Countermeasures Season 1 Episode 5 Podcast Transcript: On the Front Lines of the Opioid Crisis
Matthew Burgan [00:00:02] I think when we talk about the way that the opioid epidemic affects the community, I think it’s our natural response as humans is to go to the negative. If we lose one person to an opioid overdose, that’s too many. But the caveat is we remind ourselves of the good. You know, we look at the partnerships that we have now that we would not have had before, and those partnerships blossom into other partnerships. And it demonstrates that there’s things that we can do. There’s a saying in the fire service, right, 300 years of tradition unimpeded by progress. And here we’re able to show that we can change the way that we respond to calls. And if we can do that for opioids, maybe there’s other things we can do that for.
Narrator [00:00:45] This is Countermeasures brought to you by Emergent. Join us as we explore the shifting complex world of the opioid crisis. In each episode, we’ll hear from makers of positive change as they recount personal narratives of loss and perseverance and offer a way forward to a better future. First responders have been on the front lines of the opioid epidemic and have witnessed the progression of the crisis firsthand. According to the CDC, nonfatal opioid involved overdose, emergency medical services or EMS encounters increased on average four percent quarterly from January 2018 to March 2022. As opioid related calls have increased, EMS has had to adapt to the new reality, but our responders receiving the training and resources they need to be successful. And how can EMS partner with their communities to help combat the opioid epidemic? In this episode, we hear from first responders across the country about their experiences with the opioid epidemic. We uncover what they are doing in their communities to combat this crisis and what they think needs to be done. The voice you heard earlier is Matthew Burgan, a community paramedic at Frederick County Division of Fire Rescue. When Matthew first began working as a paramedic, opioid related calls were rare.
Matthew Burgan [00:02:16] A palpable increase noted in the number of overdose related calls and specifically the opioid related. I remember we used to get dispatched on overdose calls, and it was a big deal. You know, they didn’t happen very frequently. So when one came in, you got pretty ramped up about it and now it feels a little bit like the urgency has been lost, perhaps.
Narrator [00:02:37] Kevin Joles, the division chief of EMS for Lawrence-Douglas Fire Medical in Lawrence, Kansas, and EMS chair of the International Association of Fire Chiefs, has also noticed the increase.
Kevin Joles [00:02:49] There has been an increase of overdose calls throughout my entire career. And it gets it gets worse and worse. For the last few years in my position here in Lawrence, maybe was a little bit in denial, hoping that it really hadn’t hit the Midwest the way that some of our constituents were saying it was. And the Kansas Board of EMS had done a study and it really wasn’t really prevalent here in the Midwest, specifically in the state of Kansas. And so I, I didn’t believe it. However, here locally, we do have we do have an issue and it’s become increasingly higher over the last maybe two to three years. I actually believe that now it’s not that I think it was just more of a denial as opposed to belief. I didn’t want our community to be experiencing that. But we do have an increased frequency in overdose here and in the area.
Narrator [00:03:37] As overdose related calls increase, so does the risk of compassion fatigue. Compassion fatigue is a term that describes the emotional and physical effects of consistently treating patients who are in distress or experiencing trauma, which can contribute to burnout, cause emotional withdrawal, and even impact first responders’ ability to perform daily tasks.
Kevin Joles [00:03:57] The opioid crisis has definitely taken its toll on first responders. I would say on both the coasts, probably a little bit more than the the Midwest. Everything takes a little bit longer to get out into the middle of the country. Sometimes that’s good and sometimes that bad, that’s bad. If it’s fashion, it’s bad. If it’s a crisis like this, it’s good. In all reality, it is taking its toll on first responders. You know the increase we have folks all of all over the country that are running hundreds of calls a day in the city of overdose. I would imagine that nobody comes to work every single day thinking I don’t really care if somebody overdoses today. We want to be able to help everybody, regardless of their situation, even if we’ve seen them 25 times in the same month. But it does take its toll and it makes it more difficult to give the best care. But I know that the men and women across the country certainly don’t start out their day hoping that they see somebody suffer.
Narrator [00:04:49] In order to combat compassion fatigue, jurisdictions like Matthew’s have mental health support for their responders.
Matthew Burgan [00:04:56] I do think that there’s probably some cases where our responders are experiencing detriments to their own mental health as a result of the cumulative stress associated with the EMS response. In our organization, we are very fortunate to have a behavioral health specialist on staff, and she’s able to interface with our responders, identify when those issues are arising early and engage with them and connect them to resources that are specifically designed to help us. But I also recognize that we’re very fortunate in that regard. And I don’t know that every agency across the country has that same level of access, and it makes me worried about the quality of mental health care that we’re providing for our own in in less fortunate jurisdictions. There’s more of an emphasis being placed now on responder mental health than there ever has been, but we’re still not quite to where we need to be as a profession. And until we can really get a grasp on the compassion fatigue that our responders are experiencing and again, I think the way to do that is through the educational element. I think we still run the risk of of having our responders trying to manage in less than healthy ways, especially in those jurisdictions that don’t have a very comprehensive mental health program for their clinicians.
Kevin Joles [00:06:22] Time and time again with every interview that we do for a new firefighter. We’re in the middle of a hiring process for a firefighter. We’re in the middle of a process for mental integrated health paramedics. And usually the statement that comes out of a new candidate’s mouth during an interview is, I want to help people. And when you can’t help people or you’ve given all you can to help that person and they refuse or they just can’t get out of their own way, it becomes difficult. And so there are stigmas and some biases that are put on people and it’s unfortunate. But again, it’s the employee assistance programs and the peer support systems that we have to lean on to be able to encourage our folks that they are making a difference. They may not feel like it, but at the end of the day, they gave that person one more opportunity to to get help. And one day we can just hope that it then it helps and we can continue to say, I want to help people. And when that when that drive goes away, that’s that’s the time that you have to start thinking about maybe doing something different.
Narrator [00:07:16] EMS responders are trained to respond to a wide variety of emergencies. However, Matthew believes that many first responders don’t receive adequate training on recognizing and treating opioid emergencies.
Matthew Burgan [00:07:29] I think that the training that an EMS professional receives is lacking a little bit. I look at the way that we train our new recruits in my organization when we hire a new class that’s about 25 to 30 people and they go through a pretty rigid, paramilitaristic style academy process that lasts about 26 weeks. And in that 26 weeks, the majority of the training that they’re going to receive is focused on fire suppression and rescue operations with a a small fraction of it focused on emergency medical care. And what’s interesting about our profession in particular, specifically the fire based EMS system, is that we train our personnel to win 100 percent of the time. There’s a a very influential speaker by the name of Simon Sinek, and he describes this as game theory, and he calls that the finite versus the infinite game. Our personnel are the finite players. We have no objectives. We have established rules. And they don’t really change when our responders go on a call. In their mindset, they are there to to resolve that emergency. And so when that doesn’t happen, in the case of substance use, where the focus is on recovery more so than it is on the resuscitation alone, it can be a bit of a challenge. It can be, as Simon describes it, it can be a bit of a quagmire because the patients that we’re treating, they’re playing an infinite game. There are no rules. There are no objectives. The the objective is to live one more day and to stay alive long enough to get into recovery. And so when you when you put that finite player, right, the responder against the infinite player who’s the the opioid use victim, you get a bit of a rub. And I think it’s a challenge that a lot of our folks don’t have a true appreciation for because we don’t properly train our responders in addiction. In the typical paramedic curriculum, which is anywhere from 1500 to 2000 hours, you may get an eight hour session on addiction. And most of that’s focused on the treatment of the overdose, more so than it is that alteration in the brain chemistry and the way that substances affect the normal processing pathways and the decision making processes that people experience when they are using a substance.
Narrator [00:10:06] First responders rule as vital members of their communities puts them in a position to be critical players in the fight against the epidemic. First responders across the country have partnered with community groups and advocates to ensure they are an active part of the solution. Safe stations as a recovery support program model run out of various fire and police stations across the country. One program runs out of East Providence, Rhode Island, where John Potvin is a captain.
John Potvin [00:10:34] So the Safe Stations program really was designed to be a beacon of light for folks that needed help. So we kind of thought of it as a beacon of hope or light in the darkness, you know, for folks that are suffering. And really, we were trying to come up with a system where people could find help rather than just being brought to the emergency room, and really just a method to find a way to connect and increase access for folks that needed to be connected with a recovery program and just dropping them off in the emergency department wasn’t doing that. So they’re available 24 hours a day, seven days a week, and they’re staffed with trained personnel, EMTs and paramedics. And the whole premise and focus is to provide access. So for somebody who says, you know, I’m ready now, I want to be you know, I want to get to recovery. They can show up at our station. They’re well identified. And not every community uses fire stations. Some other places use police stations. But in the city of East Providence, those are all located at fire stations. So when they arrive, basically they just say, you know, that I’m here for a safe station or, you know, basically some I mean, obviously, the terms that they use, you know, their own words, you know, so sometimes people say, you know, I’m here, you know, I have a problem and I want I want help. So we’ll do a medical screening, make sure that they don’t have any acute, you know, medical issues going on. And then rather than, you know, throw them in the ambulance. And bring them to the hospital. We will call the recovery program and they will send a recovery coach to the station. We will stay with them. And then they will be connected with the help that they need.
Kevin Joles [00:12:26] So a safe station is important, in my opinion, for the simple fact that we’re able to give somebody help who may not have the ability to make a phone call. They feel more comfortable doing it in person as opposed to over the phone. It gives them a person to talk to in person as opposed to over the phone. We have a lot of initiatives 988, being one of them across the country that gives people somebody to talk to in a time of crisis and then we can connect those resources. But sometimes those people don’t want to share where they’re at. They’re not comfortable having them come to the house where maybe somebody is feeding that abuse. So being able to get away from wherever they’re at in a time of crisis and be able to come to the fire station, which would be considered a literally a safe place is a positive, in my opinion, and just gives them an opportunity to to get away from the the bad in their lives.
Narrator [00:13:15] Safe stations are only one element in a much larger ecosystem of support being developed to help those with opioid use dependency and to support EMS responders. In Matthew’s community, they have seen success with their peer mentorship program.
Matthew Burgan [00:13:29] We have these tremendous relationships with so many different sectors in the community, public sector and private alike. Our agency, we actually do get to enjoy the benefits of partnering with a peer recovery coach from our local health department and that peer recovery coach for people that hadn’t heard that term before. Somebody that had lived experience with addiction. We get to partner that peer with one of our community paramedics and they go out on a unit that’s sole purpose day in and day out, is to respond on substance use related calls with the deliberate intent of being an added resource, taking some of the burden off of the responders and leveraging the experience of that peer to help make a connection with the patient in a way that our responders simply are capable of doing. A lot of our folks don’t necessarily have that lived experience. And if they do, and a lot of times it’s very different than what the patients are experiencing that we’re treating. But they’re peer they’ve been there and they know what that’s like. And so it’s it hits a little bit different when it comes from somebody that that understands. I almost equated to having some street cred for me to sit and talk with the patient and withdraw. Having never experienced it myself, it’s very hard to truly understand what that’s like. But when I work with a peer, you know, they’ve been there and they get it. And a lot of times they’re using their insight to help guide my decision making process and my understanding of of where the call needs to evolve to. So that relationship is phenomenal. And the success of that unit is predicated 100 percent on that peer and their instincts and their abilities. We are very, very fortunate to have that connection. But it doesn’t just stop with our peer for the health department. We have connections all throughout our health department, so other other facets designed to help connect people to state Medicaid. We have connections in our local homeless shelters. Our hospital, we have tremendous connections there and we’re able to leverage those resources when we’re out on call to help kind of navigate people away from the health care system that really, quite frankly, don’t need to be there.
Narrator [00:15:50] In East Providence, access to naloxone has been another vital part of EMS response to opioid emergencies.
John Potvin [00:15:57] So we try and have a nalox box which has naloxone in it and a mask and gloves placed in every public building alongside every automated external defibrillator, so that we then if somebody overdoses while they’re in a city building, there is access to naloxone. The other thing is what we call grab and no naloxone. So we have naloxone placed in 13 locations throughout our city where it is just there in a box. You can just walk up, take it. No questions asked. There’s a little pamphlet that’s in there with a QR code that you can scan. It shows you a video. There’s also an info infographic that shows you how to use it. And it’s not designed as a response to an overdose at the time. It’s designed just to increase access to naloxone. And I know for a fact that we’ve had three successful resuscitations with the grab and no naloxone because they told us when the paramedics and any EMTs arrived. I want to say that with our 13 locations, we’ve distributed probably two to 300 doses, I think, in the past two years.
Narrator [00:17:14] Education is also key in the fight against the opioid epidemic. And first responders are active in prevention programs as well.
Kevin Joles [00:17:22] Here in our community, you know, luckily we have a pretty darn good basketball team here locally, the University of Kansas, the Kansas Jayhawks and and so a lot of kids and younger folks and older folks who like really look up to those to those key figures in with some of the NCAA rules changing for the names and likeness. They’re able to be on a lot of commercials and be and a lot of public access opportunities. So they are sure they we use them. I don’t necessarily use them personally, but the University of Kansas is doing that a lot with their players and getting them out in the community. And so using those types of figures. We do speak at schools, high school and up some and occasionally at some of the younger schools and we talk about prevention on some things. We do have a community that is very engaged. And so any time that we have an opportunity to share what we’re doing, we do that. We look, we’re instituting one accredited health program to be able to educate and go around as well within the schools and start always going to be clinical. It’s going to be some education driven opportunities and tasks for that group. So I think that every community has opportunities specifically here. You know, we try to take every single opportunity that we can.
John Potvin [00:18:33] We also try and provide information on how to use safely, which again, I think a lot of times people who still have that stigma about this think, well, gee, why are you telling people how to use safely? Isn’t that just perpetuating the problem? You know, my goal as an EMS provider is to try and get them to not overdose and hopefully connect them with a recovery so they can get themselves well. You know, unfortunately, if they overdose, then we lose that opportunity. But I think, sadly, some people think like, you know, you shouldn’t give people tips on how to use safely. But we also one of the components of that is we give out fentanyl test strips so that if you do use or you know somebody that does use that you could test to make sure that what you have is actually what you think it is and it’s not laced with opioid because it seems like everything in our city that is bought illicitly is contaminated with fentanyl. And one other thing that we give out is we have it almost looks like a bank envelope, like one of those little cloth envelopes with a lock on it that people can lock up their prescription medication. And realistically, it’s just keeping the honest people honest because you could cut it open. However, it does limit access, especially to younger folks are prescription medication. So we’re really trying to fight this epidemic from many different angles, you know, from the prevention with the community events and the education.
Narrator [00:20:06] In all of these communities, there is an abundance of things being done to support first responders, community members and those with opioid dependency. While we couldn’t cover them all in this episode, we encourage you to visit the show notes to learn more about what these communities are doing. While the opioid epidemic has had lasting impacts in communities across the country, Matthew endeavors to try to see the positive changes that have happened as the understanding of opioid use and dependency increases.
Matthew Burgan [00:20:35] We launched our our co-response pilot in October of 2020 and within a year of launching that, one of our law enforcement partner agencies launched a very similar co-responder model with a social worker. You know, I look at the positives, and that’s certainly one of them, right? The the outreach, the engagement. You know, we we haven’t necessarily done a great job of that in the past, and now we do. And so, you know, again, I think it’s tragic as the opioid epidemic is one of the ways that we can kind of abate that is is by also, you know, focusing on on the good that’s come out of that as well. We saw it with our co response model. When we started interacting with our responders and they would meet the peer recovery coach for the first time. You know, on the surface, it sounds a little bit ignorant, but but there’s a sentiment here that that I think really hits home or anything. I would hear people in the field say to me all the time, “Matt, that’s that’s a that’s a peer. They look normal.” And, you know, again, on the surface is a very ignorant comment. But what it tells me is that they’re starting to see what recovery looks like. And that’s not something we’re accustomed to. You know, people don’t call EMS on their best days. They they call them when the crisis is happening and they call them when things have gone sideways. And so we never get to see the good. We never get to see the recovery. The only thing that our responders ever get to see is the result of the act of addiction. And so one of the unintended consequences of our our partnership with our peer recovery program was our responders got to see success. And I think for a lot of people, getting to see that was was huge. You know, it’s again, not something they were accustomed to. So when they see a peer, it validates to them and the peers, to their credit, they do a huge job of validating it to all of our peers are very open about their experiences and they’ll be the first ones to point out, even before our responders can ask, that it was the role of the responder that helped get them into recovery. And that is just awesome to sit back and watch. I think if we had a little bit more of that kind of positive reinforcement, I think that could go a long way in addressing the compassion fatigue element as well.
Narrator [00:23:07] First responders continue to respond to overdose and opioid related calls across the country every day. Most responders have not received comprehensive training on opioid dependency and compassion fatigue is a real risk. Many responders work long hours and may not have access to services to help them cope with the realities of working in EMS and might not have a robust understanding of the realities of opioid use and dependency. But positive change is happening. Programs like safe stations, peer mentors and other preventative programs have become a central part of combating the opioid epidemic at the community level. Responders like Matthew, Kevin and John are critical to the fight against the epidemic. This episode is dedicated to all the responders who work tirelessly every day to keep our communities safe. Thank you to Matthew, Kevin and John for sharing their experiences. To learn more about the programs in each community, visit the links in the show notes. Thank you for listening to this episode of Countermeasures. To learn more about what Emergent is doing to address public health threats like the opioid crisis, visit emergentbiosolutions.com. If this episode resonated with you, consider reading and reviewing Countermeasures on your preferred podcast platform.