College of Graduate Studies: Theses & Dissertations

Term of Award

Spring 2026

Degree Name

Doctor of Public Health in Public Health Leadership (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

Department

College of Public Health

Committee Chair

William Mase

Committee Member 1

Robert Bohler

Committee Member 2

Ryan Lofaro

Abstract

Opioid overdoses remain a problem in the United States, underscoring the need for additional surveillance tools to monitor trends in opioid overdoses. Emergency Medical Services (EMS) data is a timely surveillance method that captures more potential overdoses than hospitals by representing the pre-hospital setting. Research questions in the study assess EMS responses to suspect opioid overdose incidents from 2019-2023 in Georgia to encompass the following characteristics: timeframe (pre, during, post-pandemic), urban versus rural counties, race/ethnicity, categorical type of first responder, mean dosage of naloxone in milligrams administered, and death. 84,359 records meeting the inclusion criteria were initially retrieved from the Georgia Emergency Medical Information System (GEMSIS). After data cleaning, 63,084 records remained. Weekly counts of suspect opioid overdoses were calculated and transformed into crude population rates based on 2020 U.S. Census data. Both one-way Analysis of Variance (ANOVA) and two-way ANOVA were used in addition to simple logistic regression. Weekly rates of suspected opioid overdoses in Georgia were significantly different from each other in all timeframes (p< .001). Weekly rates in urban counties were much higher than rural counties during the pandemic (p< .001). Weekly rates were significantly higher for Non-Hispanic Whites and African Americans than for Hispanics in all timeframes (p< .001). The dosage of naloxone given per suspected opioid overdose was statistically significantly lower for pre-pandemic (1.85 mg ± 1.35 mg, p < .001) timeframe versus pandemic (2.14 mg ± 1.66 mg, p< .001) timeframe. Mean naloxone dosage in milligrams first administered by all study categories of first responders were significantly higher than EMS (p< .001). Patients were 3.31 times more likely to die during the pandemic than pre-pandemic and were 4.49 times more likely to die post-pandemic than pre-pandemic. Limitations to the study included data quality issues, since information from the data elements used depends upon accurate understanding and entry by EMS personnel into electronic patient care reports (ePCRs). Recommendations include improved training for EMS in data documentation, continued research on opioid overdose in minority groups, reducing barriers to naloxone access and administration, and increasing access to MOUD.

Research Data and Supplementary Material

No

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