“You mean how many times we’ve treated this patient for an overdose? I’ve lost count too.”
We’re on another scene where the signs point to a Narcan treatment, wake-up, and refusal. Only this time it goes a little differently: Family members are now here and remember us from before. Our patient previously was obnoxious and frankly unappreciative of our efforts. Samantha and I did not respond that way, although our animal sides wanted to. We were compassionate but also confused and frustrated.
Maybe our kind attitude came across to him, maybe the time was just right, but he looked up at us and said, “Can you help me with getting off these drugs?” He was ready, finally. What would you have said back? To him, to his family? Would you be prepared to answer?
One Chief’s Approach
Take a moment to look around the country at what might stop the cycle of overdose, revival, refusal, repeat.
An absolute hero to us is Jan Rader, a fire chief in West Virginia. Her town, Huntington, was an epicenter of opioid abuse. She and other first responders knew these victims personally. Some OD victims they were able to revive, others sadly not.
Often freshly revived overdose patients want nothing to do with us. They are angry and resentful of our help, and it’s just not the time to lecture them. But what Rader did was both brilliant and effective: She created a quick-response team that followed up later to help connect abusers to recovery coaches and an addiction clinic. She also set up a program of care for first responders to deal with the fatigue and depression of seeing the abuse over and over again.
What was the result? Rader reports a 50% drop in overdose deaths in her town.1
Some aspects of what Rader did may apply to your community, others perhaps not. First, she implemented her plan in a small town (Huntington’s population is around 50,000). As she says, everyone knew everyone. After an overdose encounter her team would try to meet with the abuser within 72 hours. Team members came from EMS, the recovery community, law enforcement, and the clergy.2 This mix worked well in Rader’s community. It should be emphasized that the law enforcement officer is not there to arrest someone if he sees drug paraphernalia or a low-level offense.
The patient likely will not be euphoric about the visit. Expect a struggle with the first offer of assistance. All team members must be able to explain, “This is how we can help.”
Opioid problems are not identical from one area to another. Many sufferers abuse opioid prescriptions. In Wilmington, N.C., for instance, more than 11.6% of those who received opioid prescriptions abused the drug.3 Conversely, in other areas, heroin and fentanyl may be much more of a problem—be prepared to adapt your approach as needed.
Stress in EMS
The second part of Rader’s plan acknowledges the serious problem with stress in EMS. For more on this issue, see Hollie Backberg’s outstanding article, “Stress: The Silent Killer of the EMS Career,” from the March 2019 issue of EMS World.4
The key points here are how we treat our patients and how we treat each other. But we need to recognize there’s a problem before we can work on a solution.
1. Shaffer M. Talking about an epidemic. Ironton Tribune, 2019 Jan 3; www.irontontribune.com/2019/01/03/talking-about-an-epidemic/.
2. Willing L, FireRescue1. Opioid Solutions: Huntington Fire Chief on Harm Reduction Strategies. Efficient.gov, 2018 Dec 11; https://efficientgov.com/blog/2018/12/11/opioid-solutions-huntington-fire-chief-on-harm-reduction-strategies/.
3. Castlight Health. The opioid crisis in America’s workforce. WilmingtonNC.gov, www.wilmingtonnc.gov/home/showdocument?id=5561.
Dick Blanchet (ret)., BS, MBA, worked as a paramedic for Abbott EMS in St. Louis, Mo., and Illinois for more than 22 years. He was also a captain with Atlas Air for 22 years and an Air Force pilot for 22 years.
Samantha Greene has been a paramedic, field training officer, and operations supervisor for Abbott EMS of Illinois for the last 10 years and a lieutenant for the Madison, Ill., Fire Department for the last five.