EMS: Leave Behind Programs
EMS professionals are uniquely positioned to interrupt the cycle of nonfatal-to-fatal opioid overdoses by distributing overdose prevention tools to patients.
What is a leave behind program?
A leave behind program involves public safety personnel distributing naloxone, the opioid overdose reversal medication, and other overdose prevention tools like drug checking technologies to not just an individual who has experienced an opioid overdose but to their family, friends, and roommates as well. Information on peer supports, health care services, treatment providers, and recovery housing is often provided with the naloxone and drug checking technologies.
Naloxone rapidly reverses an opioid overdose by restoring breathing. It is most effective in keeping a person alive if given at the onset of an opioid overdose. That's why it is important people using drugs and their support networks carry naloxone. The naloxone with the person experiencing an opioid overdose or a bystander can be used while first responders are on route to the scene of an opioid overdose.
Drug checking technologies like fentanyl test strips and xylazine test strips prevent overdoses among people who drugs by informing them of what substances are present in their drug supply. It is important these tools are available and accessible to people who use drugs because they empower individuals to take steps to stay safe based on the knowledge of the substances they're using.
Leave behind programs are an evidence-based public health intervention. They complement existing community-based work to prevent and reduce opioid overdoses.
What are the benefits of leave behind programs?
Leave behind programs improve community health outcomes by increasing access to opioid overdose prevention tools and reducing opioid-related deaths.
EMS agencies with a leave behind program report greater support for their services because of the community outreach performed as part of a leave behind program. Trust in EMS services improves when a leave behind program is part of the community's EMS workflows.
Leave behind programs also improve linkages to care in the community for people who use drugs. This can reduce the calls for service related to opioid overdoses.
Leave behind program supplies
Successful leave behind programs are collaborations between local public safety and public health agencies.
EMS agencies are encouraged to collaborate with local public health agencies to establish and sustain leave behind programs.
Many local public health agencies have access to a supply of naloxone and drug checking technologies that can be shared with EMS agencies at no charge.
EMS agencies who need assistance obtaining supplies for a leave behind program can contact the Wisconsin Department of Health Services. Send requests to DHSDCTSNaloxoneDirect@dhs.wisconsin.gov.
Leave behind program training
Training is critical to the success and sustainability of a leave behind program.
There is no required training for EMS agencies to implement a leave behind program.
While a leave behind program can be implemented with minimal training, education on purpose, intent, and the why of the leave behind program increases buy-in and follow through.
Training should include public health concepts, the basics of opioid overdose prevention, and an overview of motivational interviewing techniques. Local public health and/or human services agencies may be able to provide this training to EMS agencies or connect an EMS agency to agencies with the capacity to provide this training.
Leave behind program resources
Use these resources to establish and sustain a leave behind program.
Sample leave behind program standard operating procedure
This language can be used in whole or in part in an EMS agency procedure guide.
Purpose and scope
The purpose of this procedure is to establish guidelines for the distribution of naloxone and other overdose prevention tools to patients who may be susceptible to opioid overdose, or to the family and close contacts who may be able to administer naloxone to those who have overdosed.
The primary concern at any incident is patient care. Only after the patient has been stabilized, transported, or appropriately released, should the leave behind program be discussed with the patient or close contacts.
Procedure
General
Supplies within leave behind program kits should not be used for administration by field staff providers on EMS calls. These kits are designed for distribution to and use by the public.
Naloxone stocked in medication bags on the ambulance or rapid response vehicles should not be distributed to patients or bystanders. Only the leave behind program kits should be distributed.
Leave behind program kit contents
The leave behind program kit should contain the following:
- A box with two doses of intranasal naloxone (3 mg or 4 mg)
- Naloxone administration instructions and information sheet, available from the Wisconsin Department of Health Services
- A barrier device for rescue breathing
- Fentanyl and/or xylazine test strip kits
- Test strip instructions and information sheet, available from the Wisconsin Department of Health Services
- Resource sheet with local access points for assistance obtaining additional overdose prevention supplies, substance use disorder treatment, and recovery supports
Stocking
- Ambulances and rapid response vehicles will carry a minimum of two leave behind program kits.
- Additional kits will be stored in the medication storage locker in the station.
- Crews should follow established protocols for restocking supplies distributed to community members.
Distribution
The leave behind program kit should be given to the patient or close contacts at a scene or left with a patient after transport to a hospital.
- If the patient is not transported, it may be appropriate to discuss the contents of the kit with the patient.
- If the patient is transported, it may be best to discuss the contents of the kit with close contacts and leave it behind with them.
Leave behind program kits may be given to appropriate recipients at scenes even if the original call for service is not an overdose. Personnel should use their discretion and clinical judgement to distribute kits if they feel it is appropriate.
In general, only one kit per call should be distributed. However, if personnel feel leaving more than one kit is beneficial to the recipients, they may do so.
Leave behind program kits should only be distributed as a component of an EMS call. Citizens who inquire about kits should be directed to their appropriate county health and/or human services department.
Education
It is not the responsibility of EMS personnel to teach recipients how to use naloxone or other kit components. They should show the contents of the kit to the recipients. The educational cards within the kit give a quick tutorial on how to use naloxone and the local guide has resources for how to contact local providers for further assistance.
Documentation
If a leave behind program kit is distributed on an EMS call, it should be documented in the patient case notes.
Item that can be ordered for leave behind program kits
Signs of an overdose/how to administer nasal naloxone card, P-03094 (PDF)
Send requests for printed copies of this card to dhsdcts@dhs.wisconsin.gov. The printed copies come in packs of 50. Up to two packs may be ordered at one time.
Materials that can be printed for leave behind program kits
Documents
First Responder Naloxone Leave Behind Toolkit (PDF)
This resource from Kentucky provides an overview of the structure of a leave behind program and protocols for EMS agencies.
Naloxone Leave-Behind Program Guidance for EMS (PDF)
This resource from Washington provides information on how to start an EMS leave behind program.
Engaging Emergency Medical Services in Naloxone Distribution (PDF)
This resource from the Prevention Technology Transfer Center Network provides information on the structure of leave behind programs and how EMS agencies in other states have implemented leave behind programs.
Connecting Communities to Substance Use Services: Practical Approaches for First Responders (PDF)
This resource from the Substance Abuse and Mental Health Services Administration provides information on how EMS agencies can help people experiencing substance use challenges.
Videos
Working with individuals who misuse opioids in a more compassionate way
This video from the Maryland EMS Academy and Pikesville Volunteer Fire Company highlights strategies to work with people who use drugs that promote their health and well-being.
Trauma-informed care
This video from the Maryland EMS Academy and Pikesville Volunteer Fire Company highlights why a patient-centered approach to treatment is important.
Jason Patton on intervening post-overdose
In this video from the National Association of County & City Health Officials, Jason Patton, a Maryland EMS professional explains the unique ability first responders have to intervene post-overdose, and why hope is never out of reach.
Send questions or concerns about EMS leave behind programs to DHSDCTSNaloxoneDirect@dhs.wisconsin.gov.