Another example of the critical role EMS plays in rural communities!
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How Rural Communities Are Using EMS to Help Solve the Opioid Crisis
June 27, 2025
https://www.phi.org/press/calhealth-report-how-rural-communities-are-using-ems-to-help-solve-the-opioid-crisis/
“California is one of just five states in which the rate of death from drug overdoses is higher in rural areas than urban ones, according to data from the Centers for Disease Control and Prevention. The latest data from the California Department of Public Health shows that statewide, more than 7,800 people died from opioid overdoses in 2023, the most recent year statistics are available. While Los Angeles County recorded the highest total number of opioid-related overdose deaths in 2023 at 7,847, when adjusted for population size, Alpine and Sierra counties had the highest rates, though this data is less stable given the counties’ small total population size.
Because rural EMS units often rely on volunteer crews and face geographic barriers that force them to cover large distances in more varied terrain, response times are typically slower, according to the federal Centers for Disease Control and Prevention. In California, urban EMS providers also tend to receive more funding, resulting in a higher quality of care, according to the CDC. But across the state, emergency responders in rural regions are finding solutions tailored to their communities. Driven by a desire to help patients find long-term help for drug use, emergency providers are partnering with local organizations to connect patients with mental health care and treatment programs, as well as equip communities to distribute overdose-reversal medication.
Long-term treatment, from the ambulance
Sometimes, the long-term care that patients need includes mental health treatment; other times, it’s more directly related to substance use. For patients with opioid use disorder, medications, such as methadone and buprenorphine, can be an important tool. These medications, opiates themselves, mimic the effects of opioids to help prevent withdrawal symptoms without giving the patient a sense of “high.” Usually distributed under the care of a physician in a clinic or hospital, some EMS units are finding ways to start that treatment before patients even reach the hospital.
Following an overdose, many patients refuse to be transferred to a hospital, or they leave the hospital before a long-term care plan can be established, according to EMS Bridge, a program within California Bridge to Treatment, which works to use EMS services to advance community health. Either way, surviving an overdose can trigger painful withdrawal symptoms that have historically been difficult for medics to treat. But in the last few years, some EMS units across the state and country have experimented with providing medications that help withdrawal symptoms in the ambulance before patients even reach the hospital.
In 2019, clinicians at Cooper University Health in Camden, New Jersey, began a groundbreaking experiment. They trained paramedics to begin treatment with buprenorphine in the ambulance, a practice that had historically been limited to physicians in a clinic. It was a massive success: patients who were offered methadone or buprenorphine pre-hospital were six times as likely to use it, vastly increasing their chances of long-term treatment. Clinicians in California began wondering if they could bring the same success to their communities.
Beginning with a small pilot project in Contra Costa County in 2020, EMS Bridge, a program of the Public Health Institute’s Bridge Center, began a program to train EMS professionals to administer buprenorphine through funding from CARESTAR. “If you have an overdose and survive it, you have a 10 percent change of dying within a year,” said Dr. Gene Hern, medical director for EMS Bridge and associate clinical professor of emergency medicine at UCSF. But treatment with buprenorphine can lower that mortality rate by 70 percent—a success that Hern said is unparalleled within emergency medicine.
According to the Department of Health Care Services, 1,300 paramedics across 13 California counties have been trained to administer buprenorphine in the ambulance, and with new funding, Stanislaus County will be next. Hern said that adoption in rural California can be limited because patients will need a reliable, accessible place to continue getting medication once transferred. But he sees some strengths in rural areas as well. Longer transport times can mean that medics have more time to connect with their patients, establishing a trusting relationship in which a patient may be more open to starting buprenorphine.
Being able to help patients find long-term care helps medics, too, said Vanessa Lara, EMS Bridge Program Manager. While quantitative data is difficult to collect, she said their surveys indicate that being able to watch a patient transform before their eyes helps medics feel more satisfaction in their work, as does knowing that they helped put them on a path toward long-term healing.”
Click on the link below to read the full article.
How Rural Communities Are Using EMS to Help Solve the Opioid Crisis.pdf
