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Primary Submission Category: Interventions/Programs
From Response to Prevention: Evaluating and Co-Designing Leave-Behind Naloxone Programs for County-Wide Emergency Medical Services (EMS) Uptake
Authors: Theresa Hwee, Cece Wettemann, Ohshue S. Gatanaga, Hannah Collins, Amy Poel, Samara Jamison-Heydon, Jenna van Draanen,
Presenting Author: Theresa Hwee*
Opioid overdose is a leading cause of death in Washington State, and Leave-Behind Naloxone (LBN) is an evidence-based intervention that reduces overdose death. LBN kits are given to patients or close contacts immediately after an overdose. Firefighter/EMTs are often the first to respond to overdose, yet adoption of LBN programs varies widely across EMS agencies. We ask: what organizational and contextual factors shape LBN implementation, and how can evaluation paired with co-design strengthen implementation of overdose prevention programs at a population level?
We are conducting an ongoing sequential mixed-methods evaluation of 2024-2026 LBN implementation across Seattle/King County EMS agencies in partnership with Public Health–Seattle & King County. Using RE-AIM to assess implementation and CFIR to identify contextual determinants, we will integrate administrative data (naloxone inventory, overdose call volume, LBN distribution/documentation) with semi-structured interviews with n≈20 EMS department leaders. Interviews findings will directly inform recommendations and decision-making by EMS agencies and public health partners.
Preliminary analyses of administrative data describing program uptake suggest substantial variation in LBN distribution and documentation practices across EMS agencies, highlighting the need to understand organizational context and co-design future program iterations. Finalized analyses will include descriptive and change-over-time trends, thematic summaries of implementation determinants, and mixed-method joint displays. Results will be translated into action through co-design workshops with firefighters/EMTs, EMS leadership, public health partners, and people with lived experience to refine the LBN program for increased population impact.
This project advances population health by uniquely linking implementation science with participatory co-design in emergency response systems to improve naloxone distribution and reduce overdose deaths.