We are now 13 months into a public health emergency, and the emergency is graver now than it was on April 14, 2016, when B.C. health officer Dr. Perry Kendall first declared it.
The emergency, of course, is the epidemic of opioid overdoses and overdose deaths. In 2014, British Columbia recorded 365 such deaths; in 2015, 474; in 2016, 935. So far this year, according to the latest update, 488 British Columbians have died by overdosing on illicit drug overdoses — putting us on track for a 2017 death toll of 1,464. In April alone, 136 people died. Vancouver, as the overdose epicentre, has seen 170 deaths this year.
The spread of these new opioids is also taking a toll on our first responders, including the firefighters and paramedics who must try to revive those who overdose. That, in turn, puts everyone else at risk because other health emergencies can’t be attended to.
Not all overdoses are fatal, of course, and that’s largely thanks to first responders — firefighters and paramedics. Robert Weeks, president of the 770-member Local 18 of the International Association of Fire Fighters, said that in April 2017 firefighters answered 1,365 calls. Of those, 688 were overdoses and 434 were handled by Fire Hall 2 (on Main Street near Powell Street in Vancouver) alone. That’s a daily average of over 14. Weeks contrasted this with January 2016, when Fire Hall 2 had 774 calls of all kinds and just 85 overdoses. (He also noted that other calls, such as mattress fires, might be drug-related.)
Unsurprisingly, Weeks said, firefighters stationed at Fire Hall 2 also report “dramatic stress.” Normally firefighters spend three years in a firehall before rotating to another. Now, it’s one year.
Even then, the stress is intense. Weeks said that the least understood aspect of the opioid-overdose disaster is the impact on first responders. “You see your efforts going in vain,” he said, which leads to a sense of hopelessness. As well, the sheer call volume means no downtime, no time to sit down and unwind.
The workload creates other problems. Weeks said that firefighters find it hard to maintain all the skills their job requires: “They need to be aware and train for everything,” he said. As well, fire halls all over Vancouver are often called in when the Downtown Eastside halls are overloaded. This creates holes in citywide coverage for non-opioid emergencies.
Paramedics’ sharply increased workload
Overdoses create similar stress on the 1,250 paramedics in the greater Vancouver region. Bronwyn Barter, president of the Ambulance Paramedics and Emergency Dispatchers of B.C., told The Tyee that her members responded to 19,275 overdose calls in 2016.
Paramedics are familiar with overdoses, and trained to deal with them, Barter said. The problem is the frequency of calls, which rapidly increased when fentanyl use became widespread. The stress of a sharply increased workload has led to “resilience training,” which emphasizes the early recognition of paramedics enduring daily traumas on the job, and tries to address accumulated burnout.
Robert Parkinson, health and wellness director of the APBC, said that paramedics also go through “critical incident stress debriefing,” in which the impact of trauma can be mitigated by discussing it in small groups, normalizing it rather than bottling up the experience. But this is a short-term response, and more support is needed. He said paramedics aren’t trained to spot problems in one another, so they may miss trouble signs.
Parkinson estimated that about 200 paramedics are actively seeking counselling. Post-traumatic stress disorder affects about 10 per cent, he said. “Depression and anxiety are more prevalent.” Support is also needed for partners and spouses to help them deal with paramedics’ psychological problems — especially depression.
“This is not a crisis. This is the new normal,” Bronwyn Barter said. The call volume has increased, but not the number of people to deal with it. This means other emergencies may not be attended to as promptly as they should be.
The emergence of fentanyl and now carfentanil has only added another stressor for first responders. Even skin contact with such opioids can induce an overdose. Several police officers and paramedics in the U.S. have suffered such overdoses.
Barter told The Tyee about one incident when paramedics arrived at an overdose to find one patient doing CPR on another; the first patient then fell unconscious, followed by a paramedic. The substance was never identified, but it was a clear warning of a new hazard.
The focus on the response to the overdose problem has been naloxone, and making it available to as many people as possible. That may save addicts’ lives (sometimes it can save a single addict two or three times a day). But it doesn’t really help the firefighters and paramedics who are saving them. They just have to roll out again and again, and yet again.
Responses to this disaster are growing more radical, though perhaps they’re still not radical enough. The Mayors’ Task Force on the Opioid Crisis has published recommendations emphasizing the four pillars: harm reduction, treatment, prevention, and enforcement. The Vancouver Police Department recommends treatment on demand: “evidence-based addiction treatment, including opioid-assisted therapy programs” and “concurrent mental health crisis intervention and support.”
The VPD report also noted that “as of March 2017, three police officers have been accidentally exposed to opioids during the course of their duties.”
Such recommendations show how far we’ve come since addicts were “drug fiends.” They reflect acceptance of addiction as a medical problem, not a moral lapse — much less a capital offence. As a public health issue, addiction needs a medical response.
A recent Vancouver conference of addiction experts suggested prescription heroin as a promising way to slow the overdose death rate. If addicts can use pure heroin in controlled doses, the illicit market will see its market vanish. If they use the drug in clinics, they can avoid overdoses and get counselling as well.
If nothing else, such a policy would help reduce the brutal stress and workload now endured by firefighters and paramedics as well as their families. If they don’t have to deal with one overdose after another, they can strengthen their training for other emergencies and be available to deal with them when they occur.
The days of treating drug addiction as immoral are over. The true immorality would be to go on treating our first responders as expendable.
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