Opioid epidemic strains Ohio responders
Responders are starting to see calls from the same individuals multiple times for both overdoses and other health issues
By Michael Cooper
SPRINGFIELD, Ohio — Veteran Springfield firefighter-paramedic Tristan Walker responded to a call on Feb. 3 to a familiar address on Perry Street — a young woman she’d revived from overdoses twice in December.
Walker had advised her that she might not make it the next time — especially with nearby Fire Station No. 5 closing at the beginning of the year. On this chilly February morning, the woman didn’t survive, one of three people suspected to have died from overdoses that day.
“You just kind of hope they get it,” Walker said, “but it’s hard. I wouldn’t be in this job if I didn’t care about people. If I didn’t care about people, I’d do something else.”
Public safety forces in Springfield responded to at least 130 drug overdose calls last month, which local leaders said has stretched resources and strained first responders physically and emotionally.
The Springfield News-Sun rode along with medics earlier this month to get a first-hand look at the epidemic.
The Springfield Fire-Rescue Division administered in January 250 doses of nasal Naloxone, the drug commonly referred to by its brand name Narcan, which reverses an opioid overdose. Springfield medics had never given more than 100 doses of Narcan before last December.
Between Jan. 27 and Jan. 30, the division responded to 36 overdoses and used 48 doses of Narcan.
“It’s clearly way above anything we’ve ever seen before,” Fire Chief Nick Heimlich said.
Nearly a third of the calls the Springfield Police Division responded to last year involved overdoses. Last year the division’s overall calls for service increased by 7 percent, Springfield Police Chief Steve Moody said.
“It impacts every thing we do,” Moody said.
There have been 18 suspected drug overdose deaths since Jan. 1, Clark County Coroner Dr. Richard Marsh said, but he’s still waiting toxicology reports to confirm those. The majority of drug deaths in Clark County last year involved multiple drugs, including illicit synthetic fentanyl — 50 times more powerful than heroin.
“We’re just trying to keep up with them,” Marsh said. “They’re running my investigators ragged.”
Walker will soon start her 14th year with the fire division. In the past few months, the calls for overdoses have become routine, she said.
“It’s the worst ever,” Walker said. “It’s never been this bad. It used to be you’d have an overdose every now and then, but everyday we’re going on overdoses … There’s just a lot of people dying.”
Springfield medics distributed 794 doses of Narcan in 2015. Last year, the number dipped to 776, but 143 were distributed just in December — the first time it had used more than 100 in a month in the past two years. Patients often receive more than one dose during an overdose.
The cost of heroin and fentanyl is cheap and the supply is high, Heimlich said, and fentanyl appears to cause the majority of the overdoses and suspected drug deaths.
“Before they were just high, now they’re stopping their breathing and that’s not OK,” he said.
The division, which has 127 firefighters and an annual budget of about $13 million, has started seeing calls from the same individuals multiple times for both overdoses and other health issues.
“It’s just like everything else with the epidemic — it’s the iceberg under the water that you can’t see that’s just gigantic,” Heimlich said.
In the moment, firefighters can revive overdose patients, he said, but they’re not able to help them solve larger substance abuse issues.
“That repeat exposure is very frustrating, it’s disheartening, it’s stressful, when you see people repeating those behaviors that you know are life-threatening and eventually end up taking their life,” he said. “We can’t enforce that decision [to quit] on anyone, so we’re between the rock and a hard place and that just wears people out. It just grinds you down.”
TAXING THE RESOURCES
It’s 9 a.m. Thursday, Feb. 2 — Groundhog Day. The firefighter-paramedics of Station 1 in Springfield have already been on one run on this crisp morning, just two hours into a 24-hour shift.
On this day, two medic units — Medic 1 and Medic 5 — both run out of Station 1. Medic 5 had been assigned to Station 5 on Commerce Road, which closed earlier this year.
In its last shift, the crew saw two overdoses, a light day based on recent run volumes, said Capt. Dan Faust. One day last month the two-person medic unit ran on nine overdoses in one day, he said.
“We all realize the type of illness this is once somebody’s addicted to heroin,” Faust said. “It’s just very difficult to change that and there’s a lack of resources in this community for an epidemic on this level.”
In 2015, the Springfield Fire-Rescue Division saw a 23-year high for EMS runs with more than 17,000. Last year, the division’s calls dipped to about 16,500.
The toll of staying up 20 out of 24 hours every third day can affect firefighters mentally, physically and emotionally, Faust said, driven by the number of overdoses and overall call volume.
Firefighter-paramedic Scott Kauffman prepares the Medic 1 ambulance as he and partner Matt Porteus waits to be dispatched.
The overdose runs are sporadic, Kauffman said. Some days they’ll see one or two, other days five or six. Throughout the city, he there have been as many as five or six overdose calls at one time.
“It taxes the resources,” Kauffman said. “That’s five different units who have to run on those calls.”
The volume of overdose calls can take its toll, Kauffman said. When they hear one, he said they often hear several others.
“It’s the workload and seeing it over and over again,” Kauffman said. “It can get tiresome, especially seeing how it affects family members, young family members. It doesn’t discriminate. It’s the very affluent or the very poor.”
AROUND THE TABLE
At 9:25 a.m. Feb. 2, a call comes in for a medic at a local surgical hospital for an 87-year-old man with shortness of breath. Kauffman and Porteus give the patient a breathing treatment and an IV in the ambulance before transporting him to the emergency room at Springfield Regional Medical Center.
A few minutes later, they’re in the EMS room — a place where medics can decompress and complete incident reports after an incident — at the hospital filling out a report.
Another medic from one of the townships enters after dropping off another patient.
“You have any overdoses yet?” he asks.
By 10:45 a.m., they’re back en route to Station 1.
At noon, lunch awaits. It’s a menu of a bratwursts with green peppers and onions and a side of tater tots. Minutes before food is served, Medic 1 is called out onto another run for assistance at a local nursing home. The crew won’t eat lunch until after 1:30 p.m.
A few minutes later, Medic 5 — operated by Scott Rupp and Cody Gleason — is called to investigate a change in mental status at a home on Emery Avenue. The patient was arguing with home health care workers and family members and later refused treatment, meaning Medic 5 was quickly back at Station 1.
As lunch begins, the crew sit around the table talking about everything from run volumes and to whether the groundhog saw his shadow.
“I heard on the radio this afternoon he’s only been right six out of the last 29 years,” Gleason said.
Later that afternoon, Kauffman and other crew members work on inventory for a new system that will be installed in the coming weeks. Other crew members work on a design for a new table that will include a new emblem.
For several hours, the radio is silent — not just at Station 1, but across the city.
“This is super rare,” Kauffman said.
A few hours later, the medics at Station 1 will run on two more overdoses in the city.
'PEOPLE ARE FRUSTRATED'
Last year, the police in Springfield responded to 353 calls involving overdoses, a more than 17 percent increase from 2015.
In 2017, the police division is on pace to respond to more than 1,600 calls involving an overdose.
It has an effect on operations, Moody said, because each call is a priority call, meaning officers may leave a lower priority call, such as a theft, to help medics respond to a life-saving situation.
“People are frustrated because they’ve called the police for their issue, which is important to them,” Moody said.
Officers respond to the same address multiple times for the same person, he said, similar to medics. During training this year, a mental health expert will speak with officers about how to recognize and address secondary trauma from a range of calls.
“It’s the job we do,” he said. “You don’t realize the effect it has on you. We want to make sure the guys and gals are aware of the signs. It’s tough.”
Few people face criminal charges from overdoses, Moody said, because Good Samaritan laws in Ohio provide immunity to both the person who overdosed and the person who called 911. The law is intended to discourage people from leaving someone who overdoses to die out of fear of an arrest.
The law is good for just two overdoses and not applicable for parolees. It also says the overdose patient must seek treatment within 30 days.
Police and prosecutors are reviewing those laws, Moody said, and could start charging more people.
Last year Clark County county saw 68 overdose deaths through November, Marsh said. Since that time, 19 more deaths might be drug-related, he said, meaning the number could eclipse the record set the previous year. In 2015, Clark County saw 73 drug deaths.
Reports from several of the drug deaths from last year are still being completed by the Montgomery County Coroner’s Office, Marsh said. The facility in Dayton recently had to find more space for bodies because it was overcrowded.
“They’re just getting hammered,” he said.
THE NEXT DAY
At 7 a.m. the next morning, a new crew arrives at Station 1. Shawn Anon and Robert Pennywitt will operate Medic 1, while three more firefighters — Tristan Walker, Bart Berner and Felix Shanahan — will operate Rescue 1.
The crew is in training until about 9:30 a.m. The first run of the day is to a local shelter for a man dealing with alcohol withdrawals.
After the run, the firefighters sit around the dinner table, writing reports and talking about their day. Walker is preparing breakfast bacon and pancakes for the crews.
A half-hour before lunch is ready, an ambulance and a fire engine is called to respond for a non-breather at a familiar address on Perry Street. Many of the medics — including Walker and Pennywitt — have been to the address several times before, including three times in one week in early December, according to police reports.
At 11:40 a.m., Anon is the first medic on scene at the small apartment with three air mattresses and a TV in the living room.
The woman is dead on arrival. She was later identified as Danielle Napier, a 27-year-old Springfield resident, according to a police report. The coroner is still investigating her death but it’s believed to be drug related.
Friend Deanna Howard said she believed both opiates and other health issues played a role in her death. She was recently dealing with a health issue at a local nursing home.
Howard has custody of Napier’s 5-year-old son.
“I’ve done everything under the sun to help this girl over the last year,” Howard said.
Walker had been to the address twice before and spoke with Napier both times, she said.
“I said, ‘We’re going to be on you and you’re going to dead,’ which is exactly what happened,” she said. “It got to me because we go on people over and over. You just hope that something sinks in and it didn’t work … It’s just really sad.”
There are several other people in a similar situation, Walker said. She knows she’s going to get called on another run and see them dead as well.
“Right now, it’s horrible,” Walker said. “It’s every day. It doesn’t matter what you say to people, it’s like they don’t believe you.”
Pennywitt — a veteran of 23 years at the Fire-Rescue Division — had also been to the same address multiple times. He’s been on runs to other locations in Springfield multiple times and described it as “senseless,” Pennywitt said.
“Eventually, it’s going to get them,” he said. “It’s just a matter of when.”
The National Fire Protection Association has more than 130 standards for fire services and emergency responders, Segment Director for First Responders Ken Willette said, including an occupational safety and health program for fire departments.
The standard includes behavioral health and wellness, such as peer-to-peer counseling and employee assistance programs; however, departments aren’t required to implement such a program, he said.
About 20 percent of departments have a mental health program, according to an NFPA survey completed in 2015. It’s becoming an issue as suicides and post-traumatic stress disorder have increased in recent years, said Willette, who spent 35 years in the business.
It can be difficult for firefighters to see the same events multiple times, he said, even for veterans.
“You begin to question a lot of things about people and life,” Willette said.
Springfield’s fire division doesn’t have a formal policy, Heimlich said, but it has addressed mental health in the past, including training on the issue over the years.
After a response, firefighters are often able to talk about the incident around the table after returning to the station, Heimlich said. They work in teams of multiple people, he said, unlike police officers who are often by themselves.
“The team function really builds in a system of support in our world that doesn’t exist in a lot of those other public safety environments,” Heimlich said. “It’s consistently the same people. When they’re watching out for each other, that’s exactly what happens — they watch out for each other.”
Copyright 2017 Springfield News-Sun