EDITOR'S NOTE: This article is part of an ongoing SooToday series — 'Turning the Tide' — that explores potential solutions to our city’s toxic drug crisis. You can read more about our project HERE.
When local paramedics respond to opioid calls, it can often be a challenge to find ways to help.
They might respond to someone who is simply napping in the street, or revive a person with naloxone — a drug used to reverse opioid overdoses — only to have a patient refuse further medical treatment.
“If they awaken, oftentimes, that's how it goes: ‘No, I'm good, thanks. I'm not going anywhere. I don't want to go. I'm staying here,’” says Dave Culina, commander with Sault Ste. Marie Paramedic Services.
Unlike broken bones and other straightforward medical emergencies, the opioid crisis has brought a myriad of complexities to paramedics’ day-to-day work that go far beyond simply transporting patients to the hospital.
Over the past several years, the situation has grown dire.
“I don't know how we fix it, but I've been doing this for over 20 years, and I know it's getting worse every single year,” Culina says.
Local paramedics responded to around 23,800 calls last year, around 30 per cent of which were mental health and addictions calls — a seismic increase over what Culina ran into at the beginning of his career.
“There's been a ridiculous increase over the last three, four years, but the overall increase has been over the last 10,” he says.
“I remember the first time giving naloxone, and it was like" ‘What!?’ Now it is an every day, multiple-time-per-day event by every crew on staff.”
With an ingrained desire to help, front-line medics say watching people struggle with opioids can be a taxing experience that can lead to burnout.
“Obviously, everybody that got into the career of paramedicine has, on some level, a desire to help, to care for others,” Culina says.
“You go to these calls and locations and patients over and over and over again, and that is a frustrating process. It's a sad process. It's not pleasant. You do that – and you hit repeat – obviously it's going to take a toll on you.”
It’s a sentiment that Kate Kirkham, chief with Sault Paramedic Services, agrees with.
In recent years, Sault Ste. Marie has routinely placed in Ontario’s top five for opioid death rates as the crisis has gotten worse.
“I think it's discouraging sometimes for the paramedics, because they feel the training they have and the expertise they carry doesn't always apply to the problem at hand,” she says. “They wish they could do more.”
Despite the challenges, efforts are underway try to turn the tide on the Sault's opioid emergency.
Among the changes, Sault Ste. Marie Paramedic Services is now carrying and distributing naloxone kits to help people during emergencies, and to provide access to the life-saving medication when paramedics are not around.
Moving forward, Kirkham said a variety of new measures could be coming to help keep paramedics and the community at large safe — such as de-escalation training for these types of calls, as well as administering suboxone, a prescription medication used to treat opioid addiction.
Work is also underway to allow 911 paramedics to transport patients to Ontario Addiction Treatment Centres instead of the hospital, when appropriate.
But a big change that could be on the way is expanding the community paramedic program, “which is more preventative than reactive,” Kirkham says.
“Our community paramedics are moving towards some street outreach and other supports integrated into other community areas — for example, working in the shelter, working the downtown hub,” she said.
Paramedic Services already has a community paramedicine program in place, which helps seniors with non-emergency issues, as well as those awaiting placement in long-term care.
Earlier this year, the service acquired a van for street outreach, but the community paramedicine program has yet to expand to people struggling with addictions.
“It comes down to funding,” Kirkham says.
Community paramedics could be a resource that help even more patients with non-emergency care, and even help connect them with community services they need.
“We have a lot of housing and resources that we can reach out to and the community paramedics, in particular, are very good at making ties between all these community resources and just navigating through them with the patient,” she says.
“We feel that's the next area we need to go into, is the people out on the streets or in the community that need actual assistance.”
