The growing problem of opioid addiction has become a national emergency, straining public services and medical care to their limit in some areas of the country. First responders in fire and EMS agencies are on the front lines of this crisis.
Nowhere is this more true than in West Virginia, which, according to the CDC, has the highest per capita rate of opioid addiction in the United States: more than 41 overdose deaths per 100,000 people in 2015.
Huntington, West Virginia, a city of about 50,000, is at the center of this crisis. Call volume between 2016 and 2017 has risen more than 10 percent, mostly due to medical response to overdoses. In 2017, there were at least 132 overdose deaths in Huntington and the surrounding county, an area with a total population of only 100,000.
On a single day in the summer of 2016, there were 28 overdoses in Huntington in the space of four hours, resulting in two deaths. It is estimated that at least 10 percent of the population of the greater Huntington area is addicted to opioids. About 20 percent of babies born in the area have been exposed to drugs prior to birth.
For an area that is already negatively economically affected due to loss of jobs in mining and manufacturing industries, the challenges are enormous. For example, in the middle of the spike in overdoses, the fire department was forced to lay off firefighters due to financial hard times.
Firefighter resiliency in the face of the opioid epidemic
Huntington Fire Chief Jan Rader, a 23-year veteran of the department and native to the area, is a realist when it comes to the issue. She has worked closely with Mayor Steve Williams, whom she commends for “owning the problem” and committing to gathering real-time statistics on emergency response. At all levels, the city is dedicated to putting its best resources toward mitigating the far-reaching damages of the crisis.
Some of the actions taken have been purely pragmatic. For example, needle-resistant gloves are provided to all emergency responders in the county. The department is currently considering self-defense training for all firefighters, as, according to Chief Rader, “The formula of what the product is continues to change. Right now, it’s fentanyl mixed with uppers; such as cocaine, ecstasy and methamphetamines. Now, when we wake them up with naloxone, they’re violent.” Rader is determined to put more resources toward training in situational awareness as well. “We need to be flexible during these uncertain times. We need to make sure our officers realize, if they feel threatened at all, to get the hell out.”
Other needs are less visible. “My biggest concern is mental health,” Rader noted. Members of the department might run on several overdose calls on any given shift. “They see their friends die, people they grew up with. But they feel they cannot help. Firefighters are embroiled in negativity all day long. They feel like they’re not helping. But they are.”
This negativity and hopelessness can result in firefighters resisting programs and interventions that could benefit them. For example, the department mandated participation in an online program for stress management, but there was significant push-back from members. When a local psychologist started a support group for first responders, there was resistance as well.
Rader commented, “They said they didn’t like the fact that there were EMS people there, and volunteer firefighters. They said they didn’t want to hear others’ stories. There is a stigma attached to asking for help.”
Rader is unyielding when asked about the future. Despite being eligible for retirement, the chief, who is also an RN, simply said, “I can’t walk away from my guys.” Instead, she is working hard on future efforts – resiliency training for department members and multiple grant applications which would result in embedding mental health professionals within police, fire and EMS agencies throughout the county.
In addition, the City of Huntington has filed a lawsuit against several major pharmaceutical companies for disseminating false information about opioid drugs and supporting standards of care that lead to large-scale over-prescribing of the drugs. “There has to be accountability,” Rader stressed.
Mapping the opioid epidemic
If you can’t measure it, you can’t manage it. The Huntington Fire Department and surrounding agencies have embraced this truism and are taking aggressive measure to accurately assess the scope and nature of the opioid problem in their communities.
Other agencies go a step further and engage with national tracking of opioid use and overdoses through a Department of Justice program called Overdose Mapping, part of an initiative created in 1988 called High Intensity Drug Trafficking Area (HIDTA). The intention of this program is to assist federal, state, local and tribal law enforcement agencies in collecting and sharing data related to drug trafficking and use throughout the United States. This program allows participants to see overdoses as they happen in real time across the entire country.
One fire department that has opted into this system is the Center Point Fire District, Jefferson County, Ala., the only fire agency to participate within the state. Alabama currently is not ranked as a critical state for opioid use by the CDC, but according to EMS Director, Captain William Ward, the district has seen a significant increase in responses to opioid overdoses.
In 2012, Center Point had only 11 responses that involved naloxone. In 2017, that number climbed to 207. Additionally, due to changes in drug formulas, the amount of naloxone needed per call has also increased dramatically.
This is still a relatively small number compared to other areas in the country, but Center Point is a small fire department with a large response area. The department has only four stations, with an average of 17 people on shift at any given time. The total area of coverage includes three small municipalities (Center Point, Clay and Pinson) and large swaths of unincorporated Jefferson County, a total of 65 square miles. The demographics of the district are diverse, although mostly residential.
There have been several benefits of participation in the OD mapping program for the Center Point Fire District. One benefit is improved communication and information sharing about the problem. “We have a great relationship with the Jefferson County Sheriff’s Office,” said Captain Ward. “We’re very cooperative, particularly with the middle level and street level officers who work in our district.”
Another benefit is to foster real accountability throughout the response district. According to Captain Ward, “When we have community meetings, mostly the people who attend are city council people and first responders. We really hoped we would get representation from the community, but we did not. But it occurred to me that everybody thinks the opioid crisis is somebody else’s problem. People in the meetings would say, well, those numbers are for the whole fire district; it’s really not in Clay, it’s really not in Pinson. But one thing the OD map does is that it is just cold hard data on a map, and you can see where the overdoses are. And guess what? It’s everywhere. And hopefully it will make politicians stiffen up their backs and say, I guess it is our problem. I guess we should do something.”
Safe Stations provide help when it’s needed most
When people talk about states that have been most affected by the opioid crisis, West Virginia is at the top of the list. But New Hampshire is second. According to the CDC, in 2015, New Hampshire averaged more than 34 overdose deaths per 100,000 people.
Since 2016, emergency responders in New Hampshire have a new program to help with the problem. The Safe Station program in Manchester, NH, a department of 200 people operating out of 10 stations, has now spread to many other jurisdictions in the state and beyond.
The program began almost by chance. Firefighter Christopher Hickey was on shift one day in April 2016, when the stepbrother of another firefighter on duty came to the station, looking for help. The man was addicted to heroin and was considering suicide, but desperately wanted to make a change in his life. He hoped his stepbrother could help him.
At that point, the Manchester Fire Department had done some training with members on how to refer people to recovery services, but it hadn’t been working very well. Hickey, a paramedic with no specific mental health background, had recently taught some CPR classes at the local recovery center and knew people there. Instead of just telling the man about options, Hickey and his coworker drove the man to the center themselves, got him admitted, and three days later, he was on a plane to a residential recovery program in California.
It all worked so well that Hickey thought maybe the concept could be formalized into “something like the baby safe haven program.” Addicts could come to any fire station at any hour of the day or night, and get immediate help. The idea, Hickey noted, “was to capitalize on the moment when people really want help and are ready to accept it.”
Hickey sent an email to the fire chief about the idea. The fire chief forwarded it to the mayor. And the mayor came back to the firefighter and told him, “you’ve got three weeks” to put together a program.
Developing an entirely new program in just three weeks may seem impossible, but in fact, most of the pieces were already in place. Manchester has a local recovery intake center. It has access to other resources through law enforcement, the health department, the private ambulance service and social services. There are local programs that support long term recovery goals.
What was missing was a way of guaranteeing that when someone finally makes the decision to get help – an urge that may last less than an hour before they go back to seeking the next fix – that they can get the help they seek, in the moment they need it most. And that is where the fire department comes in. “We just kind of knit it all together,” Hickey related.
The system is fairly simple. If a person in need comes to a fire station between 0900 and 2000, he or she is transferred immediately to a treatment center. If someone arrives after 2000, that person is counseled by a professional case worker or social worker on call, and provided with a place to stay for the night. The following morning, transfer to a treatment facility occurs.
Overcoming compassion fatigue
The program has been remarkably successful. Since its inception, Safe Station has received nearly 3,000 requests for assistance. Longer term tracking shows that about 70 percent of those who enter treatment in this way stay in the program. Overdose fatalities in Manchester declined by over 40 percent in 2017, compared to the previous year.
And there has been little or no pushback from firefighters and other first responders who are part of it. On the contrary, for a department that was suffering greatly from compassion fatigue from running so many overdose calls without the ability to really change anything, the ability to take action has been an antidote to despair. The program has the full support of the union. “The program has also had the effect of breaking down barriers among different agencies,” Hickey reported.
Now helping over 170 people per month, Safe Station is catching on. Most other fire departments in New Hampshire are developing and adopting similar programs. Manchester Fire gets inquiries from across the country about how to institute a similar program.
Without a doubt, Safe Station has been the first step to providing substantial help for members of the community who suffer from addiction. But the program has helped members of the department as well. “We’ve lost guys from what they’ve seen on calls,” Hickey explained. “We were so tired of doing CPR on people we knew. We needed to do something for the community and for ourselves.”
