Assessing the Population-level and Equity Impact of the Emergency Medical Services Overdose Prevention Project (EMS-OPP) Using Critical Race Theory

华盛顿州金县的过量公共卫生危机有增无减，2020年有500多人死亡，700人 2021年，利率继续上升，受影响的人之间存在巨大差异。急救医疗系统提供者 (EMS)是第一个到达服药过量现场的人，是照顾吸毒者的关键合作伙伴。 我们与吸毒者、EMS领导层和社区合作伙伴合作，收集试点数据，然后 共同设计EMS提供的干预措施，以减少耻辱并增加对以下患者的护理机会 吸毒。这些干预措施正在作为EMS过量预防项目(EMS-OPP)展开，以及 在减少获得循证医疗服务方面的种族差距方面具有巨大潜力，并改善 长期结果。EMS-OPP包括为所有EMS提供者提供的关于减少耻辱和创伤信息的培训 CARE，EMS纳洛酮留下计划，并温暖地移交给后续团队以连接到CARE。 金县EMS团队将反复采用这些计划，并计划到2020年让90%的团队参与 2026年。虽然这为评估EMS-OPP的有效性提供了一个极好的机会，但目前没有 计划对患者水平、人口水平或公平影响进行调查。因此，我们将利用自然资源 实验条件采用并行三角剖分混合方法设计，考察EMS对实验结果的影响。 关于健康结果中的种族差异的OPP。具体地说，在公共卫生关键竞赛实践的指导下，我们将 与吸毒者和西雅图及金县公共卫生机构合作：1)评估EMS的效果- 关于患者层面体验中的种族差异(例如，EMS互动中的歧视)和结果的OPP (例如，与丁丙诺啡治疗的联系)(目标1)；2)从Black的角度进一步评估EMS-OPP， 使用深入访谈的西班牙裔/拉丁裔和美国印第安人/阿拉斯加原住民非致命过量幸存者(AIM 2)；和3)审查EMS-OPP对人口一级结果中的种族差异的影响(例如， 与后续护理的联系)(目标3)。AIMS 1涉及创建一组非致命性过量用药幸存者 与最近的EMS交互，链接多个数据系统。目标2采用定性研究设计，涉及半 对来自AIM 1的黑人、西班牙裔/拉丁裔和美国印第安人/阿拉斯加原住民幸存者进行了结构化采访。 3使用来自EMS记录管理系统的数据，采用中断时间序列设计进行比较 接受EMS-OPP培训的团队与未接受EMS-OPP培训的患者之间过量用药结果的差异。为回应这一事件 不断升级的过量用药危机和结果的种族差异，州政府扩大了对EMS的资助， 培训和执业范围。我们建议的研究利用阿片类药物危机的这一关键时刻来评估 具有现实世界复杂性的结构性社区一级干预对人口水平和公平的影响 这具有扩散和扩大的潜力。调查结果将在社区场所(如海报、社区)中共享 Zine)、政策简报、会议演示文稿和学术期刊文章。 1

The public health crisis of overdose continues unabated in King County, WA, with over 500 deaths in 2020, 700 in 2021, and rates continuing to rise with vast disparities in those affected. Emergency Medical System providers (EMS) are first to arrive at the scene of an overdose and are critical partners in care for people who use drugs. We partnered with people who use drugs, EMS leadership, and community partners to collect pilot data and then co-design EMS-delivered interventions tailored to reduce stigma and increase access to care for people who use drugs. These interventions are being rolled out as the EMS Overdose Prevention Project (EMS-OPP), and hold great potential to reduce racial disparities in access to evidence-based medical services and to improve long-term outcomes. EMS-OPP includes training for all EMS providers on stigma reduction and trauma-informed care, an EMS naloxone leave-behind program, and warm hand-off to a follow-up team for connecting to care. King County EMS teams will adopt these programs iteratively, and plan to have 90% of teams participating by 2026. Although this provides an excellent opportunity to assess the effectiveness of EMS-OPP, currently no investigation of patient-level, population-level, or equity impacts is planned. Thus, we will capitalize on the natural experimental conditions using a concurrent triangulation mixed methods design to examine the impact of EMS- OPP on racial disparities in health outcomes. Specifically, guided by Public Health Critical Race Praxis, we will partner with people who use drugs and Public Health Seattle & King County to: 1) evaluate the effect of EMS- OPP on racial disparities in patient-level experiences (e.g., discrimination in EMS interactions) and outcomes (e.g., linkage to buprenorphine treatment) (Aim 1); 2) further evaluate EMS-OPP from the perspectives of Black, Hispanic/Latinx, and American Indian/Alaska Native non-fatal overdose survivors using in-depth interviews (Aim 2); and 3) examine the impact of the EMS-OPP on racial disparities in population-level outcomes (e.g., connections to follow-up care) (Aim 3). Aims 1 involves the creation of a cohort of non-fatal overdose survivors with recent EMS interactions, linking multiple data systems. Aim 2 uses a qualitative study design involving semi- structured interviews with Black, Hispanic/Latinx, and American Indian/Alaska Native survivors from Aim 1. Aim 3 uses data from the EMS Records Management System data using an interrupted time series design comparing disparities in overdose outcomes for patients treated EMS-OPP-trained teams vs. not. In response to the escalating overdose crisis, and racial disparities in outcomes, state governments have expanded EMS funding, training, and scope of practice. Our proposed study capitalizes on this key moment in the opioid crisis to assess the population-level and equity impact of a structural community-level intervention with real-world complexities that has the potential for spread and scale. Findings will be shared in community venues (e.g. posters, community zine), policy briefs, conference presentations, and academic journal articles. 1