Harm Reduction on Campus: A National Survey of Collegiate-based EMS Agencies.

OBJECTIVES: While collegiate-based emergency medical services (CBEMS) agencies have traditionally been focused on acute emergency response, their integration within student life uniquely positions them to support public health initiatives and prevent emergencies. The purpose of this study was to explore the current role of CBEMS agencies in substance use harm reduction efforts and identify the strategies and barriers that impact implementation. METHODS: We conducted an observational study with a cross-sectional online survey of CBEMS agency leaders using the National Collegiate Emergency Medical Services Foundation database. Eligible agencies demonstrated recent operational activity; those agencies outside the continental United States were excluded. The survey was distributed between May 16 and September 12, 2024 with two follow-up reminders. Quantitative data were analyzed descriptively, and qualitative responses underwent inductive thematic analysis. RESULTS: The survey achieved a 33% response rate (41/124). Among respondents, 93% stocked naloxone for emergency overdose response, 46% offered public naloxone education, and 7% distributed fentanyl test strips. Additionally, 85% offered cardiopulmonary resuscitation (CPR) training to the public. Qualitative analysis identified three primary barriers to program implementation: 1) Institutional and Policy Barriers, referring to policies and administrative inefficiencies that delay program approval; 2) Challenges in Community Engagement and Coordination and 3) Resource Constraints. CONCLUSIONS: Despite heterogeneity in operational structures, respondents demonstrated readiness for opioid overdose reversal, with naloxone stocked in nearly all agency gear bags, and established educational outreach including public CPR training and naloxone education. However, adoption of broader harm reduction strategies remained limited. Systemic barriers limited expansion of harm reduction programming. Coordinated institutional investment and standardized implementation are needed to enhance CBEMS-led CPR education and overdose preparedness.