Q&A: How is the opioid epidemic impacting first responders?
A section chief from St. Louis considers the scope and impact of opioid response on EMS providers and the role they play in combating the crisis
This feature is part of our Paramedic Chief Digital Edition, a regular supplement to EMS1.com that brings a sharpened focus to some of the most challenging topics facing paramedic chiefs and EMS leaders everywhere. To read all of the articles included in the Winter 2018 issue, click here.
By Kerri Hatt, EMS1 Senior Editor
As opioid overdose death rates rise across the nation, communities are implementing new strategies and collaborations. Widespread dissemination of naloxone – from local pharmacies, to families of overdose patients, to local distribution drives, has led to an increase in usage by non-EMS providers. Even insurance companies are waving copays.
Some cities are impacted more than others. Figures from the National Council on Alcoholism and Drug Abuse indicate a dramatic increase in opioid-related overdose deaths in the St. Louis area. Overdose deaths increased nearly 20 percent in 2016.
David K. Tan, M.D., EMT-T, FAAEM, FAEMS, is EMS section chief, Division of Emergency Medicine, at Washington University School of Medicine in St. Louis. He recently shared his perspective on the impact of the opioid epidemic on first responders.
EMS1: Though experts advise the actual risks of fentanyl exposure are low, regular reports of exposure and resulting illness risk are spreading hysteria. What can EMS leaders do to better educate providers?
Dr. Tan: When reporting incidents of mysterious illness associated with possible exposure, we must always temper our comments with solid facts and avoid sensationalism. Remember the true opioid toxidrome:
- Altered mental status, including coma
- Respiratory depression, including apnea
- Pinpoint pupils
Many of the illnesses reported in the mass media do not fit these criteria. While the victims in these stories are probably suffering from some sort of exposure to a hazardous substance, the reactions don’t often fit the opiate profile. We should take every opportunity to remind EMS providers of the importance of basic scene size-up and the use of sensible PPE, given the sum totality of any circumstance. We can spread a consistent message of tempered vigilance with common sense.
What’s the obligation of EMS directors to prepare their personnel for responding to an opioid incident?
Our clinical educators must ensure all EMS personnel are properly trained on the opiate toxidrome and specific PPE that can and should be used on every call. Our EMTs and paramedics should be expert at listing routes of exposure and effective ways of protecting themselves from such exposure.
Again, it goes to common sense scene size-up, as well as being smart about knowing what's in the community and raising awareness among all personnel about what the agency expects regarding response to overdose calls and what to do when encountering potential hazardous materials.
Most agencies also incorporate post-exposure prophylaxis protocols for incidents of hazardous materials exposure.
How are first responders being specifically impacted by the opioid epidemic?
The biggest risk to first responders is actually in responding to these calls. The National Highway Traffic Safety Administration released a report in April 2014 that provided an overview of the number of ambulance accidents in the United States. Key findings include:
- Over a 20-year period, there were an estimated 4,500 accidents involving ambulances each year.
- 35 percent of accidents resulted in injury or fatality to at least one occupant of a vehicle involved.
- An average of 29 fatal ambulance accidents produced 33 fatalities each year.
Opioid overdose patients often are not breathing or have already gone into cardiac arrest, making these emergencies a top priority for responders. But, just getting to the scene is risky.
Once there, additional risks ensue to include exposure to communicable diseases, contaminated needles, and occasionally violent patients and family members.
Does the opioid epidemic pose a risk of compassion fatigue for front line providers?
Interestingly enough, compassion fatigue can mean caring too much or an inability to care any longer. Most researchers cite the former with Charles Figley, a pioneer in compassion fatigue research, defining compassion fatigue as "the stress resulting from helping or wanting to help a traumatized or suffering person." Others use the term compassion fatigue to mean burnout with an almost apathetic approach to patients on every call.
Either way, both states are risks associated with first responders due to their immediate contact with the traumatic event. Sometimes, the difference between burnout and compassion fatigue is not as clear for emergency service personnel, and their daily exposure to the tragedies of the opioid epidemic begin to eat away at them. The impact is real, and while vehicles can be replaced for wear and tear, it isn't as easy to replace people who see the grim reality of these overdoses daily – sometimes several times a day.
What’s your biggest piece of advice for EMS providers combating the opioid epidemic?
I would encourage EMS providers to make sure to look after one another. EMS is a difficult and often thankless role that can lead to job stresses that spill over into the home and family. This must be avoided. Making sure colleagues and other coworkers get the mental health assistance and support needed, if indicated, is essential to prevent first responders from becoming the second victim of the opioid epidemic.
About the author
Kerri Hatt is senior editor, EMS1, responsible for defining original editorial content, tracking industry trends, managing expert contributors and leading execution of special coverage efforts. Prior to joining Praetorian Digital, Kerri served as an editor for medical allied health B2B publications and communities. She can be reached at firstname.lastname@example.org