Survey items were developed by consensus of the authors, and pilot tested and edited based on feedback from a separate group of 6 EMS physicians before surveying the Council. To avoid duplicate responses, only one respondent per fellowship program was requested. Council members received an invitation to participate in the survey by email from one of the authors (DCC) and 2 weekly reminders to complete the survey if they had not yet done so. The Council's members include Program Directors and Associate Program Directors at the 67 Accreditation Council of Graduate Medical Education accredited EMS fellowship programs in the US. EMS fellowship programs provide postresidency training for physicians planning careers in EMS medical oversight and out-of-hospital clinical care with EMS and interfacility transport services. METHODSД«etween Apand May 15, 2020, we conducted an online anonymous survey of 201 physicians who are members of the Council of EMS Fellowship Directors, part of the National Association of EMS Physicians. 5 In the midst of the COVID-19 pandemic and to provide information on one aspect of the effect of the pandemic on frontline EMS practices, we sought to determine the effect of COVID-19 on the perceived prevalence of opioid overdoses and the use of intranasal naloxone by EMS in the US. 6 Current guidelines for EMS clinicians recommend the use of intranasal over intramuscular naloxone 7 whereas recent guidance from the Substance Abuse Mental Health and Services Administration (SAMHSA) favors intramuscular use if sufficient personal protective equipment is not available. 3вЂ“5 Notably, some law enforcement jurisdictions have banned the administration of intranasal naloxone to avoid potential exposure of their personnel to SARS-CoV-2. 2 Anecdotal reports cite an increase in opioid overdoses during the COVID-19 pandemic, leading to responses from the American Medical Association and loosening of regulations regarding access to medications for opioid use disorder by federal entities. 1 COVID-19 in the United States (US) has occurred in the midst of an opioid crisis that averages 128 overdose deaths per day. The SARS-CoV-2 coronavirus is transmitted via droplets and secretions and may present a risk to emergency medical services (EMS) clinicians who perform procedures such as overdose reversal with intranasal naloxone. These findings may provide insight into changes in opioid overdose mortality during this time and assist in future disaster planning. Eighteen percent of respondents have discouraged or prohibited the use of intranasal naloxone with 10% encouraging the use of intramuscular naloxone. The findings varied by region of the country. Results:Д«ased on 60 respondents across all regions of the country, one fifth of surveyed communities have experienced an increase in opioid overdoses and events during which naloxone was administered, and 40% have experienced a decrease. Methods:Д«etween Apand May 15, 2020, we surveyed directors of EMS fellowship programs across the US about how overdose events and naloxone administration practices had changed in their catchment areas since March 2020. We sought to determine changes in overdose events and naloxone administration practices by EMS clinicians. Emergency medical services (EMS) clinicians may limit their use of intranasal naloxone due to concerns of novel coronavirus infection. The COVID-19 epidemic in the United States has hit in the midst of the opioid overdose crisis.

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