Opioid Crisis First Responder PTSD
Treating drug overdoses has been a long-standing issue in the United States, but recently a spotlight has been lit on the growing health risks for opioid crisis first responders. In October 2017, the White House declared the opioid crisis, which has killed more than 200,000 people since 1996, a public health emergency. The order is an important step in addressing the plague of opioid addiction in this country, but after years of responding to opioid-related health emergencies, law enforcement, paramedics, and other safety professionals are starting to need support as well.
First responders have seen countless individuals repeatedly overdose and eventually pass away, and even as treatment centers become more common in their state or county, they are often left to reckon with the trauma.
A Look into the World of First Responders in the Hardest Hit State
In Ohio, the state with the highest rate of overdose, the opioid crisis has taken a toll on first responders’ mental health. For Kelley Davidson, Communications Manager for the Grove City, Ohio Police Department and Smart911 user, the epidemic is a source of huge frustration: “The increase in opioid overdoses places greater demands on first responders as well as other community resources. The frustration comes from wanting to make a positive difference while trying to meet the ever-increasing needs”.
While in the past, the use of antidotes like Narcan for drug overdoses was rare, today’s opioid crisis paints a much different picture. According to EMS1, Lucas County, Ohio responded to 3,000 overdoses between 2014 and 2016. This is approximately four calls that firefighters, police officers, and paramedics must respond to each day. “If something happens to them I feel like it’s on my shoulders,” Deputy Charles Johnson told the publication.
This inevitable sense of responsibility, and the persistent nature of opioid addiction, is taxing for those who are on the front lines of the epidemic.
When many efforts to revive individuals who have overdosed go in vain, it creates a sense of hopelessness for first response teams that is difficult to shake. The frequency of these reports is also intense; some days, responders do not have time to rest and reflect between calls.
The Three Biggest Threats to Opioid Crisis First Responders
With over a hundred people passing away in the United States each day from opioid overdose, first responders are facing increasing health risks. The three biggest threats include:
- Contact Overdoses
- Post-Traumatic Stress Disorder (PTSD)
In recent years, accidental exposure to synthetic opioids, such as the highly-potent fentanyl, have resulted in overdoses. In June, the Drug Enforcement Administration (DEA) issued a briefing guide for first responders who might come in contact with the lethal synthetic drug, warning them: “Since fentanyl can be ingested orally, inhaled through the nose or mouth, or absorbed through the skin or eyes, any substance suspected to contain fentanyl should be treated with extreme caution as exposure to a small amount can lead to significant health‐related complications, respiratory depression, or death.”
When handling fentanyl, first responders have reported breathing problems, dizziness, and even unconsciousness. In one case, an officer in East Liverpool, Ohio brushed the drug off his uniform and it entered the system through his hands. "I started talking weird. I slowly felt my body shutting down. I could hear them talking, but I couldn't respond. I was in total shock,” the officer, Chris Green, told the Morning Journal according to CNN. He fell unconscious at the station and luckily was able to be revived with Narcan.
Contact overdoses are not limited to human first responders. K-9 units used by law enforcement to sniff out drug-related sources are also at risk from exposure to these deadly drugs. Police officers are beginning to carry naloxone in K-9 doses, which veterinarians confirm is safe. It’s becoming more common for law enforcement teams to keep specialized drug kits on hand to protect their animal companions.
Post-Traumatic Stress Disorder (PTSD)
The symptoms of PTSD are starting to make their way into the daily lives of first responders, so much to the point where it’s creating a sense of cynicism with each new opioid-related emergency call. Michael Brumage, an executive director for the Charleston Health department in Ohio, stressed the severity of PTSD, stating: “When repeatedly exposed to people who are overdosing, especially those who have repeated overdoses, we're facing cynicism, and some of the older law enforcement officers expressed a kind of detachment from both work and personal lives." Brumage says "They just became so cynical over time. They weren't as effective as they could have been — either professionally or personally."
Worse is when family members are the ones that discovered the overdosing individual and have to make the call to 9-1-1. In those situations, first responders walk into chaos, many times with children witnessing the violent overdose and the aftermath of the revival attempt. Those situations haunt first responders who are constantly reminded of that trauma each time they respond to a new call.
In addition to first responder PTSD, the emergency response teams located in areas highly affected by the opioid crisis are constantly living in stress. According to Kathryn Millán, LPC/MHSP from the Valley Hospital in Phoenix, Arizona, first responders treating opioid overdoses tend to suffer from compassion fatigue, which is facing the dilemma of loving their job of saving others but becoming burned out from the repeated number of incidents.
Valley Hospital also mentions the symptoms of first responder PTSD or burn-out, including:
- Physical or mental overwhelm or exhaustion
- Changes in perceptions of safety, community, and trust
- Intrusive memories or thoughts about past traumas
- Excessive worry about loved ones or personal safety
- Unfounded doubts that you do your job well
- Increases in anxiety or arousal, or feelings of numbness and disconnection
Support for First Responder PTSD
First responders might have personal strategies for dealing with tragedy, but several programs are being established to provide more comprehensive support to those suffering from first responder PTSD who’ve sustained mental or physical traumas as a result of the opioid crisis.
Resilience Training and Support Groups
The increase in workload has created a clear need for resilience training, in which the daily trauma that paramedics might face is recognized and they are taught to detect signs of first responder PTSD or burn-out in themselves and others. Support groups can also provide a way to process the stress of a critical incident. However, this is a short-term solution for first responders, and in many cases, additional counseling will be needed.
According to the Chicago Tribune, mindfulness courses are becoming more commonplace in areas of Oregon and, most recently, in West Virginia. While the program has been met with some resistance from first responders and other safety professionals, program leader Richard Goerling insisted to the publication that it actually improves performance in these difficult situations. "Ignoring emotion actually makes us more weak. Typically today we wait until first responders are broken, and then we try to fix them,” Goerling said.
Some 9-1-1 centers are leveraging technology to provide a step up in the opioid crisis. Communities using safety profiles give response teams the power to keep track of repeated opioid overdose incidents so that they can more quickly respond the next time. Residents can create a Smart911 safety profile and provide information to public safety agencies that will automatically present itself to call takers whenever the resident dials 9-1-1. The safety profile can contain life-saving information such as the location of naloxone kits in the home, mental health issues that can aid in how first responders approach the individual, and an emergency contact.
Another approach some communities are starting to use is training citizens to use Narcan to treat overdoses. The goal is to help alleviate some of the pressure placed on response teams. In some cities, librarians are being trained to use the antidote drug as many overdoses have occurred in libraries. Following this model, civilians that have access to the opiate antidote and proper education will be able to act in an overdose situation. Naloxone rescue kits are also being made accessible in pharmacies and as an over-the-counter remedy. Naloxone access and Good Samaritan laws could save lives.
Looking forward, addressing the health risks to first responders brought on by the opioid crisis will require a huge societal overhaul. It will take an amalgam of resources to provide relief to all those impacted by opioid use and eventually end its devastating grasp on America.