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Training for First Responders Increases Intention to Refer Overdose Survivors to Life-Saving Treatment and Harm Reduction Services

February 2, 2024
Meg Brunner
Siddiqui ST, et al. An evaluation of first responders’ intention to refer to post-overdose services following SHIELD training. Harm Reduction Journal 2024;21:39. Free online at PubMed Central
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What’s the Question?

Fire/Emergency Medical Services (EMS) personnel and Law Enforcement Officers (LEOs) are often the first professionals onsite for overdoses, giving them a unique opportunity to connect with overdose survivors at a critical time. Speaking to survivors in the moment, providing information about available health and social services, and referring them to services for drug treatment, recovery support, and housing can be a life-saving act for the survivors – and can have a positive impact on first responders’ wellbeing as well.

However, many LEO and Fire/EMS personnel are reluctant to issue referrals. They may perceive this as burdensome, not worthwhile, or not part of their job responsibilities, or they may have stigmatizing beliefs about people who use drugs (PWUD) and/or the interventions designed to help them. Additionally, they may not be aware of available referral resources in the first place.

The Safety and Health Integration in the Enforcement of Laws on Drugs (SHIELD) model seeks to address this by training first responders in public health strategies for working with PWUD and demonstrating how reducing overdoses can help mitigate their own stress and burnout.

But does this model actually work? And is there any difference in outcomes between LEO and Fire/EMS personnel who receive SHIELD training?

How Was This Study Conducted?

This SAMHSA-funded project provided SHIELD training to 1731 LEO and Fire/EMS personnel in Missouri between 2020 and 2023. Study participants (n=1223) completed online surveys before and after the training, including questions about demographics and historical experience with overdose and substance use related calls, and items quantifying their intention to refer overdose survivors to various services (scored on a scale of 1 (never) to 5 (all the time)).

What Did Researchers Find Out?

Completing the SHIELD training was associated with significantly higher intention to refer scores, with higher mean scores for referrals to drug treatment, syringe service, naloxone distribution, social supports like housing and employment, and care coordination programs after the training.

The difference of pre- and post-test scores were not large for drug treatment referral for either type of first responder, as their pre-training scores were already high for this type of referral.

The largest effects, across both types of trainees, were for referrals for syringe service programs, naloxone distribution, and care coordination. The fact LEOs reported high intention to refer survivors to syringe services after the training was especially interesting, as such programs are currently illegal in Missouri. The researchers suggest this may partly be the result of the training’s education on the positive impacts of harm reduction services; LEOs in particular might be willing to accept that harm reduction is in the interest of both public health and safety and their own personal wellness, as having to respond to multiple overdoses by the same person can wear down first responder morale and lead to burnout.

For Fire/EMS trainees, intention to refer overdose survivors for care coordination was significantly improved by the training. Fire/EMS trainees had consistently lower pre-training scores than LEOs, but higher post-training scores, possibly because law enforcement officers in Missouri have access to a behavioral health program designed specifically for police who respond to overdoses, and no such resource existed at the time for Fire/EMS. This suggests that Fire/EMS’s lower pre-test scores didn’t reflect an unwillingness to refer, but instead a lack of knowledge of available services, something remedied by the SHIELD training.

What Are the Implications for the Workforce?

Longer-term support and care for overdose survivors is crucial to the prevention of repeat overdose events. First responders can play a vital role in this, as they have a unique opportunity to speak with survivors at a critical time – immediately post-overdose. Locally-tailored training appears to be highly effective at giving first responders the knowledge and resources they need to confidently carry out referrals to treatment and harm reduction programs, something that has clear benefits to both overdose survivors and the first responders themselves.