparison.

Results

Participants were mostly white (68.1%); male (68.2%); with Advanced Life Skills training (90.9%). Mean age was 37.5 years. Providers described the “frequent flyer problem” (eg, EMS over-use by a few repeat non-emergent cases). Providers expressed disappointment with local health delivery due to resource limitations and being excluded from decision making within their administration, leading to reduced team morale and burnout. Nonetheless, providers acknowledged they are well-positioned to intervene with substance-using patients because they are in direct contact and have built rapport with them. They noted patients might be most receptive to motivational messages immediately after overdose revival, which several called “hitting their bottom.” Several stated that involvement with the proposed study would be facilitated by direct incorporation into EMS providers’ current workflow. Many recommended that research team members accompany EMS providers while on-call to observe their day-to-day work. Barriers identified by the providers included time constraints to intervene, limited knowledge of substance abuse treatment modalities, and fearing negative repercussions from supervisors and/or patients. Despite reservations, several EMS providers expressed inclination to deliver brief motivational messages to encourage substance-using patients to consider treatment, given adequate training and skill-building.

Conclusions

Emergency Medical Service providers may have many demands, including difficult case time/resource limitations. Even so, participants recognized their unique position as first responders to deliver motivational, harm-reduction messages to substance-using patients during transport. With incentivized training, implementing this program could be life- and cost-saving, improving emergency and behavioral health services. Findings will inform future efforts to connect substance users with drug treatment, potentially reducing EMS over-use in Baltimore.

Maragh-Bass AC , Fields JC , McWilliams J , Knowlton AR . Challenges and Opportunities to Engaging Emergency Medical Service Providers in Substance Use Research: A Qualitative Study. Prehosp Disaster Med. 2017;32(2):148–155.

Keywords

Emergency Medical Serviceshealth care utilizationminority healthsocio-economic statussubstance useurban health
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 32 , Issue 2 , April 2017 , pp. 148 - 155
Copyright
© World Association for Disaster and Emergency Medicine 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Conflicts of interest/funding: This study was supported by grants from the National Institutes of Health (Bethesda, Maryland USA; R01 DA019413 and R34 DA034314). This research also was supported by the Johns Hopkins Center for AIDS Research (Baltimore, Maryland USA; 1P30AI094189). The authors declare no conflicts of interest.

References

1. Lowthian, JA, Cameron, PA, Stoelwinder, JU, et al. Increasing utilization of emergency ambulances. Aust Health Rev. 2011;35(1):63-69.Google Scholar
2. National Academy of Medicine (NAM). Emergency Medical Services: At the Crossroads. Washington, DC USA: The National Academies Press; 2007.Google Scholar
3. Richard, ME, Hubble, MW, Zwehl-Burke, S. “Inappropriate” pediatric Emergency Medical Services utilization redefined. Pediatr Emerg Care. 2011;27(6):514-518.Google Scholar
4. Weber, EJ, Showstack, JA, Hunt, KA, et al. Are the uninsured responsible for the increase in emergency department visits in the United States? Ann Emerg Med. 2008;52(2):108-115.Google Scholar
5. Weaver, MD, Moore, CG, Petterson, PD, Yealy, DM. Medical necessity in Emergency Medical Services transports. Am J Med Qual. 2012;27(3):250-255.Google Scholar
6. Tang, N, Stein, J, Hsia, RY, Maselli, JH, Gonzales, R. Trends and characteristics of US emergency department visits, 1997–2007. JAMA. 2010;304(6):664-670.Google Scholar
7. Camasso-Richardson, K, Wilde, JA, Petrack, EM. Medically unnecessary pediatric ambulance transports: a medical taxi service? Acad Emerg Med. 1997;4(12):1137-1141.Google Scholar
8. Cone, DC, Schmidt, TA, Mann, NC, Brown, L. Developing research criteria to define medical necessity in Emergency Medical Services. Prehosp Emerg Care. 2004;8(2):116-125.Google ScholarPubMed
9. Cone, DC, Benson, R, Schmidt, TA, Mann, NC. Field triage systems: methodologies from the literature. Prehosp Emerg Care. 2004;8(2):130-137.Google Scholar
10. Brown, LH, Hubble, MW, Cone, DC, et al. Paramedic determinations of medical necessity: a meta-analysis. Prehosp Emerg Care. 2009;13(4):516-527.CrossRefGoogle ScholarPubMed
11. Leonard, JC, Scharff, DP, Koors, V, et al. A qualitative assessment of factors that influence Emergency Medical Services partnerships in prehospital research. Acad Emerg Med. 2012;19(2):161-173.CrossRefGoogle ScholarPubMed
12. Kost, S, Arruda, J. Appropriateness of ambulance transportation to a suburban pediatric emergency department. Prehosp Emerg Care. 1999;3(3):187-190.Google Scholar
13. Rosenberg, N, Knazik, S, Cohen, S, et al. Use of Emergency Medical Service transport system in medical patients up to 36 months of age. Pediatr Emerg Care. 1998;14(3):191-193.Google Scholar
14. Substance Abuse and Mental Health Services Administration SAMHSA, Office of Applied Studies. Results from the 2008 National Survey on Drug Use and Health: National Findings. Rockville, Maryland USA: NSDUH Series H-36, HHS Publication No. SMA 09-4434; 2009.Google Scholar
15. Brady, WJ Jr, Hennes, H, Wolf, A, et al. Pattern of Basic Life Support ambulance use in an urban pediatric population. Am J Emerg Med. 1996;14(3):250-253.CrossRefGoogle Scholar
16. Pines, JM, Mullins, PM, Cooper, JK, Feng, LB, Roth, KE. National trends in emergency department use, care patterns, and quality of care of older adults in the United States. J Amer Geriatr Soc. 2013;61(1):12-17.Google Scholar
17. Bender, DS, Skodol, AE, Pagano, ME, et al. Brief reports: prospective assessment of treatment use by patients with personality disorders. Psychiatr Serv. 2006;57(2):254-257.Google Scholar
18. Davydow, DS, Hough, CL, Zatzick, D, Katon, WJ. Psychiatric symptoms and acute care service utilization over the course of the year following medical-surgical ICU admission: a longitudinal investigation. Crit Care Med. 2014;42(12):2473-2481.Google Scholar
19. Rees, N, Rapport, F, Snooks, H. Perceptions of paramedics and emergency staff about the care they provide to people who self-harm: constructivist meta-synthesis of the qualitative literature. J Psychosom Res. 2015;78(6):529-535.Google Scholar
20. Ondler, C, Hedge, GG, Carlson, JN. Resource utilization and health care charges associated with the most frequent ED users. Am J Emerg Med. 2014;32(10):1215-1219.Google Scholar
21. Lee, MH, Schuur, JS, Zink, BJ. Owning the cost of emergency medicine: beyond 2%. Ann Emerg Med. 2013;62(5):498-505.Google Scholar
22. Durant, E, Fahimi, J. Factors associated with ambulance use among patients with low-acuity conditions. Prehosp Emerg Care. 2012;16(3):329-337.Google Scholar
23. Squire, BT, Tamayo, A, Tamayo-Sarver, JH. At-risk populations and the critically ill rely disproportionately on ambulance transport to emergency departments. Ann Emerg Med. 2010;56(4):341-347.Google Scholar
24. Blank, FS, Li, H, Henneman, PL, et al. A descriptive study of heavy emergency department users at an academic emergency department reveals heavy ED users have better access to care than average users. J Emerg Nurs. 2005;31(2):139-144.Google Scholar
25. Oates, G, Tadros, A, Davis, SM. A comparison of national emergency department use by homeless versus non-homeless people in the United States. J Health Care Poor Underserved. 2009;20(3):840-845.Google Scholar
26. Xu, KT, Nelson, BK, Berk, S. The changing profile of patients who used emergency department services in the United States: 1996 to 2005. Ann Emerg Med. 2009;54(6):805-810.Google Scholar
27. Knowlton, AR, Weir, BW, Hughes, BS, et al. Patient demographic and health factors associated with frequent use of Emergency Medical Services in a Midsized City. Acad Emerg Med. 2013;20(11):1101-1111.Google Scholar
28. O’Toole, TP, Pollini, R, Gray, P, Jones, T, Bigelow, G, Ford, DE. Factors identifying high-frequency and low-frequency health service utilization among substance-using adults. J Subst Abuse Treat. 2007;33(1):51-59.Google Scholar
29. Knowlton, A, Weir, BW, Hazzard, F, et al. EMS runs for suspected opioid overdose: implications for surveillance and prevention. Prehosp Emerg Care. 2013;17(3):317-329.Google Scholar
30. Rinke, ML, Dietrich, E, Kodeck, T, Westcoat, K. Operation care: a pilot case management intervention for frequent emergency medical system users. Am J Emerg Med. 2012;30(2):352-357.Google Scholar
31. Mandelberg, JH, Kuhn, RE, Kohn, MA. Epidemiologic analysis of an urban, public emergency department’s frequent users. Acad Emerg Med. 2000;7(6):637-646.Google Scholar
32. Billings, J, Raven, MC. Dispelling an urban legend: frequent emergency department users have substantial burden of disease. Health Aff. 2013;32(12):2099-2108.Google Scholar
33. Szekendi, MK, Williams, MV, Carrier, D, Hensley, L, Thomas, S, Cerese, J. The characteristics of patients frequently admitted to academic medical centers in the United States. J Hosp Med. 2015;10(9):563-568.Google Scholar
34. DiPietro, BY, Kindermann, D, Schenkel, SM. Ill, itinerant, and insured: the top 20 users of emergency departments in Baltimore city. Sci World J. 2012;2012:726568.Google Scholar
35. Pines, JM, Asplin, BR, Kaji, AH, et al. Frequent users of emergency department services: gaps in knowledge and a proposed research agenda. Acad Emerg Med. 2011;18(6):e64-e69.CrossRefGoogle Scholar
36. LaCalle, E, Rabin, E. Frequent users of emergency departments: the myths, the data, and the policy implications. Ann Emerg Med. 2010;56(1):42-48.Google Scholar
37. Schnall, R, Clark, S, Olender, S, Sperling, JD. Providers’ perception of the factors influencing the implementation of the New York State mandatory HIV testing law in two urban academic emergency departments. Acad Emerg Med. 2013;20:279-286.Google Scholar
38. Mahabee-Gittens, EM, Dixon, CA, Vaughn, LM, Duma, EM, Gordon, JS. Parental tobacco screening and counseling in the pediatric emergency department: practitioners’ attitudes, perceived barriers, and suggestions for implementation and maintenance. J Emerg Nurs. 2014;40(4):336-345.Google Scholar
39. Schmidt, TA, Nelson, M, Daya, M, Delorio, NM, Griffiths, D, Rosteck, P. Emergency Medical Service providers’ attitudes and experiences regarding enrolling patients in clinical research trials. Prehosp Emerg Care. 2009;13(2):160-168.CrossRefGoogle ScholarPubMed
40. Sayre, MR, Gausche-Hill, M. Conducting randomized trials in the prehospital setting. Prehosp Emerg Care. 2002;6(S2):S38-S47.Google Scholar
41. Lerner, EB, Weik, T, Edgerton, EA. Research in prehospital care: overcoming the barriers to success. Prehosp Emerg Care. 2015;20(4):448-453.Google Scholar
42. Brice, JH, Garrison, HG, Evans, AT. Study design and outcomes in out-of-hospital emergency medicine research: a ten-year analysis. Prehosp Emerg Care. 2000;4(2):144-150.Google Scholar
43. Lerner, Mosesso Jr. V, Zak, C. Implementation of research in the out-of-hospital setting. Prehosp Emerg Care. 2002;6(S2):S24-S27.Google Scholar
44. Williams, B, Perillo, S, Brown, T. What are the factors of organizational culture in health care settings that act as barriers to the implementation of evidence-based practice? A scoping review. Nurs Educ Today. 2015;35(2):e34-e41.CrossRefGoogle Scholar
45. Callaham, M. Quantifying the scanty science of prehospital emergency care. Ann Emerg Med. 1997;30(6):785-790.Google Scholar
46. Baltimore Substance Abuse Systems. Outlook and Outcomes FY 2011. http://www.bhsbaltimore.org/site/wp-content/uploads/2012/06/BSAS-Outlook-and-Outcomes-FY2011-07-16-2012-revision2.pdf. 2012. Accessed July 11, 2015.Google Scholar
47. Drug Strategies. Smart Steps: Treating Baltimore’s Drug Problem. Drug Strategies: Washington, DC. 2000. http://www.drugstrategies.com/pdf/baltimore.pdf. Accessed July 12, 2015.Google Scholar
48. Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network: Area Profiles of Drug-Related Mortality. Rockville, Maryland USA: SAMHSA; 2008.Google Scholar
49. Cheal, NE, McKnight-Eily, L, Weber, MK. Alcohol screening and brief intervention: a clinical solution to a vital public health issue. Am Nurse Today. 2014;9(9):34-35.Google Scholar
50. Cunningham, RM, Bernstein, SL, Walton, M, et al. Alcohol, tobacco, and other drugs: future directions for screening and intervention in the emergency department. Acad Emerg Med. 2009;16(11):1078-1088.Google Scholar
51. Madras, BK, Compton, WM, Avula, D, Stegbauer, T, Stein, JB, Clark, HW. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later. Drug Alcohol Depend. 2009;99(1-3):280-295.CrossRefGoogle ScholarPubMed
52. Krupski, A, Sears, JM, Joesch, JM, et al. Impact of brief interventions and brief treatment on admissions to chemical dependency treatment. Drug Alcohol Depend. 2010;110(1-2):126-136.Google Scholar
53. Heather, N. Can screening and brief intervention lead to population-level reductions in alcohol-related harm? Addict Sci Clin Pract. 2012;28(7):15.Google Scholar
54. Baltimore City Fire Department. Fire/BCFD Leadership Team. http://fire.baltimorecity.gov. Accessed June 1, 2016.Google Scholar
55. Creswell, JW. Qualitative Inquiry and Research Design: Choosing Among Five Traditions. London, United Kingdom: Sage Publications; 2007.Google Scholar
56. Bigham, BL, Aufderheide, TP, Davis, DP, et al. Knowledge translation in Emergency Medical Services: a qualitative survey of barriers to guideline implementation. Resuscitation. 2010;81(7):836-840.Google Scholar
57. Sasson, C, Forman, J, Krass, D, et al. A qualitative study to understand barriers to implementation of national guidelines for prehospital termination of unsuccessful resuscitation efforts. Prehosp Emerg Care. 2010;14(2):250-258.Google Scholar
58. Glaser, BG, Strauss, AL. The Discovery of Grounded Theory: Strategies for Qualitative Research. New York, USA: Aldine De Gruyter; 1967.Google Scholar
59. Cydulka, RK, Emerman, CL, Shade, B, et al. Stress levels in EMS personnel: a national survey. Prehosp Disaster Med. 1997;12(2):136-140.Google Scholar
60. Patterson, PD, Probst, JC, Leith, KH, et al. Recruitment and retention of emergency medical technicians: a qualitative study. J Allied Health. 2005;34(3):153-162.Google Scholar
61. Maryland Institute for Emergency Medical Services Systems. Maryland EMS Work Force Report. https://www.miemss.org/home/Portals/0/Docs/OtherPDFs/EMS_Work_Force_Report.pdf?ver=2007-10-15-135038-000. Accessed July 11, 2015.Google Scholar
Supplementary material: File

Maragh-Bass supplementary material

Maragh-Bass supplementary material 1

Download Maragh-Bass supplementary material(File)
File 22.9 KB