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Q&A: Why the opioid epidemic is a fire service issue

Fire response to the opioid crisis is evolving to meet the demands, requiring additional training and protective gear


As hydrocodone and oxycodone have given way to heroin, fentanyl and carfentanil, throughout the country, fire and EMS responders are facing increasing opioid-related calls, which – more frequently than not – means an increased call load with the same or fewer resources as before.

Mark Lockhart, fire and EMS chief for Stafford County, Virginia, has seen opioid issues in his community throughout his seven years in Stafford and his 35 years in the fire service, but nothing approaching the seriousness of the current situation. 

As hydrocodone and oxycodone have given way to heroin, fentanyl and carfentanil, throughout the country, fire and EMS responders are facing increasing opioid-related calls. (Photo/NPR)
As hydrocodone and oxycodone have given way to heroin, fentanyl and carfentanil, throughout the country, fire and EMS responders are facing increasing opioid-related calls. (Photo/NPR)

Lockhart serves as chairman of the IAFC’s EMS Section Elections Committee and is a past chairman of the By-Laws Committee and past member of the Fire-Rescue-Med Conference Planning Committee. He’s been awarded the James O. Page EMS Achievement award and the Meritorious Service Medal Award, both from IAFC’s EMS Section.

He recently sat down with Fire Chief to discuss how the fire service is on the front lines of the opioid epidemic.

Fire Chief: Why is the opioid epidemic a fire service issue?

Chief Mark Lockhart: The fire service is an all-hazard service – if there is a threat to life or property, we are duty-bound to handle it when we are called. We can’t say “it’s not my problem” when called for a possible overdose.

The opioid crisis does not recognize socioeconomic, cultural, political or any other type of boundaries. Departments of all sizes and locations are seeing calls involving opioids across our country. We’re on the frontline of this one – there’s no two ways about it.

How has the role of the fire service in combating the opioid epidemic changed over the past few years?

Our role has evolved to meet the threat. The increase in the number of opioid-related calls is impacting already limited resources. In some jurisdictions, it has taken a toll on budgets, as some agencies have seen a six- or eight-fold increase in the cost of naloxone over the last several years.

In others, it has provided them with an opportunity to reach out to assist in addressing the issue in their communities. Some states have taken steps to allow EMTs to administer naloxone, and that has been a positive step forward in our ability to treat these patients.

How can fire departments partner with other agencies and organizations to combat the opioid epidemic?

Talk with your community service board or social service agencies and find out what is being done at the community or regional level to educate people on the crisis. Ask how you can support those efforts. Get a seat at the table to be part of the global solution in your community.

In our region, the local community services board utilized the FBI’s video “Chasing the Dragon,” and hosted a series of town hall meetings in the region and included a panel discussion (including fire and rescue representatives). It was a real eye-opener for those who attended. Many had no idea of the scope of the crisis here in our community. There is no single solution for this crisis – it has to be a team effort and the fire service must be involved.

How can a chief best prepare personnel for encountering opioids and overdoses?

Training, training, training – and appropriate protective gear. Your training should include the global view on the opioid crisis and how you can aid in addressing the overall issue in your community. This is a great opportunity for community partnership with social service agencies that may be able to provide training for your staff, or additional help or support to patients, particularly those you see more than once.

They need to be aware of the threat, both in terms of call volume, and the health and safety threat to first responders. They need to have the training resources and information available to educate their personnel on the global and the local impact this crisis presents. As part of that training, departments should be ensuring their personnel have adequate personal protective equipment available and appropriate procedures and protocols in place.

As we run these calls in a wide variety of settings, it is important our crews are provided with appropriate protective gear, including ballistic/stab vests if indicated. DEA, NIOSH and the InterAgency Board for Equipment Standardization and Interoperability have issued guidelines for first responders. The key is to be appropriately prepared – both through training and equipment.

What is the biggest challenge barring the fire service from having an impact on the opioid epidemic?

I think we are making an impact and we’re doing the best we can with what we have. In many cases, additional staffing would help in handling the increased call volume. Some agencies are running short on naloxone at times, so increased production (and more affordable pricing) would also help. We need adequate funding for the prevention and treatment of opioid addiction, as well as public education and the EMS response to this crisis.

This is a wide-reaching crisis and addressing it requires a team effort. We need social services, mental health, law enforcement, public health, elected officials and the fire service to work together as a team to address the issues at the community level. We can’t solve this on our own – we’re one piece of a much bigger puzzle and we have to work with our partners to make the greatest impact.

What does the future of fire department response to the opioid epidemic look like?

We’re in it for the long haul. This isn’t like the flu, where we see a season of opioids. This is a 24/7/365 threat that shows no signs of letting up. It will continue to present a clear and present danger to first responders, and we have to be proactive in being prepared. I hope that we will see well-coordinated team approaches to the crisis develop with active involvement by the fire service.

What else should fire chiefs know about the opioid epidemic?

These drugs are not just being sold, but also transported on our nation’s roads every day – especially fentanyl and carfentanil, some of which is coming in from overseas. A brick of either drug can easily be carried in a backpack, gym bag or shipped in a 12x12x12 box – and then cut to make hundreds of thousands of pills.

If you have a major interstate, shipping hub, port or other similar facility in your area, you may have large amounts of the drug passing through. Just be aware that the threat is not just from a single user overdosing.

That said, we need to be cautious not to over-react. Opioids can be absorbed through the skin (fentanyl patches are used for pain management), but I would suggest that the greater threat is the aerosolized powder form that could be inhaled through the mouth and nose when handling the patient or being close to product on the scene. Exercise due caution and take the appropriate protective measures.

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