When a 911 call sends emergency medical services to help a person who has overdosed on opioids, it’s anyone’s guess what the scene will look like once the ambulance arrives.
“Just like everybody's home is different from the next person — you never know what you're going to walk in to and what color rug you're going to see — we have no idea where we're going into,” said Katie Benedyk, an Orange County Emergency Medical Services community paramedic.
Though dispatches to paramedics include basic information provided by the caller, the details can be scattered and imprecise.
“I could walk in and it be somebody who's overdosed by themselves with an upset girlfriend screaming at us. I can handle that,” Benedyk said. “It could be that I'm walking into a family of 30 people with somebody who's overdosed, everybody screaming. I know how to handle that one as well.”
But after the initial flurry of activity, the role of traditional paramedics is finished. With the patient revived on the scene or transported to the hospital, it’s on to the next call with no time for a follow-up.
Time and time again, the same responders will treat the same patient for the same affliction, knowing that chances are strong that they’ll be back soon. In total, about a quarter of Orange County’s yearly EMS calls are from the same group of around 30 people who call more than five times, said Kyle Ronn, quality assistance coordinator for Orange County EMS.
One fix? Community paramedics.
“I think anybody that gets into EMS, and I think everybody in our agency, does it out of some sort of desire to help somebody,” community paramedic Landon Weaver said. “On the flip side of that is the nature of emergency medicine — it's very time sensitive, and there aren't a lot of resources.”
Those repeated calls are what community paramedicine is designed to address — people without a support system or health care knowledge who, as a result, have to call for help.
“It takes a lot of digging, but there is typically an answer, even within in the small areas of our county, for almost any need that presents itself,” Weaver said. “It's just that most folks either aren't involved with the patient enough to identify these needs, or it's just not exposed, and the connection isn't made. We look at ourselves as that role, connecting all the dots.”
First introduced across parts of North Carolina in 2015 as a pilot program, Orange County recently made community paramedics a permanent part of its system. After identifying people who may need support, community paramedics proactively make phone calls and home visits to keep problems from escalating.
Benedyk and Weaver are the county’s first two to take the role, a task they said is challenging but exciting.
Orange County EMS is not the group bringing the role of community to the forefront of opioid response. The North Carolina Harm Reduction Coalition provides a variety of programs across the state, including syringe exchanges, outreach workers and overdose rescue kits with naloxone, a treatment that reverses the effects of an overdose.
NCHRC’s strategies are based on the philosophy of harm reduction, an approach that seeks to reduce the risks of drug use and focuses drug users on their own treatment.
Loftin Wilson, a harm reduction programs manager in Durham and statewide, said people who use drugs often take the role of first responder for people who have overdosed before EMS is ever called. Naloxone distribution programs play a key role in these situations — since 2013, NCHRC claims to have helped people reverse over 13,000 opioid overdoses.
“People say things like, ‘I feel like a superhero’ or, ‘I feel like I really did something that was important and meaningful. I feel like I've really contributed something to the world,’” Wilson said.
“Everything around you is telling you that you don't contribute anything to the world and your life is useless and meaningless and a drain on society. To be able to say, I am taking care of the people around me, it's meaningful because somebody's life is saved," Wilson said. "But it's also meaningful because it creates an emotion of worthiness and empowerment that can extend beyond that specific situation.”
Like NCHRC, the Orange County Sheriff’s Office, EMS and other partners distribute naloxone through an initiative called the Coordinated Opioid Overdose Reduction Effort. COORE also connects people with community paramedics and encourages people who use drugs to pursue amnesty and medical treatment.
Orange County Sheriff Charles Blackwood, one of COORE's leaders, emphasized the need for cooperation between medical and law enforcement agencies in order to solve the opioid crisis.
“I realized that the follow-up visits needed to be done by somebody other than a person wearing the badge,” Blackwood said. “I found that the time people are most vulnerable is when they're actually still coming out of or in that crisis.”
Wilson said personal relationships are necessary to help people who are addicted to substances. Because NCHRC programs are staffed by people directly impacted by drug use, especially people from marginalized identities, Wilson said providers are able to engage with participants in a nonjudgmental, supportive way.
And participants aren’t the only ones who benefit.
“I really, really benefit and learn from relationships with participants,” Wilson said. “When I talk to people and hear their experiences, there's a lot that I can relate to and there's a lot that's different from my own experience. It's a process of always being able to learn more about the world, about human experiences and about human resilience.”
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