Pinnacle: Telehealth and Addiction Care in EMS

Speaker Spotlight: Jessica Banks, EMT-P, RN and Lauren Young, LCSW

What is your agency doing to address substance use disorder in your community? If you need inspiration, look to the Palm Beach County Fire Rescue (Fla.) MIH program. In the “Behavioral Health Power Seminar” at the Pinnacle EMS conference in Orlando, Fla., Jessica Banks, EMT-P, RN and Lauren Young, LCSW presented “Telehealth and Addiction in EMS.”

When it comes to treating patients dealing with substance use disorder or alcoholism crises, EMS personnel are in a ripe position to establish a trusting relationship with them. In addition to being generally well-trusted by the public, in the healthcare continuum, “EMS is the first point of access whether we like it or not,” said Young. “We can make a big difference in our community.”

They discussed the MIH program’s multidisciplinary approach to care, involving the management of high frequency 9-1-1 utilizers, chronic disease management, addiction, pregnancy outreach, crew referrals and fall intervention. This may sound labor-intensive or unfeasible if your department lacks adequate funding or resources, but Young assured the audience that you can start with the bare bones.

“Grassroots efforts can make a huge difference, no matter what your resources are,” she said. You don’t need to apply for grants or conduct an in-depth study to get the ball rolling. PBCFR began their outreach with two small actions: making phone calls and knocking on the doors of super utilizers of 9-1-1.

In the beginning of the program, Young, one of the social workers who spearheaded the initiative, sat down with PBCFR medics and took turns making calls to fine-tune the scripts and develop an effective system of care for the patients. The phone calls are simple but require supportive language and are made within 72 hours of contact with emergency services: When calling a patient, introduce yourself, tell them your crew was on scene with them, and ask how they are doing. You might be surprised at how receptive they are to a clinician lending an ear without judgment of their circumstances or wanting anything in return.

The PBCFR Addiction Program saw massive changes in their community. In the 2017 pilot program, data indicated that EMS use by patients struggling with addiction reduced by 48% after accepting intervention resources. That number dropped to 45% in 2018, but of all the patients PBCFR has reached out to in the past 18 months, 70-78% of patients have accepted intervention resources. EMS crews also stocked vehicles with Narcan Leave Behind kits containing Narcan, support resources, and addiction care information. These were left with patients who overdosed and were also utilized during MIH home visits to provide education on Narcan and administration instructions.

Young believes we should change our language in this space. Instead of using “behavioral health disorder,” she uses “neurobiological disorder” to reflect the fact that people who are struggling with issues related to mental health and addiction aren’t consciously making poor decisions—they're battling a legitimate medical condition. Producing real results in an MIH program requires a genuinely caring approach on the medics’ parts. Compassion fatigue, of course, is a prevalent issue in EMS, especially if your agency serves a population saddled with substance abuse issues. Administering naloxone to the same patients repeatedly can be tiring, but if your attitude bars you from taking the time to understand addiction and have compassion for patients struggling with it, then maybe EMS isn’t the right place for you.

“Why are you working in EMS if you don’t care? This is a medical problem,” said Young. “We’re in the business of saving lives. That is our job—to help people who are at risk.”

If your agency is interested in implementing an MIH program, Young and Banks offer several recommendations. Getting the buy-in from your local government, administration and union will bolster support resources, and search for funding options through state or local grants. Partnering with behavioral health programs and ethical treatment providers gives patients options for treatment. Involve social workers and mental health and addiction professionals to provide supplemental care and oversee the program’s development. You can even consider on-scene telehealth assessments and investigate whether your agency can receive reimbursement through the new ET3 model (social workers are considered qualified healthcare professionals under ET3).