Md. FD plans to continue overdose peer recovery program after successful pilot
Peer recovery specialists and a community paramedic offer patients paths to treatment after overdose calls
Mary Grace Keller
The Frederick News-Post, Md.
FREDERICK COUNTY, Md. — Peer recovery specialist Brittany Rust and community paramedic Matt Burgan were combing over data at the office in December when the fire/EMS radio alerted them to an overdose in Emmitsburg.
Rust, who has experience with addiction, said they dropped everything and hopped in their response vehicle.
Working out of Frederick that day, the two knew they had to act quickly to save this person's life — but not as part of the ambulance crew. EMS personnel closer to Emmitsburg were already on the way to provide immediate care. In fact, the patient was revived before Rust and Burgan even made it to the scene.
Rust and Burgan's role that day was to help the patient, a man in his 20s, get the treatment he needed to prevent another overdose, and to support his family.
Inside the home, they found the man suffering from a Narcan-induced withdrawal and his relatives reeling from the experience.
Burgan said he and Rust sat in the bathroom with the man and started to learn his story.
"So many things go through your mind. Your instinct is to jump in and help," Burgan said in an interview, but he's learned from peer recovery specialists like Rust that sometimes the best action is to stop and listen.
"We are in recovery ourselves, so we get how they're feeling," Rust told the News-Post.
She let the man know he wasn't alone and explained the resources available to him.
When the patient needed space, Rust and Burgan turned to his family. They refilled the family's Narcan, the brand name of the overdose reversal drug naloxone, and worked through concerns about the path to treatment.
Burgan recalled the man wanted to enter an outpatient treatment program, so he and Rust made it happen. By the next day, they got the patient an evaluation to enter treatment. Part of their job is to advocate for the patient and support their goals.
The response that day is one example of the work done by the Community Outreach And Support Team (COAST) during a three-month pilot period in late 2020.
In October, Frederick County Division of Fire and Rescue Services (DFRS) partnered with the Behavioral Health Services Division of Frederick County Health Department to enact a program aimed at the recovery community.
Through the initiative, peer recovery specialists who have experience with addiction — and have received specialized training — joined Burgan on EMS calls a few hours each week from October to December. As the sole board-certified community paramedic in DFRS, Burgan has a deeper knowledge than a regular paramedic of community resources.
COAST is a new program within the county's Mobile Integrated Community Healthcare Program. Burgan likened it to fire prevention, but for EMS. If they can assist patients in the field and prevent future calls to 911 or trips to the hospital, he said it's a win for the patient and providers.
Now that the pilot program has concluded, fire/EMS and the health department are planning how to carry this program into the future and make it a consistent part of their services.
During a March news conference announcing the opening of a new treatment center, County Executive Jan Gardner said an average of five people overdosed from heroin or a related drug every week last year in Frederick County. Though there were fewer overdoses (275) than in the previous five years, there were at least 59 drug-related deaths, representing a 20 percent increase from the year prior. Overdoses are not always fatal.
That crucial moment
Burgan has worked in the fire and rescue field since 2003 and has been with the Frederick County agency since 2013. He had an early interest in the mobile health care program and through his work found himself wondering how they could improve.
Before COAST, it wasn't uncommon for DFRS to make referrals to the health department as first responders met patients in the field, Burgan said.
However, connecting patients to resources after the initial 911 response can be challenging.
By the time a referral reaches the health department, Burgan said a patient might not want help anymore.
"Being able to deliver the peer recovery resource at that time of crisis ... we're able to intervene and we're able to make an impact," Burgan said.
By the nature of his job, Burgan acknowledged it's not likely an EMS provider will have the lived addiction experience that a peer does. The peer is able to relate to a patient in a way Burgan knows he can't, though he does everything he can to let the individual know he's there for them.
"There's no training that you can provide somebody to be able to relate on the level that the peer is able to relate on," Burgan said. "The lived experience is what makes this partnership phenomenal."
Michelle Marshall, peer outreach response coordinator for the health department, manages the peers and has also responded to COAST calls with Burgan.
"There's an unspoken feeling between people who use drugs," she said. "It's that feeling of, 'I already know where you've been. I've been there, and you're not alone.'"
The health department has also conducted peer ride-alongs with the Frederick County Sheriff's Office and Frederick Police Department, Marshall said, but those were temporary. They do continue to receive referrals from police and Frederick Health Hospital, she said.
How it works
For about three months, Burgan and roughly five peers typically devoted about eight hours a day, two days a week, to COAST services. Peers took turns riding with Burgan as their schedules allowed.
DFRS identified past peak call times and planned their COAST shifts around that, according to Burgan. During a shift, Burgan and a peer would monitor their mobile data terminal for calls that might fit their expertise. When they weren't actively responding to calls, they were usually in the community trying to connect to people.
Though Burgan has the ability to revive a person who has overdosed, that's not always his primary role on COAST calls. He and a peer responded in tandem with ambulances, whose crew would address any immediate health care needs. While the patient was treated, Burgan and a peer would talk to bystanders about resources and offer Narcan training.
DFRS Chief Tom Coe said the COAST members made 84 responses during the pilot, which includes follow-up visits and outreach events. They interacted with 45 patients directly. Of those patients, 41 were eligible for additional services, and 34 of those people accepted that help.
That face-to-face contact in the moment of crisis drastically increases the likelihood of someone accepting assistance, according to Andrea Walker, director of the Behavioral Health Services Division.
"This was a natural partnership. Our peers work closely with first responders," she said. "Being on the scene together, they have the opportunity to leverage all of their skill sets."
Coe is also a fan of the pilot's success.
"It absolutely captures people while that window to accept that help is open," Coe said.
DFRS and the health department are committed to seeing the COAST program continue, though the exact date for a relaunch depends on the COVID-19 pandemic.
The county's pandemic response has required EMS professionals to put all hands on deck, including Burgan. But once the pandemic settles down, Coe said his agency will designate 16 hours of Burgan's work week to COAST services, and Walker said peer recovery specialists will be by his side.
Marshall and Burgan were elated to hear COAST will continue. They contend the work they do benefits not only patients, but first responders, too.
"What we do continues to save our lives on a daily basis," Marshall said.
There's no guarantee a COAST response will end with the patient accepting help, but it has happened on numerous occasions.
"That's a very humbling feeling to know you get to be a part of that story and created the pathway from crisis to resolution," Burgan said.
The Emmitsburg man Burgan and Rust helped in December is one of those stories. He successfully completed his treatment program.
Today, that man is four-and-a-half months sober.
(c)2021 The Frederick News-Post (Frederick, Md.)