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.
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