Responding to overdoses takes toll on Butler County first responders
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As Butler County responds to a nationwide epidemic of drug overdoses, paramedics are faced with new emerging threats in the drug supply, from fentanyl — which has largely replaced heroin since the mid-2000s — to xylazine, or “tranq” as it’s widely known.
For paramedics and people treating overdose patients, bearing witness to the public health crisis can take an emotional and mental toll.
“Burnout is in every facet of EMS,” said Keith Singleton, deputy chief of Quality EMS. “They are underpaid, overworked and seeing the worst of the worst drug overdoses.”
Singleton emphasized the need for more awareness about burnout among first responders, as well as a heightened sense of awareness that it is part of the job.
“In this job, you have to expect that,” said Conrad Pfeifer, Quality EMS director. “It’s like responding to a fire — it’s what (paramedics) are trained for.”
“We respond to overdoses as we would to any unresponsive person and treat them accordingly,” Pfeifer said.
Singleton said drug overdoses are an ongoing problem, attributing addiction and opioid-related deaths to the high rate of prescription opioids in the United States.
Citing the International Narcotics Control Board, the Congressional Research Service reported that in 2009 the United States, which has less than 5% of the world’s population, consumed roughly 30% of the world’s opioids, including more than 99% of the world’s hydrocodone and 80% of the world’s oxycodone, according to the 2021 report.
“(Overdoses are) very, very common,” Singleton said. “It’s become worse and worse.”
In his experience responding to overdoses, Singleton said addiction does not discriminate.
“The strange thing is, (addiction) is not a rich or poor thing,” Singleton said. “There are plenty of affluent people addicted to heroin — you would be amazed to know. The typical stereotype of who society would deem a drug user is not the real story.”
“There’s a lot more people addicted to opiates than we like to think,” he said.
Singleton recalled a time when he worked in Allegheny County and “overdoses were much more prevalent,” saying it was common to be called to the same house multiple times.
“They can’t afford a solid recovery plan, so they lose employment, lose insurance, lose their ability to pay for rehab,” he said.
“People just wouldn’t be able to get help,” he said. “I remember responding to an elderly female who had overdosed on heroin Christmas morning in front of her grandkids and the Christmas tree.”
As a paramedic arriving on scene, “seconds truly matter,” Singleton said, and responding to an overdose is “time critical.”
Opioids are respiratory depressants, he noted. As they slow down breathing, they can also trigger cardiac arrest.
While police will usually administer naloxone before paramedics’ arrival, first responders will evaluate patients and intubate or ventilate them en route to the hospital, if needed. With the accessibility of Narcan, Singleton said the need to transport people by ambulance to the hospital has decreased.
While first responders have to be very mindful of potential health hazards to their own safety, such as the presence of used needles, Singleton said some misconceptions around fentanyl and other opioids can be dangerous to patients.
“There is a massive campaign for law enforcement about how exposure to fentanyl will lead to an overdose if you’re exposed to it, if it touches you, if you inhale it,” he said, but “it has been proven time and time again that it is next to impossible to overdose from passive contact.”
“The problem is it causes people in public safety, like police, to withhold administering Narcan and providing first responder care because they’re afraid of this thing that will never hurt them,” Singleton said. “It’s an industrywide fight to fight all the bad PR put out over this fear of secondary overdose.”
While Singleton continues to educate and inform the community, he said responding to an overdose is the same as responding to any other call.
“It’s not up to me to judge how they got addicted,” Singleton said. “They’re medically ill. They’re treated the exact same way as any patient.”
