ARLEY - Six fire departments in Winston County will receive kits of Narcan nasal spray to administer to opioid overdose victims after nearly two dozen firefighters attended a training session on the administration of Narcan as well as a wide range of other topics.
Narcan’s active ingredient is naloxone hydrochloride, which reverses the effects of opioids like fentanyl, oxycodone and heroin—including overdoses. The number of annual opioid overdose deaths in Alabama more than doubled between 2012 and 2017, a year when 422 people died of an opioid overdose in the state, according to a widely cited statistic from the National Institute on Drug Abuse.
Members of the Addison, Arley, Central, Delmar, Haleyville and Helicon fire departments participated in the training, which was hosted by the Arley Fire Department on Saturday, March 19.
Arley Fire Chief James Rickett said his department has seen an increase in the number of overdoses to which it is called. “Ten, fifteen years ago, most of the medical calls were diabetic calls. Now it’s ODs—overdoses or (calls) related to them,” he said.
“That’s why we thought this would be a great thing: to get as many people (as possible) over here to get trained on it.”
He noted how good it was to see that so many people had been willing to give up their Saturday morning to attend the training. “I’m tickled to death this many people showed up,” he said.
In addition to giving instruction in the administration of Narcan, the three-hour training session highlighted the danger to first responders of exposure to fentanyl when it is present at scenes, encouraged the firefighters to connect any overdose patients with the Recovery Organization of Support Specialists (R.O.S.S.), a peer-run organization that assists with recovery, and provided a forum for them to discuss how to avoid burnout and compassion fatigue.
They were also invited to take part in a research study on the role of secondary trauma in occupational burnout among first responders. The study is being conducted jointly by the University of Alabama and Southern Illinois University.
“(The training) was really good, very informative,” said Jeff Marksberry, the chief of Central Fire Department.
James Liverett, the assistant chief of Delmar Fire Department, agreed, noting that he learned from the session.
“This is more of a hands-on training than what we were taking online,” Rickett observed, referring to the Narcan training his department had undergone in the past.
“We had some handouts and videos,” said Arley firefighter David Kelly. “We had some open discussion about it, too.”
Rickett said that having that kind of participation in the training was helpful.
“It was also good that we as departments came together and went through it together, kind of a community thing in cooperation,” Marksberry added. He said his department sees overdoses occasionally, more in the summer than the winter but even then only occasionally.
The training was conducted by Kimbley Terrell, the training and outreach coordinator for Project FREEDOM, a program overseen by the UA School of Social Work’s Vital Team in partnership with R.O.S.S. and the Alabama Departments of Public Health and Mental Health. Researchers at Southern Illinois University are also helping to head up the project. “FREEDOM” stands for First Responder Expansion of Education and Distribution of Overdose Medication.
Project FREEDOM is funded by a federal grant, specifically the First Responders Comprehensive Addiction and Recovery Act grant, which was awarded by the Substance Abuse and Mental Health Services Administration (SAMHSA), a U.S. Department of Health and Human Services agency.
The program’s goals are to reduce deaths caused by opioid overdoses by providing first responders with Narcan and instructing them in its use and to educate healthcare providers and the community as a whole about opioids and recovery options. It focuses on fourteen rural Alabama counties—Winston, Walker, Cullman, Morgan, Lawrence, Franklin, Marion, Fayette, Blount, St. Clair, Etowah, Marshall, Jackson and Shelby—as well as Jefferson and Tuscaloosa counties.
For each individual firefighter who participated in the March 19 training, his or her department will receive a Narcan kit containing two nasal spray doses of the life-saving drug. Once the kit is used, the firefighters can report its use to Project FREEDOM and receive another kit. They can do this twice within the fiscal year and thus can receive up to three kits per participant.
“We don’t really have (Narcan) on our trucks right now, so this will be a way of getting it,” Lt. Jared Osborne of Addison Fire Department said, noting that the training included some content that firefighters might not have previously thought about.
Like Addison, Central does not currently have a supply of Narcan but soon will thanks to Project FREEDOM. For the other departments, this supply of Narcan will add to their current stock.
Rickett noted that receiving free Narcan saves the departments a lot of money because the medicine is expensive.
“We get called out on several (ODs) a year,” Chief Neil Feist of Helicon Fire Department said. “When it’s an opioid, it (Narcan) usually saves their life.”
He said that the number of overdoses his department sees has stayed about the same.
Lael Feist, firefighter and treasurer of the Helicon FD, said, “We’ve probably administered Narcan five times within the past two years,” noting that their current supply came from the county.
Osborne said Addison FD might see an overdose every now and then but not all the time.
“One thing that I learned was about some of the help that families and addicts have available to them for their path to recovery (through R.O.S.S.),” said Lael, “so that was great. We’re excited about sharing that with the community.”
Mark Litvine, director of marketing at R.O.S.S. and one of its founders, had given a presentation on the organization and its services. He provided business cards, wallet inserts, leaflets and posters that contain the number for the R.O.S.S. 24/7 helpline, 1-844-307-1760, as well as other information about R.O.S.S. services that would be helpful to those interested in recovery from a substance use disorder.
All R.O.S.S. services are free and confidential. More information can be found at www.ross4u.org. A live chat is available at www.rosshelpline4u.org, and the organization’s email address is firstname.lastname@example.org.
The firefighters were encouraged to give the R.O.S.S. cards to victims of overdose they attend or to the patients’ families. Lael planned to put some of the posters up in public places in her community.
Risk of fentanyl
Several of the participants remarked on the portion of the training that focused on the dangers of fentanyl exposure to first responders. They had been able to view body cam videos that showed first responders reacting after accidental exposures to fentanyl. In them, the affected first responders were aided by their colleagues, who administered Narcan in at least one case.
“It’s kinda scary,” said Kelly, “the dangers with (fentanyl) and how it seems to be rapidly increasing.”
Rickett noted, “With it increasing like that, it’s something we’re going to have to watch out for.”
He continued, “It’s bad. I’ve heard of too many (affected by it)—mostly law enforcement officers are getting into it. Just touch it—that’s all you got to do. Just touch it.
“They never know who they’re pulling over on the side of the road or helping out. Same way with us. We’re going in people’s houses; we don’t know what’s on the carpet, what’s in the floor, what’s on the couch (while) we’re working on these patients.”
The participants had also watched a video that explained the kind of personal protective equipment (PPE) that first responders need when responding to scenes where fentanyl is or might be present, depending on the level of the risk of exposure.
Minimal risk situations, when there is no visible fentanyl but the presence of illegal drugs is suspected, call only for nitrile gloves.
Moderate risk situations, when small amounts of fentanyl or other illegal drugs are visible on the scene, call also for arm protection, eyewear and a respirator.
High risk situations, when large amounts of fentanyl or liquid fentanyl are visible, including at sites where fentanyl is being manufactured, stored or distributed, call for a specially trained response team in full protective suits.
Rickett said that Arley FD currently uses all the equipment recommended for minimal and moderate risk situations except for respirators. He plans to order respirators soon; every member of the department will have his or her own.
Since the Haleyville Fire Department does not receive medical calls—in Haleyville, those are handled by Regional Paramedical Service and the Haleyville Police Department— Lt. Gary Sutliff of Haleyville FD said he hadn’t realized how dangerous exposure to fentanyl could be.
“We needed to know,” he said, “so I’ll go back and I’ll advise everybody else of what we learned over here today.”
He noted that even without handling medical calls, members of his department might still encounter fentanyl on other calls; however, they already wear gear designed to protect them from airborne contaminants.
“We have protocol to follow, so we’re fairly safe anyhow,” he said. “We have to be in SCBA (a self-contained breathing apparatus) to go into anything that’s on fire.”
See complete story in the Northwest Alabamian.