The following questions are part of a comment at EMS1.com following the editorial “The common denominator of narcotic diversion.”

Since these questions are statistical by nature, I’ll do my best to answer them.

1. What is the average number of tampering/diversion cases per 1,000 Paramedics in the united states?

2.What is the ratio of fire based EMS narcotics tampering compared to private industry paramedics?

 

Question #1: What is the average number of tampering/diversion cases per 1,000 Paramedics in the United States?

Answer:  As far as I know, no one knows.  The National Institute of Justice and the DEA were unable to provide numbers concerning narcotic diversion specific to prehospital care or paramedics for that matter.  If anyone has access to those types of numbers, I would be very interested in seeing them.

Perhaps we can make an educated guess. 

The number of EMTs and Paramedics in the U.S. range from 210,700 (US Dept of Labor) to 742,000 (NAEMT).

In California the numbers are (2006):

EMTs Basic, 70,000; EMT-IIs, 119; EMT-Ps, 16,005.

Total, 86,124

Trinkoff's (2000) published study, based on a national survey of 3,600 nurses, found that nurses were significantly more likely to engage in substance abuse if they had easy access in the workplace to prescription drugs....

Use of prescription drugs ("on their own") or Illicit drug use = 10.7%

I haven’t seen a study like this for prehospital care.  IF there were one and the results were similar (taking the leap here), there may be about 22,545 (assuming US Dept of Labor numbers) EMT’s and Paramedics using prescription drugs “on their own” or illicit drugs.  While this doesn't tell us how many divert, it does give us a potential “top end” number and a starting point. 

Back to the original question, What is the average number of tampering/diversion cases per 1,000 Paramedics in the United States?  The answer then could be “something less than 107 per 1000”.  Hopefully much less. 

107 per 1000 = 10.7% which is an approximate number of EMTs and Paramedics that MAY use prescription drugs “on their own” or illicit drugs. 

Let X = the percentage that MAY be inclined to divert narcotics

Let Y = the percentage of those MAY tamper with drugs. 

For the sake of argument, let X* = 10% and Y** = 44.64%.

Then 107 x 10% x 44.64% = 4.7765

4.7764 in 1000 may tamper with drugs.

Since there are between 210,700 and 742,000 EMTs and Paramedics in the U.S. then the total number that tamper with drugs is = between 1006 and 3544. 

In California that number would be between 76 and 411 (depending if your counting Paramedics only or EMTs and Paramedics).

Since a study for prehospital care has not been done, I would stress that these numbers show only a potential.  A study may show numbers that are higher or lower and as such, this analysis holds little weight other than suggest a percentage of our community is impaired and a percentage of them are likely to steal narcotics and/or tamper with them.  Those percentages are up for debate.

Question #2: What is the ratio of fire based EMS narcotics tampering compared to private industry paramedics?

Answer:  As far as I know, no one keeps track of this either.  However, an analysis of the EMT and Paramedic articles on this site show the following:

70 (as of 05-30-10) articles involve prehospital care.

A summary of those articles plus others that come from reliable sources (ie, CA EMSA records & NJ Dept. of Health and Senior Services) and stories that I have personal knowledge of, show the following:

56 members of the EMS community (EMT or Paramedic) were accused of drug diversion.

18 - Fire Based EMS

36 - Transport or Hospital based EMS (public and private)

2 - don’t know who they worked for (records don’t always list employer)

Regarding the ratio of fire based EMS to private industry paramedics.  Where should we put public EMS (non fire)?  If we lump public EMS (transport only or hospital based paramedics) together with private industry EMS, then the ratio is 18:36 (essentially 1:2), another way to look at it is, 1/3 of the stories are Fire based EMS, and 2/3 are transport or hospital based EMS. 

To be specific to narcotic tampering and leave out other forms of diversion the numbers change. 

25 members of the EMS community were accused of tampering. 

12 - Fire Based EMS

13 - Transport or Hospital based EMS

The ratio for fire based EMS narcotics tampering compared to transport paramedics would be 12:13, about 1:1.  

These numbers are based on a very small set of data.  Additional records from CA EMSA have been obtained but not yet analyzed and no inquiry has been made to the other 48 state EMS authorities. 

I don’t want to suggest any population in EMS is more or less ethical, moral, righteous, or law abiding based on who or where they work.  Public/Private, East Coast/West Coast, Small Agency/Large Agency, it makes no difference.  Our entire community is vulnerable to narcotic tampering, and as such, we should all be cognizant to the possibility, work towards prevention, and be vigilant to the signs. 

*X = 10% a conservative guess.

** Y = 44.64% = 25 (known members of the EMS community that have been accused of Tampering) divided by 56 (known members of the EMS community that have been accused of Diversion).