Emilee Chinn

The Front Lines

2/28/2019

Local EMS can mean the difference between life and death during an overdose

Bennett Leckrone / Senior Writer

Rachel Fouts was on a routine run with an ambulance near Steubenville when she saw her first overdose.

Fouts, an emergency medical technician, and her team had just dropped off a patient at a hospital when a car pulled up next to their ambulance.

Inside the car, a woman screamed that her friend had just overdosed and needed Narcan, a life-saving drug that can treat narcotic overdoses.

“She knew everything,” Fouts said.

Before medics could ask any questions, the woman pushed a man out of the car and sped off. Fouts recalled that the woman nearly ran him over in the process. She thought the occupants of the car were afraid for both themselves and for the man who had overdosed.

“They didn’t want to get in trouble, but they wanted to help him,” she said.

The man was barely breathing, and although he wasn’t technically their patient, Fouts said she and her crew got him on a gurney and into the hospital.

Fouts, an Ohio University graduate, works with Athens County Emergency Medical Services as well as another department in Hopedale, a small village in Harrison County.

That overdose was just the first that Fouts would deal with. She isn’t alone in her experience: local EMS agencies in Athens County and in surrounding areas deal with overdoses on a regular basis.

The front lines

Ohio is in the grips of an opioid epidemic. More than 4,800 Ohioans died of unintentional drug overdoses in 2017, according to the Ohio Department of Health. That number represents more than a 1,000 percent increase from 2001, when just over 400 Ohioans died of unintentional overdoses.

The number of deaths would be higher if not for quick-responding emergency departments and Narcan, generically called naloxone, which can bring patients overdosing on opioids and narcotics back from the brink of death.

In Athens County, EMS responded to 74 reports of overdose from Jan. 1 to Dec. 31, 2018, excluding alcohol or unknown substances, Deputy Chief Tami Wires said. A total of 47 doses of naloxone were used on those patients.

Athens County EMS, along with police departments, are often the first on the scene of an overdose, Lt. Kayce Carrick said. Often, little is known about the situation until crews arrive on scene.

“Back when I started, we didn't have the overdoses we have now. I went almost half my career before I had to give my first Narcan dose.”Robert Sochia

Carrick said that often means EMS staff put themselves at risk to save patients.

“Safety is always key for our crews,” Carrick said, adding that patients can react in unpredictable ways when they are revived. “When you bring them back they can become very violent.”

Carrick said safety is a constant worry for her and other EMS leadership. Staff have been bit, kicked and punched on runs.

An epidemic of opioid use has gripped Ohio for years, but it is constantly changing. Robert Sochia has been working with the Athens County EMS for more than a decade and said he has seen both the prevalence of drugs and the method of use change over time.

“Back when I started, we didn't have the overdoses we have now,” Sochia said. “I went almost half my career before I had to give my first Narcan dose.”

According to the Ohio Department of Health, heroin use and the use of prescription opioids like painkillers has been on the decline in recent years. That void has largely been filled by fentanyl, an opioid that is 100 times more powerful than morphine.

Fentanyl, which is often mixed with stimulants like meth and cocaine, represents a challenge to EMS workers who are trying to revive overdosing patients.

Carrick said that as fentanyl has become more prevalent, so has the amount of Narcan that is used to revive patients.

“In order to combat fentanyl, it’s a very high dosage,” Carrick said.

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Emilee Chinn | PHOTO EDITOR

Robert Sochia (left) and Robert Brandenburg treat a patient before taking her to the Emergency Room at O'Bleness on Friday, Feb. 15.

Sochia echoed Carrick, adding that it takes more Narcan just to bring patients back to a livable level.

“Before, a single dose and they would be awake, walking and talking like nothing happened,” Sochia said. “Now we're getting sometimes ... two, three or four doses in until they're able to groggily wake up.”

Athens has multiple EMS stations and 43 full-time staffers, as well as various part-time staffers, ACEMS Chief Rick Callebs said.

Athens owes its EMS framework to a federal program to expand EMS access in the area that began in the 1970s and ended for Athens County in 2011 when the county created the ACEMS, Callebs said.

While Athens has enough stations and trucks to adequately cover the county with space to spare, some smaller counties deal with limited resources and all of the same problems.

Stretched thin

In Meigs County, three full-time trucks patrol the roads with two additional volunteer trucks providing support.

That situation is an improvement, Meigs County EMS Director Robert Jacks said. Meigs County has seen the construction of a freestanding emergency department since Jacks became EMS director in 2013.

That, along with having additional trucks, has been a “tremendous help,” Jacks said.

The county, however, still lacks a permanent hospital. That means the county sometimes goes without a truck as crews make the half-hour journey to Athens or Gallipolis to get patients the care they need.

“We have a lot of elderly, a lot of health-related issues in our county that we're kind of pulled away from at times because of the opioid epidemic,” Jacks said.

Limited resources in an economically distressed county can also lead to issues, Jacks said. Many patients cannot afford an ambulance and rely on Medicare or Medicaid to pay for their ride.

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Emilee Chinn | PHOTO EDITOR

Robert Brandenburg and Robert Sochia take a patient into the Emergency Room at O'Bleness on Friday, Feb. 15.

“Most of our patients are usually on Medicare or Medicaid, so we don't get fully reimbursed for those runs,” Jacks said. “It's a challenge to balance the books at the end of each pay period.”

Ambulance rides aren’t cheap: training, equipment and staffing quickly adds up. In Athens County, the charge for a basic life support run is $600, plus $11 for every mile that the patient is in the back of the ambulance, Wires said. Athens County EMS receives about $217 from Medicaid during this type of run, Wires said, but added that it depends on different types of Medicaid. ACEMS also receives about $7.50 per mile on most runs.

Wires said much of the bill is often “written off” due to contractual obligations with medicaid.

Despite challenges with funding, Jacks said Meigs County EMS does its best to keep both its patients – and themselves – healthy.

“Before the opioid epidemic they were in stressful situations,” Jacks said of his staff. “If you add the epidemic on top of that, they’re getting pulled in different directions.”

Meigs County EMS has tried different approaches to deal with stressful situations and mental health issues, Jacks said, including a stress management team and putting exercise equipment in the station.

EMS is one of the most stressful occupations in the U.S., according to the < a href="https://www.jems.com/articles/2017/05/the-stress-in-ems-effects-of-stress-on-the-unsung-heroes-of-the-ems-profession.html">Journal of Emergency Medical Services. On top of that, pay tends to be low.

“Left unaddressed, the resulting stress from crisis calls can result in mental or physical health problems many years later,” former Fire Captain Mark Lamplugh wrote.

Even despite the long hours, high stress and low pay, Jacks said EMS tend to be unsung heroes.

“It's not really recognized for the importance to our community,” He said.

The opioid epidemic has even caused misunderstanding among some across Ohio who question why EMS continue to revive people who have overdosed multiple times.

Why they revive

The use of Narcan to revive patients from overdoses has been questioned across the state, with some officials wondering why EMS agencies continue to bring patients back from the brink.

In 2017, Dan Picard, a city council member in Middletown City, Ohio, wondered if the city should continue responding to reported overdoses, according to the Dayton Daily News.

“I want to send a message to the world that you don’t want to come to Middletown to overdose because someone might not come with Narcan and save your life,” Picard said. “We need to put a fear about overdosing in Middletown.”

At the time, Middletown was reportedly on track to spend up to $100,000 on Narcan doses for that year compared to a budgeted $10,000. Similar sentiments have been shared across the state.

For EMS, however, there is no question as to reviving patients who are overdosing. Sochia said it doesn’t matter who is in need when there’s a job to do.

“We don't judge,” Sochia said. “We're here to treat someone. (Narcan) is one of the many things we have in our toolkit to take care of a person. We have a responsibility, and a duty, to do everything we can.”

The National Institute on Drug Abuse defines addiction as “a chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences and long-lasting changes in the brain.” It is defined as both a brain disease and a mental health disorder.

On the front lines of the opioid epidemic, EMS see and deal with that disease in a very real way.

Callebs said addiction is not something that warrants punishment, but rather treatment.

“Addiction is not something you can arrest yourself out of,” Callebs said. “You can't jail your way out of this problem. It's not a matter of taking people and arresting them. That doesn't get to the core of the problem.”

Callebs said that while EMS does not provide long-term services, they collaborate with Athens County agencies like the Sheriff’s Office and the Alcohol Drug Addiction and Mental Health Services Board to help get patients long-term care.

Dealing with drug overdoses and people struggling with addiction every day has changed the perceptions of many EMS staff, including Callebs.

“The drug epidemic issues we've seen in the past 10 years, they transcend gender boundaries, they transcend age boundaries, they transcend economic boundaries,” Callebs said.

Callebs said he thought the nature of the drug epidemic changed people’s perceptions and the societal stereotypes that had previously depicted addiction and drug use. Many people, Callebs said, got addicted to painkillers prescribed to them legally.

ACEMS Captain Jason Hager emphasized that paramedics exist solely to help people, regardless of their situation.

“That's why we do this job,” Hager said. “We're not here to say that you're a bad person because you do drugs.”

Sochia said he’s always been against drug use but added that his time with the EMS has changed his perspective on addiction and treatment.

“It can affect anybody,” Sochia said. “Any family can get caught by that dragon.”

Development by: Megan Knapp / Digital Production Editor

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