AR2 Opioid Unit Policy: Response & Responsibility

Alternative Response Unit 2 (AR2) Opioid Unit Policy

• The Philadelphia Fire Department is developing Alternative Response Units (ARU) to address specific incident types
• ARUs aim to provide specific care to the community, reducing unnecessary ambulance transports
• ARUs involve collaborations between the Philadelphia Fire Department, healthcare organizations, and social service agencies
• Each ARU has a defined policy and staff, detailed in an appendix
• The Philadelphia Fire Department, DBHiDS, and PDPH collaborated to establish AR2
• AR2 is located at the Fire Headquarters with secured supplies
• AR2's mission focuses on combating the opioid epidemic in Philadelphia
• AR2 serves a designated catchment area, including Engine 7, Engine 25, Engine 28, and Ladder 16's response areas

Responsibility

• Each member must use appropriate control based on their rank when implementing this procedure

EMS Administrative Chief

• The EMS Administrative Chief oversees the EMS CRR Office and reports to the Assistant Deputy Commissioner of EMS

EMS CRR Unit Head

• The EMS CRR Unit Head provides direct administrative and operational supervision for all ARUs and their members
• The EMS CRR Unit Head reports directly to the EMS Administrative Chief
• They will also perform administrative duties (roll calls, overtime, MXTs, AOR, etc.) for assigned EMS CRR personnel

ARU Fire Paramedic Lieutenant (FPL)

• The FPL leads the ARU, responsible for all administrative duties and medical oversight during operational hours
• The FPL reports to the EMS CRR Unit head for administrative and operational needs
• The FPL ensures the safe operation of the ARU vehicle, following the Safe Operation of Fire Vehicles policy
• The FPL maintains controlled drugs and logs in accordance with the Controlled Drug policy
• The FPL ensures minimum EMS supply levels for the ALS Squad, as defined by PA Dept of Health
• The FPL performs administrative duties (roll calls, overtime, MXTs, AOR, etc.) for assigned ARU personnel
• The FPL ensures proper documentation for all incidents, following EMS Documentation policy

AR2 Lead EMS Attendant

• The AR2 Lead EMS Attendant gathers equipment from the secured storage area designated by the EMS CRR office, with the FPL responsible for all equipment assigned to the unit
• Equipment storage and lock procedures are located in the EMS CRR office
• The AR2 Lead EMS Attendant prepares the vehicle for service and coordinates pickup with the Social Worker/Case Manager (CM) at 520 Delaware Ave
• The AR2 Lead EMS Attendant proceeds to the catchment area and notifies FCC when the unit is in service
• The AR2 Lead EMS Attendant monitors the designated medic band
• They will self-dispatch to suspected opioid-related incidents within the catchment area
• They will respond to a medic unit's request for AR2
• The AR2 Lead EMS Attendant coordinates the "Leave Behind Narcan" Program
• They will assist the Social Worker/CM with clients refusing transport to the hospital but seeking substance use disorder (SUD) recovery/intervention
• The AR2 Lead EMS Attendant provides clients with a courtesy ride to AR2/A during operational hours for a behavioral assessment by the Social Worker/CM

First Responder Companies (FRC)

• All FRC Company Officers, especially those in the AR2 catchment area, should be aware of this chapter and AR2's presence
• When dispatched with AR2, FRCs assist in patient care as directed by AR2 PFD personnel, and will not recall AR2
• FRCs should follow the First Responder Company chapter

Social Worker

• Must possess knowledge, resources, and information on treatment modalities and social services to support individuals in SUD recovery
• Engage individuals and provide information on drug treatment, harm reduction (syringe exchange), overdose education, and naloxone distribution
• If amenable, collect contact information for follow-up and linkage
• The staff will follow up with people who were previously treated and refused transport
• Engage community organizations and members, providing overdose education and training to individuals and families
• Attend staff meetings, act as a representative on opioid-related working groups, consult with supervisors on difficult problems, prepare reports and correspondence, and maintain records of all assigned cases for follow-up and data collection
• Maintain confidentiality of records and information
• Work collaboratively with city agencies, especially the Philadelphia Fire Department
• Evaluate program quality and effectiveness, recommending modifications
• Assess and recommend interventions for individuals and families affected by substance use disorder
• Advocates for individuals and families affected by substance use disorder
• Follow professional standards in maintaining individual files and case notes
• Maintain current information on available resources such as education material, treatment options, and treatment availability
• The social worker must collaborate with hospital (ER) social workers to ensure continuity of care (warm hand off)
• Provide coordination, linkage, monitoring, and advocacy for individuals and families
• Provide outreach, engagement, and assessment with individuals in need of service

Case Manager

• Must await mitigation of all medical emergencies prior to any client contact
• They will engage and assess opioid-related clients who refuse medic unit transport to the emergency department
• The case manager coordinates client placement in drug and alcohol treatment
• They help clients set up appointments and navigate the treatment system
• The case manager disseminates treatment and service materials to at-risk individuals and their families
• They will document engagement using the ARU Data Collection intake form located on AR2's MDTs
• They will follow up on clients who are engaged by AR2

AR2/A Fire Service Paramedic/Fire Service EMT

• AR2/A supports the ARU as dictated by rank, with the AR2/A FSP serving as a trained backup to AR2 and operating in AR2 when required. AR2/A personnel report to the AR2 FPL
• AR2/A reports to the Navy Base Fire Station at 1301 Kitty Hawk Avenue for vehicle pickup and preparation
• They complete a check of the RV and ensure all moveable objects are stowed or secured
• They proceed to the pre-determined staging area within the catchment area while ensuring safe operation of the vehicle in accordance with the Safe Operation of Fire Vehicles policy
• They notify AR2 when staged and operational
• They will also monitor the designated Medic Band
• AR2/A assists AR2 with the "Leave Behind Narcan" program
• They maintain a de-identified tracking spreadsheet of clients attended to in AR2/A

General Information

• When AR2 is the 1st PFD unit on scene, the crew performs initial assessment and provides appropriate treatments according to PA Statewide ALS and BLS Protocols
• When AR2 is not the first PFD unit on scene, the crew assists the primary unit
• When AR2 is performing a community outreach contact, they perform initial assessment and determine client AR2 eligibility. If eligible, AR2 requests an incident number via FCC and follows the EMS Refusal Checklist in PA Statewide BLS Protocol #111
• If deemed ineligible with medical symptoms, AR2 requests a medic unit via FCC to transport the patient to the appropriate emergency receiving facility, obtains the patient's contact information and follows up post-treatment. AR2 will never transport a patient to an emergency department
• Provide a courtesy ride for clients to drug and alcohol treatment services when appropriate
• Clients receiving a courtesy ride via AR2 will be documented as "Pt Refused, No Transport (Per Protocol)" for full documentation, completing assessment and required EPCR fields. The narrative should reflect the client's refusal of hospital transport and receipt of a courtesy ride to a named drug and alcohol treatment facility
• Ensure the Social Worker/CM completes the ARU Data Collection fields in the Department Specifics tab of the EPCR
• AR2 will advise FCC of all status changes
• They will perform initial assessment and provide appropriate treatments on patient contact in accordance with the PA Statewide ALS and BLS Protocols
• Request AR2 for opioid related incidents within the catchment area where patients are refusing transport to the hospital. Requests for AR2 will be made via radio through the Fire Communication Center (FCC)
• Medic Units that request AR2 for a potential client will follow the EMS Documentation policy and document transfer of care to AR2
• Contact HUP medical command for a refusal when the patient, within the catchment area during AR2's operational hours, is requesting release
• When a patient is requesting recovery/intervention from SUD and AR2 is unavailable, complete the EPCR with patient demographics and contact information, notify AR2 and provide the incident number. AR2 will follow up with the potential client
• Assist AR2 at the scene until released by the AR2 PFD member
• Distribute “Leave Behind Narcan” citywide where appropriate
• Document and notify AR2 of distribution of “Leave Behind Narcan”

References

• FIRST RESPONDER COMPANIES CHAPTER
• CONTROLLED DRUG CHAPTER
• EMS COMMUNITY RISK REDUCTION
• PHILADELPHIA ADVANCED LIFE SUPPORT PROTOCOLS
• EMS DOCUMENTATION
• SAFE OPERATION OF FIRE VEHICLES
• PA Dept of Health ALS Squad Inspection Checklist PA Dept of Health Vehicle Inspection Checklists
• PA Dept of Health ALS and BLS Protocols PA Dept of Health Resource Page