Opioids in Alexandria Part 4: The opioid crisis through an EMT’s lens

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Opioids in Alexandria Part 4: The opioid crisis through an EMT’s lens
Chad Shade has been a paramedic with the Alexandria Fire Department for 14 years (Photo Credit: Louise Krafft)
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By Alexa Epitropoulos | [email protected]

Alexandria paramedic Chad Shade’s idea of an emergency is different from that of most people.

Shade, a 14-year veteran of the Alexandria Fire Department, is equipped to deal with any call he’s dispatched to, from life-threatening situations to minor medical scares.

“Even if it’s something someone might not feel is an emergency, for that person who’s calling, it feels like an emergency to them,” Shade said. “You feel like every day that you go to work that you’re making a difference.”

Read Part 3: Inova Alexandria talks about life on the front lines of the opioid crisis

Shade’s job includes providing medical treatment on the scene, treating patients with IVs, intubating patients and administering necessary medication. He is often the first person someone in crisis sees.

That involves responding to the worst of medical cases, including opioid overdoses, where the severity can mean a patient isn’t able to breathe, is unresponsive or is in cardiac arrest, possibly before EMT providers are even able to arrive on the scene.

 “… As a paramedic, you walk into a scene, and you smell certain smells, you have vision and auditory experiences, sometimes there are tastes of things in the air. All five of your senses are impacted,” Shade said.

 Since 2015, there has been an uptick in both the number of opioid overdoses in Alexandria and the number of participants in the city’s publicly funded opioid treatment program. This surge is quantifiable with data, and it has been qualitatively felt by EMTs like Shade.

 “Unfortunately, there has been a definite increase. We can all point to different causes. All of us have different thoughts about its causes,” Shade said. “… Alexandria has been kind of a little bubble. We haven’t had as high of a percentage as some other areas in Northern Virginia, West Virginia, Maryland or D.C. However, in the past few years, it’s even increased here. Our numbers may not be as high as other areas, but you have to take into account that we’re only 15.7 square miles.”

 On the scene of an overdose

When Shade responds to an opioid overdose, his first priority depends on a patient’s situation. If the patient isn’t breathing, it would mean intubating him or her. Patients who are unresponsive are administered Narcan.

 “Someone who is a good clinician, they won’t just slam a whole bunch of Narcan into the person. They give them just enough to slowly bring them out of it,” Shade said.

 Shade is often able to put himself into the shoes of those who are suffering from the worst impacts of opioid addiction.

 “You have to look at it from a different perspective and say to yourself ‘this person just woke up, he’s kind of confused, not sure what’s going on and now there’s five or six people standing on top of him or immediately around him,’” Shade said.

 “…It’s no different than if I passed out in the middle of the street and all of the sudden I turned around and people were around me. I might be a little defensive.”

The toll on mental health

Though opioid overdoses comprise one of many categories of cases city EMT providers may encounter daily, emergencies related to opioids are often life-threatening or even fatal. Those experiences can be devastating for first responders.

“There’s always been a little more light shown on PTSD for military personnel, because they have that extremely, highly intense combat setting, but typically, [what we experience is] high intensity for a short duration,” Shade said. “We have just repetitive, constant dealing with multiple different calls, which includes calls related to opioids.”

There are other jarring factors for first responders beyond the individual being treated, such as the reaction of others on the scene.

 “When you’re dealing with potentially a really sick or even a dead individual when you get there, you always are dealing with other factors – family members who are completely distraught and upset, and rightly so. It can be a parent or a kid. You walk into places where a kid has seen their parent go down. Those are things that stick in your mind.”

Shade said, in those cases, the incident can come back to haunt them, particularly when it involves responding to a situation that hits close to home.

 “It’s easy to put yourself in a situation where you quickly relate to individuals because, with opioids, it’s one of those things where it’s very addictive. It could have been something as simple as pain medication post-surgery and people become addicted to it and they turn to other avenues to get that similar sensation or high,” Shade said.

 As awareness increases surrounding the PTSD suffered by first responders,

 many have worked to find ways to address it. Shade and his colleagues worked with city organizations and mental health professionals to found TERP, or Traumatic Exposure Response Program, in 2012 following colleague Joshua A. Weissman’s on-duty death.

 The program is a peer-to-peer counseling program, which encourages coworkers to provide an outlet to one another and allows a more proactive approach to preventing PTSD. The TERP program might, for example, call for a coworker to relieve a fellow colleague who has children from responding to a violent incident involving children. If someone needs to talk about a particular incident, a coworker would help him or her debrief.

 “You have that personal connection, that daily interaction. We’re here at the fire station for 24 hours. As people spend time with each other, they come to know each other as family. We eat and share meals together, we have bunk rooms. We’re with other people for 24 hours a day. You get to know their habits. Most of us open up and talk about our families. We talk about our hobbies. We’ll do stuff with coworkers outside of work,” Shade said.

Just as responding to the opioid crisis means taking precautions against physical dangers that potent opioids like car fentanyl pose, Shade and EMS Deputy Chief Byron Andrews are aware that mental health side effects should also be a priority.

 “I think that as an industry we’ve gotten a little better when it comes to the mental health aspect,” Andrews said. “…We’re really starting to recognize mental health is a big thing with our first responders.”

 “The good thing is it is finally starting to catch mainstream attention,” Shade said. “One of the biggest things is overcoming the mentality that if you seek out that help, sometimes people will say you’re weak … It’s easy to start to shut people out, it’s easy to turn to alcohol, it’s easy to turn to reckless behavior … We try to teach them other ways to cope, like sharing and talking with coworkers, with peers on a team, focusing on the gym. We want to give them alternative to help work through that.”

 The administrative aspect of battling opioids

 While Shade is on the front lines, Andrews has been battling the opioid epidemic from the

administrative side. He, along with representatives from the Alexandria Police Department, the Alexandria Sheriff’s Department, the Alexandria Health Department, the city’s Opioid Treatment Program and others, are part of an opioid work group that meets every two months to discuss their experiences surrounding the local opioid crisis and share their efforts to combat it.

 “We’ve been trying to see what we can do within the city to monitor what’s going on and to start developing some strategies on how to prevent or decrease the number of opiate overdoses within the city and to be able to respond in the event that something does occur,” Andrews, who has been the city’s EMS deputy chief for about four years, said. “… It’s a forum where everybody can come together and say ‘hey, what are we seeing out there?’”

The increase in the number and severity of opioid overdoses hasn’t necessarily meant Alexandria EMS workers have changed their procedure. It has meant, however, that Alexandria EMT administrators are considering expanding the number of first responders who are able to administer Narcan, a powerful drug that can reverse the effects of an opioid overdose.

 “ … What’s now occurring is the frequency is starting to increase,” Andrews said. “As a result of the increase and the number of incidents, we do need to change our protocols as far as possibly allowing our [basic life support] providers and EMTs to start administering Narcan.”

Members of the department and its leadership are also looking at ways to be part of a citywide solution moving forward.

 “I think it’s community awareness. I think it’s education of the dangers associated, the education of how addictive the medication is, certainly [it means being] supportive of legislative and regulatory measures,” Andrews said.

 ‘Why I love to do this job’

Every time Shade shows up for another 24-hour shift, he never has an idea of what to

Chad Shade (Photo Credit: Louise Krafft)

expect. There’s always, however, one major constant.

 “We see people at their absolute worst, whether it’s just a horrible experience that they’re dealing with, whether it’s a medical experience, whether it’s a trauma,” Shade said. “But you also see people at their absolute best. You see people who rise above and beyond and they’re putting themselves in harm’s way … That reassures why I love to do this job.”

Read Part 5: What makes the drugs dangerous and addictive

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