Chemsex: core knowledge for emergency medical service responders

The aim of this professional practice article is to increase awareness and knowledge of chemsex among emergency medical service (EMS) clinicians.

EMS clinicians can expect to be called on to respond to medical emergencies across the range and breadth of human behaviours, some of which will take them into areas they are unfamiliar with and/or that involve illegal activity. It is likely that many EMS clinicians would regard chemsex as one such area. A secretive activity, largely occurring out of sight of wider society, chemsex involves the planned use of specific drugs to enhance, prolong and sustain sexual experiences. Most chemsex is consensual, with participants engaging in it because they derive pleasure and enjoyment from the activity. Many do not regard their participation as problematic and so are highly unlikely to have previously discussed this aspect of their lives with a medical or harm-reduction professional. Engagement in chemsex does, however, carry significant risks of both mental and physical harms. When something goes wrong at an event, EMS can expect to be called to respond.In this article, chemsex scenarios are combined with literature drawn from a range of sources to explore multiple aspects of chemsex from the perspective of EMS clinicians.

Chemsex invokes a complex interaction between physical health, mental health, social care, addiction medicine, sexual health and criminal justice. In providing a community-based response, EMS clinicians are uniquely placed as the only element of healthcare that sees chemsex participants at the event location, often while the incident is still going on. Equipping responders with core knowledge of chemsex activities will ensure they are best able to provide a response that is knowledgeable, patient-centred and offers unconditional positive regard. Clinicians that are chemsex-aware will be in a better position to recognise and understand the drugs that may have been taken and their associated toxidrome and appreciate the significant risk of physical and mental trauma. They will also recognise they are in a unique and privileged position and feel confident to engage in harm reduction with this very high-risk and largely unseen cohort of patients.