EMS Updates: While Overdoses Fall, Opioids Rates Increase
ESO recently released a mid-year update to its extensive nationwide 2019 EMS Index report, adding to the original 7.8 million patient records an additional 3.8 records gathered in the first half of 2019.
While the overall number of overdose encounters continued a downward trend, the number of opioid overdoses actually increased during the same time, a concerning statistic for EMS agencies working diligently to reduce the impact of opioid abuse in the U.S.
Insight Into Industry Trends
The ESO EMS Index, now in its second year, collects and reports national data from the EMS industry; this year the report covered six key metrics:
- Stroke assessment performance
- ETCO2 after advanced airway procedure
- 12-lead performance for adult patients experiencing chest pain
- Aspirin administration for adult patients experiencing chest pain
- Percent of patients suffering from overdose, with an opioid subgroup analysis
- Influenza-like surveillance
The original report was based on 7.58 million patient encounters in 2018 and information from more than 1,2000 agencies, helping EMS agencies not only benchmark their own performance with their peers, but also help set new quality and protocol goals for the upcoming year.
At the end of June 2019, ESO released an update to the Index, adding data from the first half of 2019 which encompassed an additional 3.8 million patient records. While several of the metrics showed continued improvements, one trend unfortunately took a less encouraging turn – namely, the rate of opioid encounters.
Promising Initial Results
The overall overdose metric in the Index looked at the number of patient encounters where an overdose was suspected, compared to the total volume of patient encounters. In 2018, 125,768 patients had a primary impression related to overdose (or 1.65% of all encounters, which was exactly the same as rate as 2017). Men accounted for 58.2% of overdose encounters; women accounted for 41.8%.
Looking at a subgroup of opioid overdose encounters during this same original time, a downward trend seemed to suggest that these opioid overdoses were also decreasing, although the numbers had not yet reached a statistical significance. Interestingly, the collected data also suggested that 94% of opioid overdoses involved illicit drugs, while only 4% involved prescription opioids (2% did not include documentation of substance type).
Initially, this suggested a positive trend. We concluded that some of the opioid overdose decrease was a result of self- or “buddy” treatment, with the availability of widely distributed intranasal naloxone kits, as well as a concerted focus on appropriate prescribing practices. In any case, the data seemed to suggest an encouraging trend that nationwide efforts were gaining ground against the opioid epidemic.
Opioid Trends Change Course
Unfortunately, adding in the metrics from the first half of 2019, the decreasing trend on opioid overdose did not hold true. While the rate of overall overdose encounters continued to decrease another .06%, down to 1.59%, the percentage of opioid-related encounters actually increased over this same time.
Based on this insight, EMS agencies are encouraged to continue identifying and documenting opioid encounters as an essential effort to combat this public health epidemic. Recommended best practices include:
- Monitor incidents in your community and anticipate trends. Look for geographic hotspots in your community (based on data from your ePCR) to create preventative programs in areas with particularly dense activity.
- If your ePCR vendor offers extended data collection for opioid cases, make this a validation rule. More data and information on the incident and situational issues related to overdose events will provide valuable insights.
- Investigate novel approaches to encourage patients who have experienced an overdose to seek rehabilitation.
Next Steps: Best Practices for Documenting the Opioid Crisis
For more information how documentation can help your agency combat the opioid epidemic, download the free guide, Documenting the Opioid Crisis for Actionable Data: 6 Best Practices for First Responders.