- Associated Press - Monday, March 26, 2018

BARRE, Vt. (AP) - The opioid epidemic in Vermont is making the already-dangerous job of being a first responder more dangerous.

Officials in both law enforcement and emergency medical services say they’ve had to put more emphasis on their employees’ safety than in the past.

Tim Bombardier, director of public safety in Barre City, said when a call comes in for an overdose, things can get violent. His department has taken an “administer and step back” approach to overdoses.

“A lot of people wake up swinging. We’ve had first responders on both the police and fire side struck by people they are trying to save,” Bombardier said.

He said people are out of it - “on death’s door” - and then all of a sudden they are brought back and don’t know what’s going on. They will respond with a punch or a kick, he said. It’s becoming common practice around the state for police to respond with EMS if an overdose is called in, to make sure the scene is safe before medical service is provided.

Even when someone brought back from an overdose doesn’t get violent, Bombardier said, that person is just as likely to be disrespectful or dismissive of those who brought them back.

“We have a lot of overdose calls where someone is brought back using (the overdose reversal drug) Narcan and they refuse to be transported by police. Somebody’s just saved somebody’s life and you’re trying to convince them, on the side of the road, to either get medical attention (and) drug counseling attention and their attitude is ‘I don’t want anything to do with you.’ That’s a little surprising,” he said.

At first, Bombardier’s employees were put off by such a response from a person whose life they just saved, but now it’s common, he said.

Inge Smith-Luce is a paramedic out of Manchester and teaches paramedicine at Vermont Technical College. She started her EMS career in 1992 and noted things started to change about 10 to 15 years ago with the influx of opioids.

“We worry a lot more about the people we’re taking care of having needles on them. We worry more about violence on-scene. . Things can escalate very quickly. It can be very scary,” she said.

When she gets an overdose call, Smith-Luce said the first thing that goes through her mind is her personal safety. The next is whether the person overdosing is going to live, and then how far away that person is from the nearest hospital.

“We are 45 minutes from Rutland and 35 minutes from Bennington so we’re kind of in the middle of nowhere. So when we have (a call) that’s really bad, we have a long time in the truck by ourselves,” she said.

Besides a stressful scene at an overdose, she said the opioid epidemic has increased the call volume for first responders, which also adds stress.

Kandis Charlton, a paramedic with Regional Ambulance Service, which serves Rutland, said she takes a “trust no one, suspect everyone” approach at a scene.

Charlton said the scene of an overdose is complete chaos. People brought back can be very upset that emergency personnel are in their homes and they can be in denial about their addiction. She said patients she’s brought back from an overdose have run the spectrum from embarrassed to angry, which is discouraging for emergency responders.

Substances that caused the overdose are another potential hazard.

Bombardier said first responders now have to make sure they don’t get exposed to the substance taken by the patient. Pills are easier to identify because the drugs come with certain shapes and markings.

“But a white or brownish powdered substance in a bag? You don’t know if it’s heroin, fentanyl, carfentanyl, baking powder or any combination thereof. In the 38 years I’ve been doing this, I have seen people cut drugs with everything from baby powder to rat poison,” he said.

Bombardier acknowledged careers in law enforcement and EMS have always had their risks.

“And now incorporated into that line of work is the potential for a new thing coming down the road. Exposure to an unknown substance in a glassine bag. Now we’re carrying Narcan not only to perform our duties to save people who have overdosed, we’re also carrying it for ourselves and our fellow officers,” he said.

With powdered substances showing up more often in drug cases, it’s changed how his department handles traffic stops, search warrants and pat downs.

“You find a bag, everything kind of slows down,” Bombardier said.

Previously, a substance in a sealed bag was marked and put in an evidence bag. Now, he said police will wonder what else is in the vehicle or home and if there is any of the substance lying around that they could be exposed to.

He recalled an incident where one of his officers was likely exposed to opioids when he was handed bail money. Bombardier said the situation wasn’t life threatening, but the officer was taken to Central Vermont Medical Center for treatment.

In the past, Bombardier said officers used to package suspected drugs in the evidence room so they could be sent out for testing at the Vermont Forensic Laboratory. Now, because there is a danger that a spilled strong opiate could get airborne and cause exposure through breathing, they have had to build a separate room in the police station’s garage specifically for handling drugs so substances don’t make their way into the main building’s ventilation system.

Bombardier said he’s also had to put in place safety protocols for his dispatchers, because residents will come into the police station looking to turn in drugs they’ve found.

Dan Batsie, EMS chief at the Vermont Department of Health, said the state is constantly having conversations about how to address safety concerns for first responders - conversations they weren’t having in the past. And the drug dealers aren’t helping. He said the “gold standard” of a narcotic for a drug dealer is to have a very powerful drug in very small volumes that’s easier to transport and hide from law enforcement.

“That’s why fentanyl has been such a scourge because the equivalent amount of heroin in its pure form doesn’t give you same effects,” he said.

The epidemic has also resulted in syringes found at playgrounds and on the side of the street. To combat this, Deputy Barre City Fire Chief Joseph Aldsworth said the Department of Health has given the city a grant to install sharp boxes in specific locations, such as churches, public bathrooms and the courthouse. Aldsworth said they hope people will dump their needles in the box instead of in the street.

Even though the opioid epidemic has made their jobs more dangerous, emergency responders are quick to point out overdose victims are still people - someone’s son or daughter, mother or father.

Bombardier said he’s heard from residents asking why they bother reviving someone who has overdosed, saying they should let them die. He recalled an incident where a young woman who didn’t drink or use drugs decided to use drugs for the first time and overdosed.

“If it were not for Narcan, she would not be here. For that person and that person only, us carrying Narcan is worth it,” he said.

Charlton said overdose patients are sick, addicted to a drug that takes anybody and everybody hostage. Some of the people she’s treated are highly educated and no one would guess they have an opioid addiction.

“There have been some times where they are very embarrassed when they wake up. I take a moment to give them their dignity and step away from the scene. I will take a moment to give them what information we have for community resources,” she said.

Smith-Luce echoed Charlton’s sentiment.

“It’s probably one of the hardest things in the world to treat because it’s a mental health problem that doesn’t really have a cure. There’s no medication that cures that,” she said.

Det. Trooper Amber Pouliot has responded to several overdoses in her seven years with Vermont State Police and said she’s seen success stories first-hand.

She serves on the treatment court at the courthouse in Barre. Pouliot said she has seen cases where she responded to an overdose and that person went on to graduate from the treatment program.

“That’s one of the benefits of treatment court. I wish all law enforcement could see that side of it,” she said.

Pouliot said it’s encouraging to both addicts and those who deal with them to see success stories.

“To see them come out and be a productive member of society is great. That’s what we’re here for,” she said.

Bombardier said someone came in last week to speak with him. He said this person had contact with police and the fire department as a result of an overdose, and was charged for drug possession and other crimes.

“It happened to be a turning point for this person. And they were coming in to thank the police and fire. Not only for saving their life, but for sending them to court and putting them in a position where they really had to make a choice of, ‘Do I continue with this lifestyle, risk my life, risk my health, risk hurting other people or do I clean up my act.’ That person has now been clean and sober for nearly two years,” he said.


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