Firefighters carry a variety of tools that can help them save lives in emergencies. The latest addition to that kit: easy to administer doses of the anti-overdose drug Narcan.
“It's amazing,” said Worcester Fire Department Chief Michael Lavoie. “In 2016, we had 737 incidents involving opiates, and we administered 241 doses of Narcan.”
It frequently falls on firefighters to administer the drug, because they’re usually the first on the scene in the case of emergency.
“The quicker you can get Narcan onboard a patient the better. Firefighters and fire departments are spread out strategically,” said Lavoie. “We can get there usually faster than both police and the EMS.”
Chief Lavoie says the frequent overdose calls can be difficult and dangerous. One of his firefighters got stuck by an addict’s needle as he was attempting to revive her. Some of new synthetics hitting the streets, like carfentanyl, are so potent that first responders can overdose themselves, just by touching them. In fact, Lavoie says, the firefighters have doubled the amount of Narcan they carry around, in case they ever need it themselves.
Now the firefighters are being asked to do more.
A few months ago, the city’s commissioner for Health and Human Services, Dr. Matilda Castiel, asked Lavoie how the fire department could participate more in outreach programs for addicts. She wondered if the fire station could become a place where addicts could go for a referral if they were looking for assistance.
“I thought that could possibly work down the road,” said Lavoie, “but we needed first to educate our firefighters.”
That education started last month, led by the commissioner herself. Castiel is a physician with a background in emergency medicine, and during the training she delivered a lecture on the neuroscience of addiction as part of a session titled, "Addiction — It's not a Choice, It's a Disease."
“I want people to understand that this is a disease that needs to be treated. If we take the stigma out of this then people will start talking more about it,” said Castille, between training classes with groups of firefighters.
She added that she was encouraged by what she heard from the firefighters during the sessions. “Five [or] 10 years ago you wouldn't see anybody raising their hands and saying, … 'You know somebody, my family or a friend of mine has [an opiate addiction],’” she said. “That wasn't even a topic that you talked about. The fact that that's even happening now, it's huge.”
At times though, the clinical approach clashed with what the firefighters say they experience in the streets.
Lavoie regularly meets with each of his fire crews, and a few days after the training, I sat in as he debriefed with the firefighters of Engine 4, who serve the area of town where overdose calls are most frequent. Some of the firefighters pushed back on the notion that they needed to work at humanizing addicts in the context of their job.
“To humanize the addict for the common Joe, that's fine,” says firefighter Ben Dio, but “to humanize the addict to the person that has to go to the addict four times a shift? You’re stripping away his armor. You're stripping away his ability to do a good job for the ten addicts he's gotta go to next week, because to humanize every addict, to humanize every patient means that we take on a little bit of that pain. Because it does tear you apart, you can only go to so many broken homes so many times.”
As Dio went into more detail, it became clear why he didn’t need additional training to humanize drug addicts.
“My sister-in-law died from a heroin overdose. We were her foster family, took care of her growing up, and it was one of the hardest things,” he said. “She died on 60 days sober, moving into her sober house. She just had a bad day and pressure got to her. She relapsed and the relapse is what killed her. So, you know, this epidemic touches everybody on every level. It really does.”
Dio saids this wasn’t always the case. Before he was a firefighter, he worked as an EMT, and over the years he has witnessed a change, as synthetic opiates became more common.
“When I first started EMS, the people you were getting for heroin would've been your street people, the stereotypical junkie," he said. "And then you started seeing the oxycontin. Nobody was calling it opiate overdose. It was kids doing pills. “
Just as Dio tells me this, a call comes in for a possible OD.
I jump in the engine with the crew, and we drive to the scene. There’s a car parked on the side of the street, with an unresponsive man slumped back in the driver’s seat. The track marks on his arms are visible 20 feet away.
The crew gently lifts the man out of the car, stretch him out on the asphalt, and check his vitals. He’s barely breathing. They set up oxygen, while one firefighter pumps a breathing bag. Another firefighter delivers a dose of narcan into the man’s nose.
Not more than a couple of minutes later, the man sits up, awake and alert, as if he just woke up from a nap. Confused, he looks around at the crowd of first responders and onlookers, some of whom applaud. By then, EMTs have arrived with an ambulance, and the firefighters give them a debrief. They help the man to his feet. And though he couldn’t breathe on his own moments earlier, he walks himself into the back of the ambulance.
And that’s it. The firefighters barely have their seat belts on before the next call comes in. This kind of scene is now part of their routine — sometimes a single crew can get several overdose calls in one shift.
“You can get Narcan out to the people, and that's great because a little shot of Narcan can keep somebody alive one more day to try to get to the help they need,” said Dio. “But [there’s] just no good answer right now.”
In the meantime, Lavoie says overdose calls for the Worcester Fire Department are actually on track to be down in 2017, but it’s not a sign the addiction problem is getting better. He says among the factors causing this decrease are more cases of friends and family privately administering Narcan, and other addicts simply dying outright from the more powerful opiates that are now on the streets.
