Airway & Respiratory, Patient Care

Substance Abuse

Lately, there has been a lot of attention on drug testing in EMS. With a safety-sensitive job like EMS, career and volunteer departments need to ensure for the public that all personnel that provide care on the streets are free from the influence of illegal drugs.

There have been a number of recent cases involving the use of illegal drugs, as well as the misuse of drugs (like morphine) from the service drug supply by EMS personnel. These cases often end with jail time and the loss of a career for the EMS provider. Bad publicity and tainted morale for the entire EMS agency also results.

In 2007, an Indiana paramedic admitted to police that he stole morphine and meperidine (Demerol) and replaced the syringes with other harmless but ineffective liquids. His paramedic certification was suspended and after a plea agreement, he got 15 days in jail.

And the problem isn_t just a field-provider issue. In 2006, a California judge sentenced a former paramedic chief to 16 months in prison for stealing 358 vials of morphine — acts the judge said had endangered the public and violated its trust.

Is the problem increasing and if so, why? A Jan. 28, 2007, special report in the Sacramento Bee noted that the California EMS agency logged more than 65 drug and alcohol cases in 2005Ï2006, up from only eight cases in the prior two years. The article concluded that ˙the heroes we count on to reach the scene first when we_re most vulnerable tend to be the last to seek help for themselves.Ó

One paramedic substance abuser recited a rescue professional’s credo that turns dangerous for those with addictions — and those they rescue: ˙I can fix anything and everyone, including me.Ó Another medic reported he was working 90 hours a week, having marital difficulties and raising a premature baby with health problems while he was abusing chlordiazepoxide (Librium). Alcohol and pills, he said, had become a form of escape.

What_s the cause of this increase? Many factors contribute to the increase in substance abuse among EMS providers, and it_s not easy to point to one single root cause. These factors include: easy access to drug supplies, shortages of EMTs and paramedics (placing greater strain and longer work hours on existing providers), increased call volumes and higher stress levels with less down time as our elderly population explodes, management that_s stretched so thin that there_s less direct supervision, and an overall lack of focus on making good substance abuse prevention programs a high priority.

The federal government expects its contractors and grant recipients to maintain a ˙drug-free workplace.Ó The federal Drug Free Workplace Act of 1988 (DFWA) affects many more EMS agencies today due to the increase in federal grants for homeland security and other special public-safety projects. Many federal contractors and every federal-grant recipient must establish a drug-free workplace, which includes:

  • Publishing a drug-free workplace policy;„
  • Establishing drug-free awareness programs;„
  • Notifying employees that as a condition of employment they must abide by the policy and notify the employer if convicted of a criminal drug violation in the workplace;
  • Notifying the contracting or grant-awarding agency when an employee has been convicted of a criminal drug violation in the workplace;
  • Imposing a penalty or requiring satisfactory participation in a drug-abuse assistance or rehab program for employees convicted of a reportable workplace drug conviction; and
  • Making good faithful, ongoing efforts to maintain a drug-free workplace.„„„„„

EMS agencies have the right to establish drug-testing programs as part of their drug-free workplace initiatives. Drug tests fall into two general categories: random testing and reasonable suspicion testing. There has been much debate over the years as to which type of test is more effective and fair. Good random testing programs are truly random and should include all personnel, not just field providers. Reasonable suspicion testing requires supervisors trained to recognize signs and symptoms of active substance abuse to appropriately select those for drug testing to avoid discriminatory application.

If an employee is selected for a drug test, there_s some expectation of privacy when the sample is collected. But the employer also has the right to monitor the collection to help prevent ˙adulterationÓ of the sample or the replacement of the sample with a false one. (The Internet has numerous sites where products can be found to help employees improperly ˙passÓ a drug test.) Employees often have the right to request a second confirmation test of the sample that was taken to minimize the impact of false tests.

The key to successful drug-testing programs is solid education and treatment. Many active substance abusers can be counseled and rehabilitated — termination need not be the only option. In some states, successful completion of a rehab program may be a condition of keeping your EMS certification. Employers can also offer a ˙last chanceÓ agreement to employees who have an established substance abuse problem. With these agreements, the employer can require you to participate in counseling, rehab and periodic follow-up testing as a condition of continued employment. If you don_t agree to this ˙last chanceÓ or if you fail to live up to the agreement, the employer can usually immediately terminate your employment.

Many labor unions will agree to a program that includes last chance agreements and these terminations usually aren_t ˙grieveableÓ under the normal grievance procedure. Disability discrimination laws may provide some job protection to EMS employees who have a history of substance abuse but aren_t actively using them. Past medically diagnosed substance-abuse problems may also be considered a ˙disabilityÓ under the Americans with Disabilities Act and similar state laws.

Everyone can agree that substance abuse in the EMS workplace cannot be tolerated. It poses a serious threat not only to the safety of the public but also to other coworkers and to the abuser as well. The key to success in preventing it is to first recognize that we_re in a profession that makes us vulnerable — we have to take care of ourselves or we can_t help others who may need us. EMS agencies must establish well-defined organizational prevention programs that everyone understands and couple that with fair and consistent enforcement.