Clark County

Program Objectives & Goals

Short Term

• Develop a county wide civilian response network using the Pulse Point smart phone app
• Continue to modify and test the Everbridge one touch notification system to mobilize resources in a mass overdose situation
• Fortify the options available in transitioning the patient from the ED to the ED Follow-up Clinic

Long Term

• Add Narcan training to the Pulse Point civilian response network
• Develop recovery navigator program to assist patient from ED presentation to stable outpatient treatment regimen
• Formalize ED initiated medication-assisted treatment (MAT) program

Activities

The Clark County Health Department will monitor ED overdose data and utilize our early response network to mobilize resources to the affected area.   Continue to build our civilian response network to provide rapid treatment to overdose patients.  Increase civilian Narcan training to allow for targeted Narcan delivery.  Add resources to our ED Addiction Transition Team Program and continue to identify barriers to transitioning to the ED Follow-up Clinic.  Develop our ED initiated MAT program with streamlined transition to community providers

Overdose Response Plan

The rapid response project is a community based, multidisciplinary framework to address the opiate epidemic in Clark County, Indiana from the point of entry with initial use to an endpoint of successful recovery.

The initial stage involves the use of two early notification systems to address acute overdose patients. Pulse Point is a smart phone application that allows those have been trained in CPR to respond to a cardiac arrest. First responders and healthcare workers will be added to the roster, and CPR classes have already been held in six community locations to train laypersons, who will also be able to respond. These providers will also be Narcan trained, as a majority of critical overdose patients will be called in under the ‘unconscious, unresponsive’ code. This program will dramatically decrease our time to response in the individual acute overdose.

Everbridge is the second early notification system. It is a one touch notification system that allows rapid dissemination of information to various county entities. The Indiana ESSENCE early notification system monitors for increased overdose activity in our county. Everbridge will be used to increase EMS coverage in the affected area, notify the local emergency department to flex open beds to treat a patient influx, as well as allow Inpatient Behavioral Health Assessors to identify placement options.

The next stage begins when the opioid addicted patient arrives in the emergency department, both in the acute overdose setting and the patient who presents for opioid detox. They will first be evaluated medically. Any patients who are medically unstable will be admitted to the hospital for treatment as appropriate. Once medically cleared, the ED behavioral health assessor will assess the patient. At their discretion and pending bed availability, they may be admitted to the behavioral unit for detox. However, in the absence of suicidal ideation or other extenuating circumstances, a majority of patients are cleared for outpatient management.

Patients that are cleared for discharge are offered assistance from the Addiction Transition Team. They are given a handout with local resources and programs. The main point of entry in the outpatient transition program is the ER Follow-up Clinic. This once weekly clinic is coordinated through Clark Memorial ED and LifeSpring Health Systems Federally Qualified Health Center. Patients who have been seen in the ED may be seen on a walk-in basis regardless of ability to pay. At this appointment, they are again evaluated for medical stability. They are given an appointment for behavioral health treatment as well as medications to assist with withdrawal symptoms. Simultaneously friends and family members who attend the appointment are offered Narcan training. Patients may continue to return to clinic as needed until medically stable in the outpatient setting. We are also in discussion with telemedicine providers to shorten the gap from presentation to behavioral health treatment.

The eventual goal of the Addiction Transition Team is to have recovery navigators that evaluate the patient in the acute setting, either face to face or by telephone follow-up within 24 hours. They can reinforce with the patient the resources available and help them navigate any barriers that may be present. As the Addiction Transition Team graduates begin to reassimilate into the community, the goal is to enter them into the recovery navigator program to close the loop from opiate addiction to full recovery.

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