Opioids and First Responders: Answering the Call

(fire truck sirens) (dramatic music) - A lot of product gets sold in and around these neighborhood streets that we work in.

We're right in the middle of one of the biggest selling areas.

- I woke up just so confused.

Like I didn't know where I was.

I still had the needle in my arm.

I was kinda upset because I wasn't high anymore.

- Some of the most troubling OD calls we go on is when we pull up and we find a young mother with her 18-month-old baby in the backseat and a needle in her arm.

- The next thing I remember is I woke up, the drugs had actually overpowered the Narcan.

I had to be Narcan'd again in the ambulance and then a third time at the hospital.

- Everyone of them is somebodies son, or somebodies daughter, or somebodies mother, or somebodies brother, or somebodies wife, and I remember all of them.

- Out of all the calls I've been on I think the hardest ones are when I actually have to tell the family that their loved one's dead.

- They went were they're serving needles and they're risking their safety to go into a place to save my life when I could have been just another statistic a drug addict on the street that died.

(dramatic music) (muffled talking) (dramatic music) (indistinct conversation) (firetruck exhaust sounds) - I became a firefighter because I like to help people.

I'm sure that's a very common answer, when you ask people, but ever since I was young I've always really liked to help people.

When I was a kid, a big red fire truck was always one of my favorites so, when I found out you could actually get paid to do this, to be a fireman, and as soon as I found out that, I was like, "now that's the job for me".

- This work is very demanding.

It's very rewarding.

Two days are never the same.

So it challenges you on a lot of fronts.

To stay mentally sharp, To stay really physically prepared for a lot of things, a lot of the ups and the downs and the stress, and the stress mentally and physically so it's a lot of preparation.

You see the house fire fully evolved and we go in, and then we come out.

But there's a lot of prep work so it's a very rewarding job.

(firetruck sirens) - When I became a firefighter I thought that the majority of our work would be fighting fires.

That's changed now, we serve all different types of calls, all different types of people, all different responses.

I never thought that the majority of our calls would be overdoses and drug related calls.

And I never expected that to be the case.

- I don't think I've ever actually sat down and counted "yup that's one for the day, that's two".

So no, on a very busy night where we're running 25, plus, calls.

We can go easily on 10, 10, 11, 12 overdose calls.

(engine roaring) - [kid] Bye!

- [paramedic] Bye!

(engine roaring) - [Paramedic 1] They made a drug bust in this house over here.

$450,000 in cash.

- [Paramedic 2] Six.

- 650?

- Yeah.

- This white house right here?

- Yeah.

- We had the shoot out.

- At this fire station we're in a unique situation.

This seems to be the epicenter of the heroine epidemic.

If you want to buy heroine this is where you come to.

Yesterday the guys came in said, "There's somebody OD'ing on our front bench."

I go, "Really?"

Walked out and there's somebody OD'ing on our front bench.

So it's not uncommon for me to walk out pick up a needle, sit at the picnic table and pick a needle up out of the flower bed.

There are many, many areas, I can draw a circle around this fire station and we could go out and pick up needles all day.

So, it's a free open air drug market, it operates 24/7.

- [fireman] Fire department.

You guys okay?

- [unknown] Yeah.

- [fireman] All right.

Just checking.

- [fireman] Yeah I know you had to walk down, you know, so.

- (woman laughs) No we've been here since (mumbles) - No, no, dude, we just came to check on you guys.

- [unknown male] I was petrified, I thought it was the police.

- [fireman] No, nope.

Hey we're here, like I said, we just came to see if you guys need anything?

If you were okay?

- [unknown male] No, you just woke me up brother!

- [fireman] Sorry, I didn't mean to ruin it for you!

But if you need anything, don't hesitate to call.

Stop over to fire house on Clinton Avenue if you ever need anything.

- I grew up in this neighborhood.

My parents still live in this neighborhood, my brother lives in this neighborhood.

I still live in this neighborhood.

When I was a young kid, it was a lot different than it is now.

Families, everybody lived together, everybody was happy, you know.

Everybody trusted each other and took care of each other.

It's a lot different now, you know, kids can't play on the street, there's needles.

You know vacant houses with needles, all over the place.

There's violence, you know, there's homelessness, there's drug dealers on the corner and people fighting and problems like that.

It's not as safe as it use to be.

The neighborhoods kind of held hostage you know by this war with the drugs and the money that it produces and the problems are all associated with it.

And it's not a good thing, you know, all the goodness that comes out of this neighborhood is all overshadowed by the drugs and the violence that accompanies it.

(car seatbelt dinging sound) - Amos fourteen Andrew ALS.

(dispatcher speaking indistinctly) (ambulance sirens) - [dispatcher] 3391... (ambulance sirens) - Working a rural community is really difficult.

You know everybody for the most part.

Especially in this town, you're very close knit.

You know your neighbor, your neighbor knows you.

Very small town less than maybe two thousand.

We cover about a hundred square mile secular area.

(ambulance sirens) Compass is a couple different towns, the farm land, it could be the woods.

I grew up here, and I want to help my community, I've always wanted to be somebody that people are calling because they need help.

They don't call me because they're having a good day.

They don't call us because they're having a good day.

They have probably had the worst day of their life and probably want somebody to come and help them.

And I want to be that person that they have helping them.

(doors opening) (doors closing) - [paramedic] Good?

(ambulance sirens) - [dispatcher] (indistinct) (door closes) (dog barks) - [unknown] Got one down on book.

- [fireman] How long she been down buddy?

- [unknown male] I don't know, I just came up, she came upstairs not even twenty minutes ago.

Twenty minutes ago?

She's been like this for over twenty minutes?

- [unknown male] I wouldn't know.

She said she was coming to lay down.

- [fireman] Any other medical history?

- [unknown male] Um... - So often in healthcare we use the term compassion fatigue.

And especially in society, as well, when something becomes our norm no matter how upsetting it is, no matter that, you know, we have children that are dying.

When it's regular and constant, it gets too tiring to continuously care.

And so we get tired and it becomes noise.

(people talking indistinctly) - [parademic] We're going to have to go to the hospital.

- [unknown] Why?

- [parademic] Because you overdosed.

How many bags did you take?

Just so we--you're not in trouble.

We just want to help you.

- [unknown] I'm not in trouble am I?

- If the people who see it daily who can not ignore it.

Whether that is police, or fire, or EMS.

We can't ignore that.

It can't become our background noise.

'Cause we're nowhere near a solution on this.

We've had more death from this disease than all the people who died of AIDS during the 1980s and 1990s.

We have far surpassed that, and that was an epidemic that we thought we would learn from.

(door closes) (engine idling) - [dispatch] She overdosed 193 (indistinct over radio) - [unknown male] Come upstairs.

(muffled voices) (static noise) (indistinct conversation) (dispatcher muffled) - [Paramedic 1] He's still breathing.

Let's get him right out in the hall.

- [Paramedic 2] Hang on one second.

- [Paramedic 1] Oh he's freaking cold.

Oh he's moving.

(fumbling noises) - [Paramedic 2] What did he take?

- [unknown woman] I don't know.

- Hey buddy?

- Do you have the bottle or something?

- What's your name?

- [unknown woman] I think these pills.

- What's his name again?

- [unknown woman] These pills, I don't know, I-- (muffled talking) (dispatch static) - [paramedic] He's never been known to use any?

Heroine or opioids?

I mean, he's not in trouble, it'll just help us treat him if we know.

- [unknown woman] No.

- [fireman] Where'd he'd get these?

- [fireman] So we go on a heroine overdose is how they put it out on the radio.

Unfortunately we've become so proficient at doing this we don't even have to talk to each other.

You know one of the crew members, one of my guys asked me one day, "What is the difference between people living and "dying from a heroine overdose?"

And I told him I said, "The only reason people live through "a heroine overdose is because "someone is there to call for them."

When we find a person dead it is usually because no one was there with them to call.

They stop breathing, their heart stops beating, and they pretty much die and go to sleep.

I mean, we found people that were blue, no breaths at all, heart rate 150, and that surviving patient we can administer the Narcan start to pushing it into their system through IV and easily enough they sit up, "What happened?"

And they're never, they've never used heroine.

This is always the thing, "I didn't use heroine."

We know.

It's hard to admit, for these people, that they used and that they're in this position, but we know.

- Drugs in rural areas are actually making what once was a very safe place, more dangerous.

Everybody thinks that drugs are only in the cities or suburbs but in reality, they're out in the country.

(foot steps) - [paramedic] Check his pupils.

See if he's breathing and he's got a pulse.

[Offscreen] The training for this is very important because we want to fight how we train and train how we fight.

A lot of that goes for how realistic the training is and how you can actually make a difference.

So what you saw was my partner and I going in from being dispatched into confirming that it was a heroine overdose or some form of opiod overdose.

Administrating the Narcan, performing the bag valve ventilations.

Waking them up and trying to keep them calm to the point that they understand what's going on.

In the rural setting, drugs could range from heroine, to fentanyl, to methamphetamines, cocaine...

But what a lot of people don't think about is the pills that are in our medicine cabinets that are prescribed to us.

A lot of people are abusing things like the oxycodone, morphine, gabapentin is one of them that's been pretty big these days.

Okay answer this honestly we are not the police I need to know have you taken any drugs today?

- I think as macho men no one really wants to address, they don't want to admit that these things bother them.

Over the years you've seen guys fall victim to alcoholism.

I've seen, since I've been on, known 5, maybe 6 guys that have committed suicide.

- Many of us, personal friends of mine, myself, you know, we have problems with alcoholism, drug abuse, ourselves.

We have, very few of us have positive outlets for it because it's tough to develop.

I mean this isn't stress from work in an office.

This is seeing people die and having lives in our hands.

- (chuckles) I mean you can see I've put on a little bit of weight, since I've been doing this, so, you know, unhealthy habits eating-wise, drinking is a very easy one to get into, thankfully I never got way into that, but I've definitely had those nights where you get home and you have a couple too many.

And definitely many peers.

I've had peers who have overdosed in the past, guys that struggle with alcohol use all the time, you know, I'm grateful that I didn't fall into those depths and I was able, I have a good support group that caught me.

- All right so tonight we're covering mental health and EMS.

I've been seeing things over the past couple of years and wanted to kind of get this topic started so I've been doing stuff the past five or six months, kind of looking into this.

If you guys want to give me your thoughts and opinions throughout the class just pipe up.

The more interactive we have it, the easier it is and the more fun it is.

The topic of mental health had been on my mind for a while and in May I lost one of my bosses, at the other agency that I work for, to suicide and...

Totally unexpected nobody saw it coming, nobody saw the warning signs, and that kind of made me jump into the, "let's look into this", "let's start talking about this".

I created a survey which almost 250 people filled out that sort of lead up to the class that I taught on mental health.

A few months ago one of my co-workers said, "Yeah we know we're all messed up, "why are we talking about this?

"Why do we need to know that, you know, "we all have issues about these calls?"

So I kind of wanted to get the discussion going and a lot of stigma about mental health and not being able to talk to people.

You know.

Here it says there's no shame in admitting that you're human.

I'm trying to bring about some discussion and make it so that (drowned out by speaker) - To watch an eighteen or twenty year old, their life slip away, and they had everything going for them in the world other than this issue, and now they've lost their life.

You can't fathom that.

You can't wrap your head around it and realizing how much it effects their families and themselves and watching the death toll rise.

It takes a huge chunk of your mental health not being able to do anything about it.

But to see young kids dying is probably the worst.

- This is going to take a toll not only on, you know, their career, but them personally and one of the biggest concerns we have is, not only are we just seeing people dying unnecessarily, we're going to lose a group of professionals because their careers will be cut short because repeated trauma like this and seeing it over and over and over again?

Burns people out.

You can't go to work everyday knowing that you're going to see a young person, who has no other medical problems other than struggling with whatever chemical that they're struggling with, die.

That's not something that you can have happen to you everyday in your career and expect that it isn't going to change you, and shorten what you do from a career standpoint.

- I find myself in a unique situation.

My son, Cody, died from a heroine overdose.

I work in the busiest company in the city that deals with heroine overdoses.

- I remember it like it was yesterday I got a phone call from a friend of mine who was working at the fire house that responded to Cody's overdose and told me that he had died.

- Cody got, I believe, addicted to heroine because when he was in twelfth grade he broke his foot in football and they prescribed him pain medication which ultimately lead to an addiction.

Then when he was working at Pizza Hut his manager decided, "hey, I got something "cheaper that works just as good", and that was it.

Once you do it you're hooked.

- I don't know how he does his job.

I don't know how he gets up everyday and comes here and he's constantly reminded not just from our calls but from calls throughout the city.

Overdose calls, you know, people unresponsive.

I don't know how he does it.

I think his desire to help people, and maybe save someone else's life, that's what motivates him, and I think that's what drives him, is just the hope and just the prayer that he could help someone else because he wasn't able to be there for his son through his overdose.

- My brother, Shawn, he was seven years older than I was.

His addiction started because of an injury, serval years before the big issue started.

He broke his ankle, and they started prescribing him the oxycodone.

The different pain medications to help him get through the injury and that kid of got him started on the path of getting addicted.

1408 copy.

CPR in progress with one Narcan on board.

When my pager went off, I got up just like I normally did because I wanted to go help somebody.

1408 copy.

CPR still in progress with two rounds of Narcan.

Fortunately stopped myself before I got to the front door and realized that was my brother in there.

And there was other people responding and I said, "that's my brother I'm not going in there."

Knowing that I can't see that.

Because I know I'd never be able to unsee it.

They worked on him in the house.

Tried Narcan, they gave him an IV, they intubated him, got him in the ambulance and took him to the hospital.

And I knew he wasn't coming out of it.

So now it was about how do I go and handle my parents?

And how do I handle basically getting ready for my brothers death?

It really didn't affect me until, I'd say probably about three months after, after the funeral was all done, after the condolences were done, kind of getting back into life.

I went on a call with one of our paramedics that ended up turning into cardiac arrest, and as soon as I was doing CPR on the individual, I look down and all I can visually see is my brothers face.

So I felt like I was doing CPR on my brother and I think it was just a subtle message in my brain saying, "you're not dealing with this appropriately."

And that really messed with me to the point that I actually was on the hairline of quitting EMS as a whole.

And that's when I went and got help, and said, "something is definitely wrong".

And if it wasn't for my co workers, or the volunteers here, pushing me, saying, "Go get some help," I probably wouldn't be here.

- This used to be a business.

Especially when I first started, where it was very, there was a lot of machismo, you know, it was very alpha, you know, you weren't allowed to be affected by this stuff.

Thankfully that's starting to change.

It's becoming more okay to talk about the fact that these things do wear on you.

Personally, I see a therapist.

I have been diagnosed with PTSD.

I'm not ashamed to talk about it.

I take medications and I talk about this stuff.

- Lately there's been a lot of talk about PTSD amongst the fire department, police department, fist responders.

I think this is the first time that people are starting to recognize that PTSD doesn't have to be a one time event.

It is actually an accumulative event of tragic things you've seen in your life and things that have happened.

Whether you're in the military, you're a police officer, you're an EMT, or a firefighter.

I'm sure doctors and nurses have it.

I think a lot more people that are in the service industry and help people that are in need may have PTSD at some level because it is taxing to see people suffering.

- [paramedic] Hey there how are you doing?

You nodded off there.

- [unknown woman] Yeah.

- [paramedic] Yeah you nodded off.

How much did you use?

- [unknown woman] (slurring) What do you mean?

- [paramedic] Couple bags?

- [unknown women] Yeah.

- [paramedic] All right.

Did you get anything?

- [paramedic] 128 on 72.

- [paramedic] That's good.

(dispatch beeping) - What I hear in the stories of first responders is that, we don't want to admit our own suffering.

And there's a kind of vulnerability that comes with saying this is really hard.

And it's really weighing me down.

If we can do that in community and make it an acknowledgement of our humanity, that we are human beings and that actually it's expected, as a human being, that we are going to have these kinds of responses.

Can help people be able to release it, rather than to have it accumulate day after day, week after week, month after month, in a way that eventually causes burn out.

(engine idling) - [paramedic] It's okay dear.

Hold my hand.

(woman crying) It's okay.

It's okay.

- [unknown woman] Sorry.

- [paramedic] No, don't be sorry, it's okay.

It's okay.

(woman crying) Slowly in through your nose and out through your mouth.

There you go honey.

Just relax it's going to be okay.

You're not in any trouble.

She said she did a couple of bags, she's been clean for a little while, but she's real upset right now.

- [paramedic] Did you guys give her anything?

No, she's got a needle on top of her purse.

- [unknown woman] (gasping) I'm sorry.

- [paramedic] It's okay.

It's okay.

It's going to be okay.

(woman crying) Just breathe.

(woman breathing) - How is it that we take people who sought out this work because of their compassion, because of their big hearts, and put them in situations that are devastating?

That an over time have accumulative effect upon how they feel physically, how they feel emotionally and also on their mind set how they see the world?

They see things that don't fit at times with their beliefs about how things should go, and that can be very difficult for people to process and make sense of.

So ultimately what seems to help people, is if they find someway of making the meaning of the experience and trying to either improve the system in some way, or help others that have been affected.

That seems to be a critical part of healing in the face of all this trauma and sadness that healers experience.

- I do remember coming to, aspirating and vomiting, and seeing his face carrying me down these stairs.

Two fire fighters were down in front of me with his arms underneath me, hooked, and then I went back out and I woke back up in the ambulance.

- Krista is a person that we saved, on Orchard street, I believe the street was.

She was friends with Cody.

- [Krista] John and Carrie Vagg and their daughters came to my wedding, and I got to share the best day of my life with them, and I would not be here without John.

I wouldn't have my son.

I have a one year old who's never seen me use.

I have a beautiful husband and a home and that's not where I was five years ago.

I was in jail and I had nobody.

- [John] I've seen you know one, (pastor speaking) good story in 200, you know.

The odds are so slim, that somebody actually makes it out and makes something of their life.

I'm very impressed to see that but I always worry.

As stressful as this job can be, that's what keeps me going personally.

Our hope that we can affect somebodies life positively and there's always hope.

I say it all the time, that hopes springs eternal!

And you never know what it is that can help them.

Maybe it's just a kind word, maybe it's a pat on the back, saying, "you can do this, you can help yourself, "you can get fixed," you know, and you never know and we'll never know and we don't ever find out, for the most part, if someone's helped themselves or made it out of this debilitating crisis that they're in.

(firetruck siren) But there's always hope.

(gentle piano music) (firetruck sirens) (gentle piano music)