Rubén Rosario: Firefighters save lives in a new way as opioid scourge claims victims

Feb. 2--The 911 dispatch call came in around 2 a.m. a month ago -- male unconscious, not breathing.

Firefighter/EMT Elizabeth Kadlec and her fire station rig crew at the time arrived first on the scene at a home in North Minneapolis. Tick tock, tick tock. Seconds matter in such situations.

Kadlec and fellow crew members found the young male lying on the living room floor. About eight family members surrounded him. Most were in a state of screaming, panic and hysteria.

"It was so chaotic that we needed to call the police in to help calm things down so we could tend to him," the 14-year veteran recalled as we chatted last week inside Fire Station 5 off 27th Street and Bloomington Avenue in the city's Phillips neighborhood.

A sister of the unconscious 15-year-old confided to Kadlec and others that her brother abused opioids.

A vial of naloxone, better known as Narcan, was administered nasally through an atomizer. Within seconds, the boy regained consciousness.

Now calm and breathing on his own, the boy did not at first believe family members who informed him that he was pretty much out of it and undergoing cardiac arrest.

"He was just amazed," Kadlec, 39, a mother of two, recalled. The boy, like all such patients, was then taken by the hospital EMS ambulance for observation and further treatment.

This incident, among tragically too many these days, burst my childhood-dream-job bubble.

I never imagined that would be a crucial part of a smoke-eater's job when I was growing up. I wanted to be a firefighter -- snuffing out a raging inferno or racing into a blazing home to rescue people.

But more often than not, firefighters like Kadlec and fire paramedics are now racing into buildings to save the lives of, or, better put, revive people undergoing potentially lethal opiate-induced overdoses.

"It's a temporary fix," Kadlec explained, referring to the more than 50 Narcan runs she has been involved with during calls in recent years.

Yes. Temporary is an accurate but underrated descriptor. Kadlec does not know the fate of that boy whose life she and her crew revived that early morning. She hopes it was a wake-up call. She hopes he still walks among us, addiction-free.

But without that first response, who knows how many more opiate-related deaths there would be out there. In 2017, 422 souls in this state died of such overdoses.

"The ability to administer naloxone (Narcan) by our first-responder partners is a critical life-saving tool," said Martin Scheerer, chief of Hennepin EMS. "The quicker naloxone can be administered, the quicker the patient may regain a pulse and start breathing again, giving them a better chance of survival and reducing their risk of permanent brain injury or deficit."

Kadlec and fellow firefighters across the Twin Cities and the nation are frequently being asked to revive such folks while staffing the front lines of a public health crisis that does not seem to show much sign of slowing down soon.

Consider this: From May 4, 2016, when Minneapolis rigs at its 19 fire stations first went out equipped with Narcan, through Tuesday of last week, firefighters had revived 920 individuals undergoing an opiate-suspected overdose episode. There have been 24 such Narcan administered runs by EMT-trained firefighters in the state's largest city so far this year. The locations are mostly poor areas but also middle-class areas where the stereotypical response is "this does not happen here." It does.

"It's everywhere," said Deputy Chief of EMS Amber Lage, a 20-veteran. "What is certain is that it's not getting better. We are still seeing the numbers increasing."

Along with Fire Chief John Fruetel, a 40-year veteran and like Kadlec a born-and-bred Minneapolitan, Lage felt it necessary to require battalion chiefs, captains and fire station grunts to meticulously log and report the where, when and generally the who of Narcan runs.

So, combing through nearly four years of spreadsheets, one finds the following narrative from May 8, 2016, just four days after the department went Narcan-ready:

"Engine 1 arrived at 3rd St and 1st Ave for a OD. Upon arrival we found a female outside of a parked vehicle's passenger side door on the ground and unconscious. There also was a male in the driver's seat unconscious as well. The female had shallow breaths and a weak thready heart rate. Engine 1 placed an oral airway and high flow O2 with the ambu bag. The male had the same symptoms and we did the same for him. Engine 1 administered 1 round of nasal Narcan to the female and HCMC administered 2 doses of Narcan via IM (injection into a muscle). The female responded shortly after this by becoming awake and alert. The male also received a dose of Narcan via IV. He also came to shortly after."

Flash forward to last week on a call from the fire station where Kadlec was recently reassigned and where I met her last week. Her co-workers did not have to travel far. The crisis literally drove up to Fire Station 5's "apron," the term for the station's front entrance.

"E5 had a car pull onto the ramp with 1 PT (patient) that had OD'd on heroin. MFD called for MPD and EMS. PT had pulse but was not breathing and was very pale. MFD inserted an oral airway, gave ventilations. Vitals: P 110, O2 42%. MFD used BVM at 10 LPM to ventilate PT. PT O2 level increased to 100%, and Pulse reduced to 78. PT had pinpointed pupils and still had no respiratory drive. MFD gave 1 dose of Narcan in PT's left nare. PT responded slowly, and MFD moved PT into station. Car drove off. PT was able to be roused but would fall unconscious if not stimulated. HCMC arrived and took over care. MFD assisted loading PT into ambulance. HCMC released MFD .:."

The scene is much the same across the river in the Saintly City, whose fire department makeup is structurally different in that, unlike Minneapolis, it has paramedic-trained medic units and ambulances that operate out of several of the city's 12 fire stations.

Such medic units are the ones primarily responsible for responding to medical-emergency runs that include opiate-related cases.

The numbers in St. Paul are also alarming, although details and public discourse on the issue are problematic because "as the ambulance service provider, we have significant HIPPA (Health Insurance Portability and Accountability Act) patient privacy rules," explained St. Paul Deputy Fire Chief Roy Mokosso.

In the past five years, approximately 2,800 doses of Narcan have been administered by St. Paul Fire paramedics, according to figures provided by Mokosso. He noted that the price of Narcan has jumped from $30 a vial to $40 this year.

As a firefighter and as a captain working out of Station 18 in the city's Frogtown neighborhood, responding to overdose calls was "unfortunately a common occurrence," Mokosso shared. "With Opioid overdoses Narcan works and can have an immediate effect. Patients sometimes come back from near pulseless activity to sitting up confused and combative."

Fruetel said his department in Minneapolis has so far been able to absorb Narcan-related expenses through the department's general operating budget and various charitable grants. But much of the expense is tied to Narcan training, which is required every two years.

"Moneywise, there's been no money," Fruetel said. "We found the money because there was a need -- an overwhelming need in the community -- and we needed to address it."

Twin Cities cops are also equipped with Narcan. Officers in Minneapolis administered the life-reviving narcotic 173 times since they began carrying it in squad cars in the summer of 2018. Saintly City cops have used Narcan to revive OD victims in 108 incidents since 2018.

I asked Kadlec if there was an emotional residue to these types of emergency runs, compared with others.

"People deal with this differently," said Kadlec, who grew up mostly in South Minneapolis. There have been times, she confided, when fellow firefighters responded to Narcan-related calls involving neighbors, people they know or even relatives.

Lage noted that the Narcan runs remain constant even though the drug is now more readily and publicly available. Still, it can be a double-edged sword given that some users might take things to the edge, knowing a buddy or partner has a Narcan vial nearby in the event of an overdose.

"It's obviously an epidemic, and the numbers show it," Lage told me. Narcan "is not a solution, but we certainly know that we have saved many lives because of it."

True that.

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