This year, the University of Toronto IHI Chapter is taking part in a campaign to change the narrative associated with substance use disorders. Our vision is to highlight concepts critical to tackling stigma, empower diverse stakeholders at the center of the epidemic and recognize promising initiatives designed to support the community. Our main goal is to humanize individuals suffering from substance use disorders by committing to reducing health inequities and raising awareness.
In light of this campaign we sought to investigate the impacts of the opioid epidemic on first responders within our community. We interviewed Fire, Paramedic and Police representatives. This is what they had to say:
Q 1: Emergency response teams often work in unpredictable and uncontrolled environments. What do you like the most about your job? What do you like the least?
Fire: I think it takes a certain type of person to be a first responder. I think you need to be willing to do whatever is necessary to protect the public/community that you serve. Most are willing to sacrifice their own safety to help others.
Paramedic: It can be challenging at times, particularly when we have to perform various medical procedures in enclosed, unsanitary and poorly lit environments. We have to consider multiple factors simultaneously to ensure best patient care and timely extrication. This unpredictability is one of the factors that drew me to this position in the first place. I love the fast-paced environment and having the opportunity to work in interprofessional teams. My least favorite aspect is clean-up, which at times can be extensive and tedious.
Police: What I like the best...the answer is in the question. Working in unpredictable uncontrolled environments. I like working in teams. Worst part...paperwork related to the good parts of the job.
Q 2: How do substance use disorders impact your daily work, particularly with the emergence of the opioid epidemic?
Fire: A lot of services and personnel are being used in these circumstances. This is important because if another call comes in, the manpower is being used for something that is fully preventable. Exposure is also always a possibility and risk.
Paramedic: Overdose from all substances is a cause for concern for us, to respond quickly and appropriately. This is not limited to opioids. Over the years however, opioids have certainly been more on our radar. As paramedics, we tend to see the worst cases, and often they are preventable. I believe greater community support and services need to be established so that we can prevent such fatalities that we are seeing now.
Police: Opioid crises are draining the resources of all first responders. Many are repeat customers. All calls for services for all overdoses require a three-tiered response. Police/Ambulance/Fire Rescue...not to mention the health care costs associated with the individual after they are accepted by the hospital...right now fentanyl overdoses are the most impactful. Many drugs like heroin, and cocaine are cut with fentanyl which increases the chances of overdose. Crystal meth is also a concern over overdosing.
Q 3: Is there any specific training that you’ve received in regards to the opioid epidemic? Is exposure to fentanyl/fentanyl analogues a cause of concern? Has there been a focus on utilizing a language of recovery?
Fire: Firefighters are trained on Naloxone and how to it affects a person who is overdosing. Firefighters are also trained how to approach overdose calls, first ensuring that all Personal Protective Equipment (PPE) is worn at all times in order to protect the firefighter and then ensuring the safety of the patient.
Paramedic: We always ensure to wear protective equipment for every call, and are always cognizant of our environment. We have constant quarterly training throughout the year to keep skills and medical procedures relevant, and to address trends within the region (e.g. an increase in call number for overdoses). There is no specific focus on language of recovery, however, being in a public service field there is always a level of professionalism we have to uphold. We always try to be respectful and non-biased in any situation.
Anyone who uses recreational drugs is at risk to overdose as drugs can be laced with cheaper substances to increase profit. That being said patients that misuse substances alone are more likely to have a fatal result because there is no one to call for help. This is particularly why harm reduction services (e.g. overdose prevention sites and safe injection sites) are important.
Police: I am trained on how to administer naloxone but I am not allowed to use it. The Toronto Police Service is currently trying to find a solution to protect their officers from the Special Investigations Unit (SIU), which are private investigators separate from the Police who investigate any wrongdoing conducted by an officer.
As it is right now, if I administered naloxone and the intervention did not work leading to death, I would have to be investigated by the SIU. In fact, anything hands on that could potentially harm another individual needs to be investigated by the SIU. It is sad that these procedures often prohibit us from doing everything we could to save someone’s life.
Q 4: What is your biggest piece of advice for new trainees to better prepare them to deal with the realities of the opioid epidemic/substance use disorders? What do you think the public should be more aware about?
Fire: Do as much research as possible to find out how opioids work and how they can be absorbed by personnel. Ensure that all PPE is worn at all times, particularly when dealing with possible opioid situations. I think the public should know how to mitigate the effects of opioids, but also how to avoid them in the first place. The public should be aware of how dangerous these drugs can be.
Paramedic: As a paramedic, college is a great place to grasp the theory, however the reality of the epidemic is difficult to fully understand until you see it first hand. My biggest piece of advice for new trainees is to take advantage of the entire training process, stay vigilant and don’t be afraid to ask questions. As for the public, stay informed. The complexity of this epidemic cannot be understated as there are a lot of factors at play. It’s easy to blame the user or prescribing practices but at the end of the day this epidemic should be approached from a social and health policy lens. We are all in this together and it will take bringing diverse stakeholders to make an impact.
Police: Trainees should know that there is no specific food group that this crisis is affecting. Rich poor, middle class are all dropping dead; this crisis does not discriminate. The public should know about the huge drain the opioid crisis is having on the health care system and first responders.
Q 5: We believe it is important to explore the mental health impacts on first responders due to their immediate and recurrent exposure to traumatic events. How do you prevent burnout and emotional fatigue?
Fire: I think a lot of what first responders go through can be difficult mentally and emotionally. What has helped a lot of people is having a physical and an emotional outlet. For a lot, physical activity is helpful to relieve stress, and for others it’s helpful to talk with peers or professionals.
Paramedic: I personally try to maintain a good work-life balance, by making time for friends/family and by participating in recreational activities. I think self-reflection is really important, to recognize the first signs of burnout, as they can be different in different individuals.
Police: Compartmentalize...don't immerse yourself in your occupation. Have outside interests. Maintain a fitness regime. Know what you’re getting yourself into before joining the job. Know that you’re going to see sh*# so have processes in place to deal with it.
A Note from UT IHI:
In the time following this interview, the SIU changed naloxone policy for Police Officers on November 15, 2018. For more information please see related article here.
On January 28, 2019, we are hosting an event called “Narratives of Hope” which will feature an art exhibit, speaker panel and networking opportunities. Our Chapter is looking for community members who have been impacted by substance use, either directly or indirectly, to share their story. This can be in the form of a painting, a written story, or other forms of creative expression. For more information, see the submission form here.