“We get tunnel vision”: Emergency medical service providers’ views on the opioid epidemic in Baltimore City

Objective: To understand the needs of Emergency Medical Service (EMS) providers caring for substance users in an urban setting. Design: Qualitative interviews with EMS providers regarding perceptions of substance users and treatment programs. Setting: Baltimore City. Participants: Twenty-two Baltimore City Fire Department EMS providers. Interventions: Semistructured in-depth interviews were conducted with 22 EMS providers. Topics included experiences caring for substance-using patients and attitudes about local harm reduction approaches. Main outcome measure: Providers were asked their views on receiving training to deliver a brief motivational intervention to encourage patients to enter drug treatment. Interviews were transcribed and analyzed using constant comparison. Results: Participants were mostly Male (68.2 percent), White (66.6 percent), and had Advanced Life Skills training (90.9 percent). Mean experience was 8.7 years. Many providers described EMS misusers as mostly male and middle-aged, although there were variations in substance use patterns among all races and income levels. Most stated that repeated care provision to a small number of substance-users negatively impacted care quality. Provider demands included departmental policies and resource limitations. Many expressed willingness to deliver motivational messages to substance-using patients to consider drug treatment. Other stated that behavioral interventions were beyond their job duties and most reported having little-to-no knowledge of local treatment programs. Conclusions: EMS providers may be uniquely positioned to deliver substance use treatment messages to substance users. This could be a life- and cost-saving improvement to EMS in Baltimore City with incentivized training. More research is needed to inform opioid use preparedness in urban settings, which remain at the center of the opioid epidemic.