Administration and Leadership

New Jersey’s EMS Response to the Opioid Epidemic

Similar to many states around the country, New Jersey continues to experience a growing opioid epidemic.Among many professionals battling this epidemic on the frontline are New Jersey’s 32,000 EMS providers. Compounding the problem with illicit opioid use is the high incidence of fentanyl-related overdoses within the state. The opioid epidemic is so severe that, according to New Jersey’s real-time dashboard of opioid-related data, it has already claimed 1,562 lives in the state from January 1 through July 7, placing us on track to exceed previous annual state opioid overdose death statistics.

New Jersey’s EMS Background

New Jersey utilizes a tiered system of response. Emergency calls are screened by the local dispatch center and resources are assigned based on priority. Calls that are deemed non-life threatening are assigned a local basic life support unit (BLS); life threatening calls receive the addition of a regionally based advanced life support Mobile Intensive Care Units (MICU). New Jersey’s EMS force consists of more than 500 BLS agencies and 21 MICU agencies providing 100 regionally based units.

The Problem

With the number of suspected opioid overdoses skyrocketing, State officials recognized the need for some significant changes. Prior to 2014, the use of naloxone for the reversal of suspected opioid overdoses was restricted to MICU Paramedics. With the 2013 signing of the Opioid Overdose Prevention Act, use of naloxone was expanded to both BLS Emergency Medical Technicians as well as law enforcement. With hundreds of licensed and volunteer agencies in New Jersey, the tracking of naloxone usage and its outcomes has proven to be quite a business intelligence undertaking. For BLS agencies, naloxone usage is permitted under specific criteria: the agency must be registered with the New Jersey Department of Health (NJDOH); must have a Medical Director; and must report the use of naloxone to the NJDOH within 24 hours of administration. In January 2018, New Jersey enacted the EMS Data Law (N.J.S.A. 26:2K-66) which mandates all EMS agencies, regardless of licensed or volunteer status, to submit their electronic patient care records (ePCR) in a format compliant with the National Emergency Medical Services Information System (NEMSIS) coding, to the NJDOH.

The year 2014 also saw the evolution of important partnerships. New Jersey State Police’s Drug Monitoring Initiative (DMI) partnered with the NJDOH with the goal of combining data resources to combat the rising overdose problem. Working with the State Attorney General’s office and the NJDOH’s Data Privacy Officer, a Data Use Agreement was created allowing bi-directional data sharing of law enforcement and EMS data. This agreement outlines specific data elements to be shared that provide a clearer understanding of the statewide epidemic while respecting patient privacy and maintaining the minimum data needed to accomplish this goal.

Working Together

Using the ImageTrend™ State Repository, the NJDOH reports daily the total number of EMS naloxone administrations to the DMI who then monitors for trends, identifies hot spots, and transmits alerts based on surge thresholds. Law Enforcement administration are also entering data into the State Repository, which is combined with EMS data to provide a common operating picture. Using ImageTrend™ reporting technology, the NJDOH created a dashboard that displays daily weekly and monthly administrations trending at a glance. The dashboard can be customized by jurisdiction or variable of interest.

The partnership with law enforcement has helped to educate New Jersey EMS to think differently through statewide awareness training through the DMI. EMS providers are taught the importance of recognizing “drug stamp” markings on drug paraphernalia. EMS can report this data to their local law enforcement who shares that data with the DMI. State Police track the stamp information, monitoring geographic trending of the stamps, perform toxicology analysis, and report out weekly to industry stakeholders on various chemical makeups of the trending drugs. For example, if a strain of potent fentanyl-laced heroin is found, the DMI reports that information to its law enforcement and EMS stakeholders to ensure they are aware and prepared to address the drug cocktail, (e.g. may require more than a single naloxone administration).

Public awareness and involvement is also vital. In addition to addiction and recovery resources such as ReachNJ.gov which provides multiple resources for individuals and families suffering from opioid addiction and 211.org, a national “one-stop” source offering assistance various issues, the State Attorney General’s office has developed a public Dashboard called NJCares.org, which contains a wealth of opioid-related information. The NJDOH’s EMS naloxone data is one of the many data sources that is updated monthly and available to the public. The site also includes opioid prescription information collected through the state’s Prescription Drug Monitoring Program and confirmation of opioid-related deaths as determined by county and state medical examiners.

Helping on a Local Level

the NJDOH’s Office of EMS has several new initiatives underway to combat the state’s opioid problem. With 21 counties in New Jersey, emphasis has been placed on getting real-time information to the local and regional level. The NJDOH is implementing an analytics and monitoring module that will “plug” into the existing EMS Data Repository. This tool allows for county public health and law enforcement officials to monitor their own real-time suspected opioid and other drug overdoses, as well as identify surges through “hot spot” geo-mapping. It further provides a critical alert system for the affected county and surrounding counties when potentially lethal overdose surges occur.

Joining Prehospital & Hospital Data

One area of discrepancy identified in opioid monitoring is suspected opioid overdose patients that arrive at the Emergency Department without EMS intervention or contact. To help combat this, the NJDOH has been approached by local healthcare systems looking to report these encounters through the NJDOH’s EMS Data Repository. The result is likely more accurate and complete real-time reporting of suspected opioid overdoses. Such data can be used to direct proper recovery and prevention resources to areas in need.

Recovery

New Jersey’s EMS 32,000 providers encounter overdose victims every single day. These patients often refuse further treatment (after naloxone administration) and decline transport to a medical facility. In the first half of 2018 alone, approximately 11% of suspected opioid overdose patients encountered by EMS refused further treatment or transport to a definitive care facility It is not uncommon for EMS providers to treat the same patient several times in a week or even in the same working day. To break the cycle of repeated overdoses we must incorporate the NJ’s EMS workforce into recovery efforts. The NJDOH is creating recovery resource materials for EMS providers to distribute to overdose patients while still respecting patient privacy. Additionally, due to the sheer volume of frontline overdose treatment occurring, emphasis needs to be placed on addressing pre-hospital and emergency department providers’ compassion fatigue. By offering education to providers on addiction as a treatable and recoverable disease (including specific pathways to help those suffering from substance use disorder) and offering tools to prevent clinician burnout and improve professionalism in the face of adversity, New Jersey’s EMS can become the front-line defense towards successful intervention.

As the opioid epidemic continues to grow in New Jersey and around the country, states need to employ alternative, non-traditional methods for combating the problem. From emergency treatment to recovery and prevention, EMS providers truly make a difference. To increase their capacity and reduce this rising opioid death trend, additional attention and support must be directed to the State’s EMS resources. Often overlooked, EMS is a vital resource in the battle to overcome this deadly plague.

Editor’s note: Timothy Seplaki, EMT-P, is a finalist for a 2018 Hooley Award in the New Frontier category. The Innovation, Service and New Frontier Hooley Awards will be presented at ImageTrend Connect on July 18, 2018.