N.H. first responders to make house calls for drug treatment

NH Project FIRST enlists “quick response teams” to return after an overdose call and offer to connect individuals with services at their local treatment hub

Shawne Wickham
The New Hampshire Union Leader, Manchester

First responders have been on the front lines of the state’s drug crisis from the beginning, responding to overdoses, saving lives with Narcan and transporting patients to emergency rooms for care.

Now they want to do even more.

NH Project FIRST is a Mobile Integrated Healthcare (MIH) program for first responders.
NH Project FIRST is a Mobile Integrated Healthcare (MIH) program for first responders. (Photo/NH.gov)

A new program allows communities to set up what some are calling “mobile Safe Stations,” a nod to the successful programs in Nashua and Manchester that encourage individuals to walk into any fire station and ask for help with substance use disorders.

NH Project FIRST (First Responders Initiating Recovery, Support & Training) enlists “quick response teams” to return after an overdose call and offer to connect individuals with services at their local treatment hub, such as medication-assisted treatment, counseling and recovery support. Teams also will teach family members how to use rescue breathing and Narcan to revive an overdose victim.

Paula Holigan is program manager for Project FIRST, which is funded through the federal Substance Abuse and Mental Health Services Administration (SAMHSA). A firefighter and advanced EMT, Holigan said first responders are ideally suited to make these connections. “People open their homes to us,” she said. “They trust us; they respect us.”

It’s a voluntary program; individuals have to agree to the initial home visit and any treatment services, she said.

Five New Hampshire fire departments are the first to receive grant funding — and each is taking a different approach.

• In Concord, all first responders will go through training, and a full-time program coordinator will be hired;

• Epping’s team will respond to any of the 35 towns in its Seacoast mutual aid group;

• Laconia is adding a recovery coach to work with individuals and families;

• Hooksett is creating a dedicated team to offer prevention and treatment help;

• And in Dunbarton, fire and police personnel will both participate.

Concord Deputy Fire Chief Aaron McIntire said his city had looked at the Safe Station model, but it wasn’t feasible. Concord has four fire stations, staffed by 21 people at any given time. And with an average of 9,000 service calls a year, he said, ”Our firehouses are empty most of the time because the crews are out on calls.”

What does work is the city’s mobile crisis team that responds to behavioral health emergencies, McIntire said. And that’s what they plan to model their new Project FIRST team after.

“We’ve found people are most vulnerable to change when they are in crisis,” he said. “Everybody has that moment when they’re ready to say, OK, I’m willing to change.”

And when EMTs have just revived someone from an overdose, he said, “That’s when we want to be able to say OK, we’re going to take you up on that.”

Lt. Brian Keyes has already been doing this kind of work as the recovery coordinator for the Laconia Fire Department, working closely with the police department and recovery community. The new funding, he said, will allow him to bring in a second recovery coach.

Keyes said he’s seen how successful this approach can be. Of the 126 individuals he’s been in contact with since 2016, 82 are in long-term recovery. “What I’ve learned is no one wants to be doing this,” he said. “Everyone wants a way out.”

“We don’t give up on anyone,” he said.

Friday afternoon at Hooksett’s public safety headquarters, a half-dozen firefighters and EMTs sat around a conference table as Holigan and Laurie Warnock, the program instructor, walked them through how Project FIRST will work. Warnock told the team they are the “first step” toward getting someone into recovery.

“You’re the first person they may be encountering who’s saying there’s stuff out that may be able to help you,” she said. “This is where they’re at right now. You’re helping them to get to the next point, or at least see a path to the next point.”

Hooksett Fire Capt. Joseph Stalker credits Manchester for pioneering the Safe Station model. “They took a lot of risk, and essentially, I think, paved the way for first responders initiating that recovery treatment help that traditionally we haven’t done,” he said.

His department tried the Safe Station model but ran into the same challenge as Concord, Stalker said: When crews are out on calls, the Riverside Street station is empty. Project FIRST solves that problem by bringing help directly to the individuals who need it, he said.

“We’re in year six of this epidemic and I think what’s starting to hit a lot of people now is compassion fatigue,” Stalker said. “We should all be looking at this problem and saying what more can we do?”

“If we could provide services that prevent the overdose in the first place, we’d be doing a whole lot better job,” he said.

Once Hooksett’s mobile team is up and running, Stalker said, he hopes to expand it to surrounding communities.

Epping is taking a regional approach from the start. The federal grant will allow the fire department to hire two part-time recovery coaches who will respond after an overdose in any of the 35 communities in its mutual aid area, according to Brenda Silva, the department’s administrative assistant.

Silva said Epping Fire Chief Don DeAngelis “wanted to go big and make a difference, and see if we can make a dent in this crisis and get people the help that they need.”

In Dunbarton, both police and fire personnel will work on the Project FIRST team. Police Sgt. Chris Remillard said the partnership allows them to take a “patient-centered” approach. “Ultimately, our goal is to provide a timely, compassionate, and resourceful approach to those that need help or guidance, whether it is someone who has an opioid addiction or family members that have been affected,” he said.

Dunbarton Fire Chief Jonathan Wiggin said in his town of fewer than 3,000 residents, firefighters and EMTs responding to an overdose call often know the individual or family involved. “This program came along and looked like a good way to maybe help these people out,” he said.

The Executive Council has already accepted the SAMHSA funding for Dunbarton, Epping and Hooksett. The funding for Concord and Laconia comes up at its next meeting on Wednesday, and Concord’s Deputy Fire Chief McIntire said he expects a quick turnaround once the approval comes through.

“I want to be boots on the ground by March,” he said.

Paula Holigan said first responders are eager to take this next step. “People are broken and we need to be able to help them,” she said.

Beyond the Stigma, a series exploring solutions to the state’s addiction and mental health challenges, is sponsored by the New Hampshire Solutions Journalism Lab at the Nackey S. Loeb School of Communications and funded by the New Hampshire Charitable Foundation, Dartmouth-Hitchcock Medical Center, NAMI New Hampshire, and private individuals. Contact reporter Shawne K. Wickham at swickham@unionleader.com. To read previous stories in this series, visit: unionleader.com/stigma.


©2019 The New Hampshire Union Leader (Manchester, N.H.)

McClatchy-Tribune News Service

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