A quick Google search of the keyword “opioid” will bring up over six million news stories – and that’s just during one specific time of the day.
Now, imagine those news stories and how they may be affecting fire and EMS departments worldwide. What we do know, according to the Centers for Disease Control and Prevention, is that 91 Americans die every day from an opioid overdose. Even more shocking is a new report that claims opioid overdoses could kill nearly 500,000 Americans in the next decade.
Fire Chief Christopher Snedeker with the North Beaver Township Volunteer Fire Department in New Castle, Pa., said his department started noticing an uptick in opioid-related calls last year. And, unfortunately, they haven’t slowed down.
The opioid epidemic
The opioid epidemic is a widespread issue; it does not discriminate based on urban or rural areas and it affects both career and volunteer fire departments.
Snedeker, who has been with the department for 12 years, was in the U.S. Marine Corps Reserve before joining the fire service.
“When I got out of boot camp, I was looking for something exciting to do and I was drawn to the fire department. I joined, got my EMT certification after I came back from a deployment in Iraq and I’ve been on the EMS side for about 10 years,” he noted.
Snedeker, who works in a warehousing facility and is also an EMS instructor, grew up in the area where he now volunteers. He was acting chief last year because the current chief fell ill. He officially took over as fire chief on Jan. 1, 2018. The department has about 20 active volunteer firefighters and 60 total on the department roster.
It wasn’t until last year, Snedeker said, that his department started seeing a difference in calls involving opioid overdoses.
“Before last year, we would get overdose calls, but a lot of those were either because it was a suicide attempt or someone who accidentally took too much medication. Then, all of a sudden, we started seeing an uptick.”
Last year, the department ran over 360 calls – which may not seem like a lot to a career department in an urban area. However, it’s quite substantial for their jurisdiction, which serves a population of 5,000.
For North Beaver Township Volunteer Fire Department, crews run about one or two overdose calls every couple of weeks. In comparison, a nearby fire department, according to Snedeker, runs about two overdose calls a day.
“For us, that’s significant compared to never having any.”
Many of the overdose calls, he said, end up being repeat patients.
“We’re going to the same individual multiple times and it usually doesn’t stop until, unfortunately, there’s that final time that someone didn’t find them quick enough and we’re unable to revive them.”
One of the biggest issues for Snedeker’s department, like many other volunteer fire departments, is staffing.
Answering the calls
The increase in opioid-related calls is adding a strain to an already limited department. The department is currently working with local officials to add a daylight crewmember to handle the increase in call volume.
“We are very limited during the day,” Snedeker explained. “A lot of our overdose calls are coming in during daylight hours when we are the least bit staffed.”
Snedeker said they have been lucky because one firefighter has a flexible enough job that allows him to answer calls during the day. Still, he’s not always available. “It’s not fair to have to make one guy leave work all the time and handle that all by himself.”
Another issue for the department, Snedeker mentioned, is making sure volunteer firefighters don’t burn out.
“For every five people that we bring in, we maybe get one that will stay. We try to do everything we can for the ones that are available and make sure that they’re not getting frustrated with running these types of calls.”
Snedeker said it’s key for a fire department member in a leadership position – whether they’re career or volunteer – to always have a positive outlook. “If I’m sitting there and complaining about these calls, then of course that’s going to rub off on them and they’re going to be miserable about it. Your members have to take cues off of you.”
He also said it’s imperative for firefighters to be compassionate. “We’re not the judge or the jury on who this person is or why they continue to do it. These people didn’t necessarily choose to end up with an addiction. I have empathy and sympathy toward them and their families – that’s the biggest motivation for me.
“I tell my firefighters to not even look at it as that person that you’re responding to every single time, thinking, ‘oh, why can’t they get this figured out?’ It’s putting it into perspective that you’ve got an entire family trying to get them off of this and that’s who we’re trying to help; we’re trying to help the family buy one more chance to get this person the help they need.”
Last year the county rolled out a program to help overdose patients get into a rehab facility. It is, however, completely voluntary if a person wants to accept the help or not.
Training requirements
The state of Pennsylvania has no mandatory training requirements for volunteer firefighters. In spite of this, the North Beaver Township Volunteer Fire Department does require firefighters go through the county’s fire department training.
“A lot of them have the option to get their Firefighter I certification after that and we highly encourage it, but we don’t make that part mandatory.”
Everything else, such as first responder and vehicle rescue training, is not required but still encouraged.
“We have been looking at possibly making some of the requirements a little more stringent,” Snedeker said. “I can’t be at every call; we need to make sure that the people we have responding know what they’re doing. We can’t afford to show up at an MVA and have people on scene without proper training and knowledge.”
All officers, Snedeker explained, are required to have firefighter training, vehicle rescue training and hazmat training.
“We have a couple that are finishing up their EMS certifications, so they will be trained in every facet that we do.”
For some volunteers, they are unwilling to accept that fire departments are running more EMS calls than ever before. “They don’t want to hear that we are more of an EMS department than a fire department. I’ve been trying to get more people medically trained, but I have members saying that they didn’t join to become an EMT. That’s the nature of what the fire service is now. You have to be trained in all manners – you can’t just say you’re a firefighter and nothing else.”
The department’s EMS personnel are trained to administer naloxone. Currently, the department carries one vial of naloxone. The department, which operates two stations, doesn’t have a second dosage of naloxone for multiple trucks.
“If we had a second dosage to carry on the other truck, then we wouldn’t have to always run to the one station to get the truck that has it.”
Backup during combative situations
Aside from training, Snedeker said in a perfect world, he would also like to see a system in place to make sure firefighters have backup while on overdose calls. Departments have to take into consideration that overdose calls can sometimes mean walking into the unknown.
“We don’t always have enough guys to respond, especially late at night. And we have to be very careful because when these people are waking up, some of them become combative. We haven’t had an issue yet, but there have been issues in other areas where they revive someone and they try to attack the EMS crew. You have no idea what you’re potentially walking into.”
The jurisdiction’s police station is also part-time. “If something bad were to happen when police weren’t on duty, then we don’t necessarily have the backup. That’s not to say that we need full-time police, but I just want to make sure that someone has our backs if we get into a situation where we have a combative patient.”
Snedeker also said he believes there should be some sort of mandatory detox or program in place to help people rather than just giving them naloxone.
“A lot of the times they refuse treatment; you just go, give them a dose of naloxone, they wake up and then they do it again a few days later.”
Snedeker acknowledged that it may not be the end-all solution to the problem, but “may be a better option than having people continue what they’re doing. I understand that it’s not a simple thing. Without the help, most people are not going to get that help on their own.
It’s also tough, because as a volunteer fire department, a lot of the people we’re dealing with are people we know in one way, shape or form. It’s not like a career department form a large city where you’re running these strangers every day; we know these patients. Some of them we grew up with, it’s hard to see them struggling.”
As a result, Snedeker said running the overdose calls can affect his firefighters differently because they’re a rural department.
“When it comes to someone you know or love, it’s not easy to separate yourself from the situation. It will take its toll on you if you’re dealing with these calls involving people you know. It hits you differently.”
Despite the challenges, Snedeker said firefighting and helping people is in his blood. The opioid epidemic has not sidelined his passion. As a matter of fact, it has made his job even that more important.
“It’s not every day, but we do get to see the impact we make by doing what we do. It’s very gratifying. There’s just something about being able to help someone.”
