MANCHESTER, NH – Last Wednesday was another tough one for our first responders. Within three hours time police and fire responded to eight overdoses, and two deaths. June is not even halfway through, and there have been more than two-dozen drug overdoses.
It’s the new normal here.
After 20 years serving as a first-responder, what’s happened to the city in the last few years has changed everything about the job, says Christopher Hickey, Manchester’s Director of Emergency Services.
What’s happening has changed him.
“The city has a very high turnover when it comes to emergency medical services, predominantly because of the call volume and the nature of calls we encounter. There are only three of us that are left from the original group I started with in Manchester 16 years ago,” Hickey says. “This city will chew you up and spit you out.”
The ‘big city’ and the problems that go with it aren’t for everybody, he says. American Medical Response has definitely lost personnel to this drug crisis.
“They say it’s just too much, or that it’s not what they signed up for, or just because of sheer call volume. I completely understand. And I tell all our employees, listen, you try but if you don’t succeed it’s fine; this city isn’t for everyone,” says Hickey. “Everyone wants the big city kind of stuff, until you experience it first-hand. It’s not something you can describe, or be prepared for. I’m surprised I’ve stuck it out in the city as long as I have, to be honest.”
Hickey says for all the efforts made to turn the tide, it’s still a difficult reality to face day in and day out. He acknowledges his mental outlook has changed, from optimistic to pessimistic.
“How I react to things has changed, the eagerness has dissipated quite a bit. It’s the overall stressors of not only working in this field, but working in this field in such a high-volume community. When I first started we answered about 10,000 calls a year. Now that number has doubled. I’d say we do 22,000 easily, and that’s just for medical calls. That doesn’t include box alarms, fire calls, or specialized tech rescue calls,” Hickey says.
Police Chief Nick Willard sees the same phenomenon with the police department rank and file, something he identifies as first-responder fatigue.
“We’re responding to more calls for service than ever in the history of the Manchester Police Department,” says Willard. “We’re already well over 50,000 calls for service this year so far. We’re not even halfway through the year.”
Last year police responded to nearly 700 calls related to overdoses, 100 of them fatal. If there is a darker side possible to the opioid epidemic, it would be the toll it’s taking on our city police, fire and ambulance personnel.
“They’re seeing more death than they’ve ever seen before, and the peripheral things that go along with it,” Willard says, including fallout for family members whose loved ones are dealing with addiction. Typical overdose patients range in age from 16 to 75, from all socio-economic backgrounds, leaving a lot of pain and grief in their wake.
Burn out is a very real thing
“A lot of these people have children, so my officers are seeing children living in deplorable conditions, children who’ve witnessed a mother or father overdose in the home,” he says. “We recently got a 911 call from a 5 year old, where the mother wouldn’t wake up. And although Manchester Police officers are tough and appear bullet proof, most all of them are mothers or fathers. It’s tough for them out there.”
Willard likens it to post-traumatic stress.
“We talk a lot about all the different nuances of the opioid crisis, how it affects families of those suffering from the disease of addiction, how it affects the economy, our medical institutions – and that we now have babies being born addicted who are in recovery from the day they’re born – that’s taxing on our medical community. We talk about all these other things, but we don’t talk so much about the fatigue it places on first-responders,” says Willard.
“Burn out is a very real thing, even until recently it wasn’t talked about at all anywhere, and in the last two to three years it’s come to the forefront – police, fire and private EMS have come to realize that what we deal with on a daily basis is like no other profession,” Hickey says. “You have those moments when you don’t know what you’re walking into, or what’s waiting around the corner. As a paramedic you sit there when someone’s in crisis, whether it’s mental or physical or emotional, cardiac or respiratory, and you’re expected to fix the problem or stabilize the patient until you get to the ER, knowing that one wrong move or medication, one wrong dose can have a significantly different outcome. Physically, it takes a toll also, as we move patients that vary in size through a variety of living arrangements to get them the help they need.”
Retraining for all the city’s first-responders has been necessary, given the issue of deadlier drugs on the street that can do harm on contact, including the powerful opioids fentanyl and carfentanil.
“Potential exposure to an officer who has to go inside a vehicle during a traffic stop, when there are drugs involved due to potency of those drugs, is worrisome for any police chief who cares about the men and women under his or her command,” says Willard
It’s not just the pace, or the nature of the calls, or the negative outcomes, he says. Officer safety is still his greatest concern, but this drug epidemic has added a new layer of uncertainty each time an officer answers a call.
“Every day I’m concerned about the protection of the officers themselves from the very drugs we’re trying to prevent people from taking, and prevent them from selling,” says Willard.
Peer-to-peer support for first-responders
Preventative training and measures are now in place, and include more layers of protective gear and new equipment for field-testing drugs that don’t require packaging to be opened. “We don’t want them to run the risk of being exposed,” says Willard. It’s a safety concern that even extends to Manchester’s K9 unit, and how contact with dangerous drugs might hurt the dogs as they do the one job they’ve been trained to do.
As the state medical examiner’s office scrambles to keep up with tracking overdose information, even that system is feeling the weight of the increased demand for services, says Kim Fallon, Chief Forensic Investigator for the state’s Medical Examiner’s office.
“Yes, it’s overwhelming. We’re not keeping current with toxicology data. There are still 2016 cases that have not been finalized. Hopefully, they will be finished by the end of June,” says Fallon.
She explains the process involved in confirming cause of death, and why doing so in a timely manner matters to loved ones.
“When it looks like an overdose death, the cause of death on the death certificates is initially ‘pending toxicology.’ Then, when all the test results come back and the doctor reviews the results and completes the histology [looks at tissue under the microscope] he or she determines the cause of death and completes a supplemental death certificate worksheet, which is sent to Vital Records,” Fallon says.
“But often, the doctors can’t review all of the tests results very promptly, because they are in the morgue doing more autopsies – and many of them are drug deaths. Until the supplemental death certificate is done, families can’t get life insurance, pension funds or social security, so the delayed death certificate can be a big problem for them, too,” Fallon says.
Willard explains another symptom the drug epidemic has created in our community is an uptick in violent crimes – for 2016 that was the one area that spiked – particularly shootings between individuals who sell drugs and gang-related activity, he says.
“Right now we’re actually seeing a slight down tick from last year, but officers are on guard because they’re going to more gunshot calls. And then, they go from that to a person who is in need of services, maybe experiencing a drug overdose, so then they have to switch over in their minds to helping someone live, because our main function is to preserve life – protect it, of course – but preserve it as well; that’s their first responsibility, to save a life,” Willard says.
To help combat “first-responder fatigue,” uniformed officers participate in Critical Incident Management Team training, where mental health counselors are brought in to educate and train officers about how to effectively deal with someone in crisis.
“It’s a more soft-handed, less authoritative approach, and then they actually role play with officers. We want to be able to get someone the services they need, rather than into handcuffs,” says Willard. “The old way was ‘go to the hospital or go in handcuffs’ – and more often than not, they’d go in handcuffs. We’re going from incarcerating people to getting people help for treatment. That’s a big shift for law enforcement.”
The most important facet of that training is peer-to-peer outreach.
“We don’t wait for someone to ask. If we know they’ve encountered a situation there’s immediate and confidential outreach,” says Willard. “Many of the strategies in place are more current and new to our profession than what was happening five or 10 years ago.”
Hickey says likewise, making sure first-responders get the care they need, post-call trauma, is an integral part of the job.
“We don’t look for thanks or praise or anything like that because we know we have a job to do, and we’re trained to do it. But especially when it comes to fire service and EMS, we’re always together as a team, whether it’s an engine company or crews. For police officers, it’s more of a solo effort when they answer calls, fire and EMS rely on each other, and so we talk things out. There are no ifs, ands or buts about it, especially if something really bad happens, we bring everyone together who’s been on a call and we talk,” says Hickey.
He cites a fatal fire call in 2016 on Wilson Street in which four people died.
“Two of them were children. After something like that, we have a critical incident debriefing and allow people to say whatever’s on their mind in a non-judgemental setting, so it’s not something they take home with them to their own families,” Hickey says.
CrimeLine meets Safe Station
One of the newest initiatives, rolled out this month, has grown out of the unexpected partnership that’s been forged between law enforcement and fire personnel through Safe Station.
Willard pulls a business card out of his pocket – on one side is the Manchester 24-hour CrimeLine tip line phone number with police and fire department emblems. On the flip side, an inspirational quote from Willard, “Never lose sight that you inspire others in your recovery,” and information on how to find CrimeLine online.
It’s an initiative that grew out of the conversations fire department personnel found themselves having with those who were coming to Safe Stations for help.
“They have people who want to give information about their drug dealers – lately, they’re hearing things like, ‘My drug dealer told me it was regular fentanyl but it was actually carfentanil,’ and they’re upset about it. At the same time, they’re reluctant to give the names of their dealers to a firefighter. So we came up with the idea that by creating these cards, it empowers them with a couple different means of communication with law enforcement,” Willard explains.
“These people who are coming for help are frustrated and they don’t know who to turn to, because they don’t want to be ‘rats.’ We’re encouraging them to drop a dime through CrimeLine on the dealers,” Willard says. “And the quote is meant as a way of encouraging them, to reinforce that they’re on the right track.”
The cards are being carried by police officers, firefighters and counselors at Serenity Place and HOPE for NH Recovery, as another “weapon” in the first-responder arsenal. The current drug battle has changed everything we know about the yin and yang of what it takes to respond to the need; crime-fighting balanced by compassion.
“We’ll see if it works and circle back to see if tips to CrimeLine have increased or if we find it didn’t bear any fruit. People coming in for rehab want to take down the dealers as much as anyone, and that’s a good sign,” Willard says.
Hickey agrees that it’s not all bad news in the trenches. One other thing has changed in the last few years, and it’s palpable.
“If you’d asked us three years ago what our thoughts about drug issues were, the majority of first-responders would say something like, ‘why can’t these people stop putting needles in arms?’ We considered it a choice. But the more we’ve interacted with people who are struggling with that, you don’t hear that attitude from first responders any more – from cops to firemen and paramedics – this epidemic has changed our mentality. We are seeing it’s not a choice. Addiction is something these people are powerless to control,” Hickey says. “What’s really changed is the process we follow to try and get in front of the overdoses, and get them the help they need.”
Process, and attitudes are changing, he says – it’s been slow, and not everyone agrees about how to solve the epidemic, but he hasn’t given up hope, he says, or else he wouldn’t be showing up for work every day.
“We are seeing attitudes changing from within the system. Safe Station is catching on around the country. The overall mentality around what’s needed to really help these people is changing. That seems like a good sign,” Hickey says. “The more people who recognize that we need to focus on solutions, the sooner we might see some real progress.”