An evaluation of first responders' intention to refer to post-overdose services following SHIELD training

Background: First responders (law enforcement officers [LEO] and Fire/Emergency Medical Services [EMS]) can play a vital prevention role, connecting overdose survivors to treatment and recovery services. This study was conducted to examine the effect of training on first responders’ intention to refer overdose survivors to treatment, syringe service, naloxone distribution, social support, and care-coordination, and whether the outcome differed by first responder profession. Methods First responders in Missouri were trained using the SHIELD (Safety and Health Integration in the Enforcement of Laws on Drugs) model. Trainees’ intent to refer (ITR) overdose survivors to prevention and supportive services was assessed pre- and post-training (1–5 scale). Trainees were also asked if they ever witnessed an overdose fatality. Mixed model analysis was conducted to assess change in mean ITR scores between pre- and post-training, and between profession type, while adjusting for random effects between individual trainees and baseline characteristics. Results Between July 2020 and January 2023, 742 first responders completed pre- and post-training surveys. SHIELD training was associated with first responders’ intention to refer, increasing overall ITR to any type of support service from 2.30 (± 0.99) to 3.90 (± 0.99), with ITR to naloxone distribution (1.83 to 3.88) and syringe exchange (1.73 to 3.69) demonstrating the greatest changes. There was a significant increase in ITR score from pre- to post-test (β = 2.15; 95% CI: 1.99, 2.30), and LEO had a higher score than Fire/EMS (0.509, 95% CI = 0.367, 0.651). Conclusion Training bundling occupational safety with harm reduction content is immediately effective at increasing first responders’ intention to connect overdose survivors to community substance use services. When provided with the rationale and instruction to execute referrals, first responders are amenable, and their positive response highlights the opportunity for growth in increasing referral partnerships and collaborations. Further research is necessary to assess whether ITR translates to referral behavior in the field.