The effects of fentanyl aren’t just hitting those unknowingly ingesting this deadly drug.
West Shore paramedics and first responders deal with this crisis every day and have had to taken precautionary measures to protect their own. “There’s another side to the whole opioid crisis and that’s the effect on first responders and paramedics … It takes a massive toll,” said View Royal Fire Chief Paul Hurst. “That’s first and foremost my concern, the cause and effect it’s having on my staff … We watch that very closely.”
With increased access to doctors, therapists and a team of medical professionals, Hurst said, keeping his firefighters healthy is priority one for the department. “We look after each other,” he said, adding they have also expanded their critical incident debriefing sessions. “If my staff are well, they can take care of the community.”
But it’s not just taking a toll on the firefighters who are often first on a scene of a medical call.
“The paramedics are the front line, they’re doing this every day,” Hurst said. And it’s a job that often goes unnoticed. “They don’t get enough credit for what they do … Their job is thankless; they do not receive the praise and support other agencies get.”
Brad Cameron, B.C. Emergency Health Services district manager of Victoria, added, “it strikes home … It effects us.”
To battle staff burnout and the increased workload, Cameron has scheduled an additional ambulance on Fridays, Saturdays and Sundays, statistically the busiest days for overdoses. “You get to a point when you get empathy burnout. You hit a critical point … We’ve had more than a few people crash and had to take time off,” he said.
B.C. EHS has also increased the availability of its critical incident stress team and put other safeguards in place to protect its team.
With no municipal boundaries to confine them, paramedics cover a wide area “and they can go from OD to OD,” Hurst said.
He’s heard of situations where paramedics revived a patient, transported them to hospital, then had to come to their aid again later in the same shift.
“How do you rationally deal with that? You’re trying to help these people, but it’s just so out of control.”
The relentless number of overdose calls is putting a huge strain not only on naloxone and other medical supplies, but also on staff, Cameron said.
Typically, when paramedics respond to an overdose involving heroin, he said, they are on scene for 10 to 15 minutes before they start seeing positive responses from patients. But when fentanyl is involved, paramedics can be on scene for more than 25 minutes. They can also encounter other problems that result in longer callouts.
“When you wake someone up, they’re pissed off because you’ve taken away their high and they’re already hypoxic, so they’re kind of out of it,” Cameron said, noting that often patients will get hostile.
Hurst added, “this isn’t a typical medical call … Those have expected outcomes.”
Overdose calls are unpredictable, he said. They can morph from an overdose to a cardiac arrest, to a wife performing CPR on her husband, to first responders arriving, administering naloxone and the patient regaining consciousness, then refusing further medical treatment.
“It goes from one level to another … managing that is challenging,” Hurst said, adding first responders have had to radically change their approach. “Some of these drugs are so powerful I don’t know if there’s anything first responders can do … It’s literally Russian roulette (for users); you don’t know what you’ve injected and what the outcome will be.”
Cameron added, “these people have no idea of what they’re getting into.”
For recreational users, Hurst said, “I would hope it would give people pause to reconsider.” But he acknowledged addiction is a tricky beast. “I don’t think we’re going to stop the drug use, it’s how we manage it.”
Another killer hits the streets
West Shore first responders and paramedics continue to battle a deadly killer that is fentanyl. Making matters worse is the appearance of carfentanil on the illegal drug market.
This synthetic opioid, sometimes used to tranquilize elephants, is similar to fentanyl, but 100 times more potent and an estimated 10,000 times stronger than morphine. With confirmed reports of the drug’s presence in Vancouver and even as close as Nanaimo, Brad Cameron, B.C. Emergency Health Services district manager for Victoria, said it’s only a matter of time before it gravitates to Victoria. “We’ve seen evidence it’s already here,” he added.
Roughly six weeks ago, local paramedics encountered a patient who required 10 milligrams of naloxone before showing any sign of a positive response. With an average dose containing 0.4 milligrams of the drug, Cameron said it’s not uncommon for patients to receive multiple doses. That usually means a patient has been administered less than 2 milligrams.
“The amount of naloxone we’re going through is skyrocketing,” he said, adding that is a reflection of the potency of drugs and the number of calls they are receiving.
Like everything, supply and demand also factors into price and Cameron said naloxone is more expensive now than ever.
According to a Ministry of Health spokesperson, there was a modest increase to the cost of naloxone when the province switched suppliers a few months ago, but she would not release the cost per dose. The B.C. Centre for Disease Control’s current supplier is Teligent.
Roughly 16,500 naloxone kits were distributed at no charge in 2016 through the province’s Take Home Naloxone program. Kits can also be purchased by the public at many pharmacies for roughly $50. Pharmacists can provide instruction on how to use the kit and more training is available online at towardtheheart.com.
If you missed Part One of this two-part series, read “OPIOID CRISIS: Recreational drug users hit hardest” online.