More victims of ODs: First responders suffer compassion fatigue
The man was still, mouth open, head back in a white Crown Victoria stalled in the middle of a neighborhood street.
A paramedic pushed a flexible tube in the man's vein to pump in lifesaving naloxone to block the effects of whatever opioid he had taken and, if all worked well, revive him. Routine work. A little girl stopped her bicycle, clutching a melting red ice pop as she watched.
"This is just normal for her," said David Geiger, director of Covington Emergency Medical Services, nodding toward the child.
It's also normal for him and countless other first responders across the country, who are tiring of the unrelenting stream of overdoses. They are professional. They tell you straight out: "I save lives." But, seeing so many children as accidental victims of the heroin epidemic, seeing repeat patients and responding to an extreme number of these cases can lead to a certain weariness of it all.
"It's upsetting and it's devastating," said Lt. Joshua Campbell, an 11-plus year City of Covington paramedic.
"They're in gas station bathrooms. Some are getting pushed out of cars," he said. They are in fast-food restaurants, homes, parking lots, alleys. Some are behind the wheel of a car, careening across a median. There was one recently whose car kept going, onto the sidewalk, up to a porch, Campbell said. "There were kids on that front porch playing."
What used to be unheard of is common now to police, emergency medical personnel and social workers. Some have become more like counselors or pastors or caregivers interceding for children.
They save lives, but they cannot force people into treatment. They cannot stop the overdose tide.
One paramedic remembers when the hair on the back of his neck would stand on end as he headed out on an overdose call. Not anymore.
This is the classic definition of compassion fatigue, when typically caring people find themselves unable to empathize anymore because the frequency of the appeals for their help is so overwhelming.
The Ohio Department of Mental Health and Substance Abuse researchers say first responders are suffering from the opioid epidemic.
The state plans to tackle the issue with grant money from the federal 21st Century Cures Act. In April, the department received $52 million over two years to help communities fight the opioid epidemic. Ohio will use some of the money to create training for first responders in preventing, recognizing and dealing with this kind of trauma.
"The situations that we're coming upon have not been dealt with before," said Advanced Life Support Lt. John Williams of the Cincinnati Fire Department. First responders themselves are in danger of overdosing from the powerful synthetic opiates routinely mixed with heroin and other drugs. They have to be hyper-vigilant about blood spatter and needle sticks so they can protect themselves from hepatitis C, which so many heroin users have contracted from contaminated needles.
Add to that what many of the professionals are thinking, explained Geiger: "This is 100 percent preventable."
More than tired
Again and again in the Cincinnati area, first responders say the words "the children."
The emergency workers aren't angry, they are tired. That is until they begin to talk about this set of victims.
Then, they are mad. Sometimes at the addicted parents. Usually at the lack of adequate addiction treatment in the region.
"Last month, a 10-year-old came down in the morning and her father was snoring," said Williams. "She went upstairs and came back in the afternoon. She couldn't wake him up."
"There's been times when a son or daughter went down and the mom is hysterical," Campbell said. "Or the kids are just playing around, and they come up and they're like, 'Is mom OK?' 'Is daddy OK?' " Campbell has had to respond to five calls in recent years for people he recognized as former classmates at Holmes High School.
Back in the Crown Vic, the naloxone took effect, and the mannequin-like body morphed into fast-motion, a startled, "Whoa!" coming from his mouth. "Was I dead?"
The medics calmed the frightened, agitated overdose survivor.
Per the usual, he was astonished. The medics were not.
They got out a gurney, but naloxone works fast, and the man walked to the ambulance, still shocked that he'd overdosed.
"Was I dead?" he asked again. "Can't believe I did this! Holy Lord."
Overdoses come at all hours of the day and night, and the medics never know when there will be an onslaught.
"We're reeling just trying to get a grasp on it," Williams said.
Cincinnati is among the latest cities in the region to form quick response teams as a potential solution. They consist of a firefighter/medic, a police officer and an addiction counselor. They knock on overdose survivors' doors and try to guide people into treatment that could last: Often it's medication-assisted treatment, a combination of medication and psycho-social counseling.
But without that treatment, Geiger said, the overdoses will just keep coming.
Rachel White, a Cincinnati Police patrol officer, has only used naloxone twice on overdose victims. But in her work, she's checked on heroin users again and again.
"There's a lot of people, they're not ready to get help," said White, a 15-year veteran officer with Cincinnati. "Even though I've seen them multiple times and talked to them multiple times, they're not."
Cincinnati bicycle patrol officer Tammy Hussels sees a lot of heroin users downtown, and she's used naloxone. "It's an amazing drug," she said. It's hard for her to acknowledge a police loss of compassion for these people. "You do care," she said. But after a while, it's just part of the job.
"There are some people out there that have to have heroin two or three times a day. Some are beginners," Hussels said. She tries to convince them all to get treatment. "I've only had a couple that'll go get help."
Lawrence Bennett, chairman of the Fire Science and Emergency Management program at UC College of Engineering and Applied Sciences, is helping to train Ohio medics how to join with other community experts, such as the quick response teams, to provide care to opioid-addicted patients. "As a professor at UC, to me it was obvious that we needed to bring a new course of community paramedicine, community resources to the addicted person, their family members," he said.
Kevin Kehl, Ohio's trauma-informed care expert, has worked with the Ohio Peace Officers Training Academy to better prepare police for the heroin and opioid epidemic and other issues.
"They're experiencing things that they're not accustomed to," said Kehl, who works for the Ohio Department of Mental Health and Substance Abuse. "That weren't really in the job description."
It's not just firefighters and EMTs and police officers, he said.
"The caseworkers are seeing things that they have never seen before," Kehl said, such as "a 5-year-old Narcaning his mom."
Angela Sausser, executive director of the Ohio Public Children Services Association, said the work is taking a toll on the Ohio Job and Family Services Child Protective caseworkers. "They've had to wake sleeping children because a parent overdosed and died in the next room. They've seen toddlers who've ingested heroin and overdosed. They see relapse of parents who'd been in treatment, with whom the caseworkers had been working with to bring the child back to their home."
"Parents have overdosed in school parking lots," Sausser said.
One in seven caseworkers in Ohio left Children Services last year, without any performance issues. While she can't be sure their departures had to do with the opioid crisis, Sausser said she has no doubt that it's made an impact.
The mounting numbers
In 2016 in Hamilton County, 2,390 911 dispatches were responses to overdoses, with 3,550 emergency room visits to local hospitals occurring as a result of overdoses and more than 195 heroin-related deaths reported. As of March 22 this year, Hamilton County hospital emergency departments alone handled 662 suspected overdose cases. Total 911 dispatches for unintentional drug overdose was at 953.
This year through March, the Cincinnati Fire Department alone went through 2,243.1 milligrams of Narcan. January tallied almost 400, February 643, and March, 1,201 milligrams of the lifesaving overdose reversal drug. All of Hamilton County first responders used about 5,478 doses of the drug in 2016, according to Hamilton County Public Health. Two milligrams used to be a common dose, but since the deadly opioid fentanyl and its other forms got in the mix, medics find themselves using four, even eight or more doses, to restore proper breathing in a patient. Medics across the region point to soaring overdoses and the increasing cost of naloxone to combat them.
Covington's Lt. Campbell says he can feel frustrated about the cycling overdoses. But he makes it clear that those feelings will never impede his work nor his desire to save those who overdose because of an addiction.
He has heard the mantra from those unaffected by the heroin epidemic. "Let them die," they write on social media.
"You know what my response is?" Campbell asked.
"What church do you go to?"