title: Challenges and Opportunities to Engaging Emergency Medical Service Providers in Substance Use Research: A Qualitative Study.
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.
authors.affiliation: 1Center for Surgery and Public Health,Brigham and Women's Hospital,Harvard Schools of Medicine and Public Health,Boston,MassachusettsUSA.
authors.forename: Allysha C
authors.initials: AC
authors.lastname: Maragh-Bass
authors.affiliation: 2Johns Hopkins Bloomberg School of Public Health,Department of Health,Behavior and Society,Baltimore,MarylandUSA.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Fields
authors.affiliation: 2Johns Hopkins Bloomberg School of Public Health,Department of Health,Behavior and Society,Baltimore,MarylandUSA.
authors.forename: Junette
authors.initials: J
authors.lastname: McWilliams
authors.affiliation: 2Johns Hopkins Bloomberg School of Public Health,Department of Health,Behavior and Society,Baltimore,MarylandUSA.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Knowlton
mesh_terms: D000328:Adult; D062787:Drug Overdose / Q000517:prevention & control*; D004634:Emergency Medical Technicians; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009270:Naloxone / Q000008:administration & dosage*; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D010865:Pilot Projects; D012107:Research Design; D015819:Substance Abuse, Intravenous / Q000517:prevention & control*
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone
keywords:  ALS Advanced Life Support;  BCFD Baltimore City Fire Department;  BLS Basic Life Support;  ED emergency department;  EMS Emergency Medical Services;  JHSPH Johns Hopkins Bloomberg School of Public Health;  NAM National Academy of Medicine; Emergency Medical Services; health care utilization; minority health; socio-economic status; substance use; urban health