We do. Calling 9-1-1 is the best way to call for help in case of an emergency. We see this program as a “both/and” solution: “Call 9-1-1 and dispatch community responders.” There simply aren’t enough ambulances, fire engines and police cruisers to respond to every single overdose quick enough to reduce fatal opioid overdoses to 0 – which is our end goal. Some other considerations:

• Frequency and rates of overdoses have increased dramatically since 2000, taxing many local emergency response systems to breaking point. We believe that community responders can work in parallel with formal 9-1-1 responders.

• In many rural communities, response times for formal 9-1-1 responders are too long. Using community responders helps reduce response times dramatically.
• New forms of overdose-reversing medication make it easier for non-medical professionals to effectively learn how to administer a life-saving dose in time to save a life.
• In some communities, witnesses to overdoses are reluctant to call 9-1-1 for fear of legal repercussions or their own safety. Knowing that community responders with “lived” and “learned” experience with substance use disorder would also be responding could help to mitigate those fears.

Hopefully this is never the situation. If it is, we still propose that it should be a “both/and” proposition and not “either/or”. If the situation is such that 9-1-1 isn’t available quick enough, additional contact points for finding community responders with overdose-reversing medication will increase the likelihood of overdoses being reported while filling in the gaps among belabored emergency services.

Because we see these community-based networks as a “both/and” solution, if community responders don’t show up, it’s ok because a 9-1-1 response has already been activated. Nonetheless, getting community responders to show up when they’re alerted is crucial, and it’s also a challenge that volunteer emergency services across the U.S. solve every day. The solution comes down to strong leadership, having sufficient responders in a specific area, and aligned incentives. Sufficient numbers can be recruited and retained with a good strategy:

• Recruit the right people – Ensure that potential responders are comfortable with a closeup look at opioid abuse and are properly trained in response protocols, such as administering overdose-reversing medication
• Dispatch multiple responders – Create schedules for potential responders so two or more may be dispatched to a single incident
• Offer incentives – Reward emergency responders and volunteers for their participation, keeping them active and evangelizing the strengths of the program

Overdose-reversing medication is preferably administered by or with a medical professional, but this is not always possible nor is it even necessary.

• Many areas with high substance use do not have enough medical professionals to respond in time to save lives.
• Research has found minimal risks associated with treatment followed by release.[1],[2]
• Non-medical professionals can be trained to recognize factors besides overdose at an incident, prompting calls to 9-1-1 or medical professionals.

[1] Rudolph SS, Jehu G, Nielsen SL, Nielsen K, Siersma V, Rasmussen LS. Prehospital treatment of overdose in Copenhagen: Is it safe to discharge on-scene? Resuscitation. 2011;82(11):1414–8. [2] Wampler DA, Molina DK, McManus J, Laws P, Manifold CA. No Deaths Associated with Patient Refusal of Transport After … . Prehosp Emerg Care. 2011;15(3):320–4.

The reality is that it’s impossible to completely guarantee 100% safety for responders, whether they’re professional emergency crews or community members. But we also think the safety concerns should be evaluate more by probability than possibility. Read this blog post to learn more.