The dispatch goes out at 12:40 p.m. on Saturday, Dec. 2. “Attention, Engine 4. Number 35 Kilby Street. First responder.”
Three Worcester Fire Department firefighters on duty at Engine 4 in the Park Avenue station respond. Thirty-five seconds after the initial call, they’re en route to the bike path adjacent to the Boys & Girls Club of Worcester on Tainter Street.
“Female having difficulty breathing.”
At 12:43, Engine 4 arrives almost simultaneously along with paramedics. A young woman is sitting, her back against a wall, her head down.
Fearing the position of her head is restricting her breathing, first responders lift her head. She’s breathing, but not well. Her pinpoint pupils are the telltale sign of someone under the influence of an opioid.
Paramedics inject one dose of naloxone, more commonly known as Narcan, into the young woman. She begins to come around, but paramedics determine she needs a second dose.
With the second dose, she begins to rouse. Then she starts to cry.
“Not again,” she says.
The 23-year-old is not a longtime user, first responders surmise; there’s only one fresh needle mark in her arm. She lives in a suburban town that borders Worcester.
“I can’t believe it happened again,” she tells the first responders. “This happens every time I come to Worcester.”
Worcester Sun recently spent 40 hours over two days with the Worcester Fire Department. The Sun was assigned to Engine 4 Group 3 in the Park Avenue fire station, the busiest in the city based on the number of calls to the two companies there, Engine 4 and Ladder 7.
Over the two days the Sun spent with Engine 4, not including four hours in which the Engine 4 crew was training, Engine 4 had 21 calls, or “runs.”
Four firefighters on 24-hour shifts are assigned to each truck. Because of vacations and ship-outs — when a firefighter is sent from his home station to cover an opening at another — both ran with the minimum, an officer and two firefighters.
Engine companies handle the bulk of the first-responder work. Ladder companies handle first-responder calls if the Engine company is on a run.
Engine 4 Lt. Matthew R. Petty is the officer for Group 3 Engine 4. A firefighter for 10 years, he was promoted in January and assigned to Ladder 4 at the Webster Square station. He bid to return to Engine 4 in October.
Benjamin J. Dio, John M. Dwyer and Andrew J. Cavanaugh are the firefighters assigned to Engine 4. On the Sun’s first day with Engine 4, Nov. 27, Cavanaugh was shipped out to the Webster Square station. On Dec. 2, Dwyer filled in on Ladder 7.
Firefighters respond first because they can usually be first on the scene.
“Our job is CPR if there needs to be, defib, Narcan, oxygen, and just assess the situation to see if we can help them further,” Petty said. “When we’re on the scene and it’s a medical, it’s ours until the paramedics get there. Once they are there, they take control.”
Engine 4 is a 2003 E-One Cyclone II. It’s more than 25 feet long, just shy of 10 feet high, can pump 1,500 gallons of water per minute, and has a 500-gallon water tank and thousands of feet of firehose.
But, time and again, the most commonly used equipment is contained in a 9-square-foot cabinet in the right rear of the vehicle. This is where the first-responder gear is stored, primarily in two light canvas bags, one of which contains the Narcan supply.
As wonder drugs go, this one is hard to beat. “It attaches to the same parts of the brain that receive heroin and other opioids, and it blocks the opioids,” according to the website naloxoneinfo.org.
So effective has Narcan use been in combating the opioid epidemic that it’s hard to believe it was patented back in the 1960s and approved by the U.S. Food and Drug Administration for treating opioid overdoses in 1971, according to the American Chemical Society.
Narcan was only given by injection until the FDA approved it as a nasal spray in November 2015.
The Worcester Fire Department started carrying Narcan about three years ago, shortly after the Worcester Police Department equipped and trained its officers.
The use of Narcan by firefighters, paramedics and police is a response to the opioid epidemic that has gripped the nation.
The hopeful news, according to updated data by the Mass. Department of Public Health, is that opioid overdoses in the state have dropped by 10 percent during the first nine months of this year compared with the same period in 2016.
The bad news for the Worcester Fire Department and other first responders is that the decrease in deaths has not been accompanied by fewer opioid-related first-responder calls. In fact, the trend is the opposite.
According to data from the WFD, Engine 4 responded to 53 opiate-related calls in the first 11 months of 2016 and 91 so far in 2017. The trend is citywide, the number of opiate-related calls jumping from 413 in the first 11 months of 2016 to 579 in the same period of 2017.
Meanwhile, the number of calls that resulted in Narcan administered by WFD firefighters has dropped from 193 in the first 11 months of 2016 to 147 in 2017. Engine 4 firefighters have also had to administer fewer doses of Narcan this year, 23, than last, 38.
The increase in the number of opiate-related calls, firefighters say, is related to the increase in the availability of opiates.
“We’ve opened a backdoor to this addiction with pharmaceuticals,” Dio said. “Before, so long as you didn’t have a massive event in your life … there was a good chance you were not going to become a heroin addict. … But not anymore.”
Dio calls it “the bony fingers of heroin.” He said opiate addiction used to be perceived as “the addiction of the downtrodden,” adding: “It was very rare to find someone of good social standing that’s a heroin addict. But now there’s a whole ‘nother avenue to get into the drug, with the pharmaceuticals. Now it’s just exploded. It’s the common man’s problem.”
Noting that prescription opioids created a “huge onramp” to addiction, Petty said, “If you’re walking and breathing, you’re a candidate” to become an addict.
For Worcester firefighters, the availability of Narcan is relatively new. But keeping alive those who overdose is not. The leading cause of overdose deaths is respiratory failure. Under the influence of an opioid, the body can essentially forget to breathe.
Prior to using Narcan, Worcester firefighters saved lives by “bagging” overdose victims, essentially breathing for them, until paramedics arrived.
It’s little wonder that when the goal is simply to keep someone breathing, the ability to use a drug to accomplish what was done by hand seems to firefighters less miraculous than it might seem to the public. In this light, Narcan is a new tool for a job firefighters and other first responders have been doing for years.
“We were doing it before it was cool,” Dio said. “We’ve been doing this (saving lives) for years. Nothing’s changed here.”
But perhaps what’s changed more is the public’s understanding of the job firefighters and other first responders do on a routine basis: face pain and despair while trying to save lives or otherwise assist those they serve.
First responders steel themselves against the volume of calls and their macabre randomness by focusing on the task at hand.
“It’s a job. No matter what, we’re still going to do it,” Petty said. If it’s an overdose, “I’m going to give them Narcan and do 100 percent to bring them back, whether it’s somebody I’m related to or some guy I go to every day. If you go to the same person every day, you give the same effort. … Whoever calls, you’re getting everything.”
“You’re getting everything,” Dio said. “We want you to live, even if living means you shoot up again tomorrow, (because) maybe between now and tomorrow something might change.
“In this job, you can’t isolate yourself from the travesties that exist in modern society,” he added. “The guys who don’t learn to deal with it, they’re gone. They’re not on this job anymore because they couldn’t do it.”
It’s that focus on the job at hand that allows these emergency workers to keep doing it. It’s a must, considering the sheer number of first-responder calls they face.
From Jan. 1 to Nov. 30 of this year, Engine 4 responded to 3,696 calls, an average of 11 per day, according to the Worcester Fire Department. A full 66.4 percent, nearly two-thirds, of those calls were first-responder calls.
This is roughly the same breakdown as for the WFD as a whole, which had 25,838 first-responder calls out of a total of 38,009 — 68 percent — through Nov. 30.
“All of us in this room have been doing it for over 10 years and … we get a very unique perspective and it comes off very cold, and not very empathetic, but it really is,” Dio said.
“I’ve seen parents crying because their children are dead on the floor from overdosing; that’s a fact,” he said. “That’s something you can’t prepare for. … I go to three of these a shift and every time I go to one, I chip off a little piece of myself and leave it with them. Not humanizing (every) addict is a self-preservation technique for those of us who have to go (there) every day and keep their head on, and then come back out and hug their kids.”
Despite firefighters’ best efforts, sometimes the humanity breaks through.
Of the thousands of runs he’s been on, Dio recounts one that affected him deeply: a call from an elderly couple in which the wife had a heart attack that ended her life.
“I hung on it and hung on it for weeks,” he said.
“Neither one of them understood what was happening, the husband or wife, but we did, and I think that’s what (messed) with my head a little bit. I knew how this was going to end. … You know what, 10 minutes ago they thought they were going to bed and they thought they were just going to go on with their life. And 15 minutes later, she’s dead and his world’s falling apart. That’s how quick life happens to people, and so sometimes it’s those things (that affect you).”
With the volume of first-responder calls, it’s easy to forget the role defined by their job title.
Dwyer said, “Thirty years ago, it was just fire calls,” but the nature of the work had changed.
“We all know we have to do medical calls,” Dio said. “But we’re still here for three tones (the sound of a fire alarm). We’re here to put fires out. We’re firefighters. We love doing that.”
“You know what the job is going to take,” Dwyer said. “I think we all like engine work not because of all the medicals we do, but because when there is a fire, you’re going in with a hose line.”
Anyone can be a first responder. That’s good, but it’s also bad.
A call comes in at 6:04 p.m. on Saturday, Dec. 2. “Engine 4. 2 King Street on a first-responder. It’s going to be outside in the back. There’s a male on the ground.”
In less than five minutes, Engine 4 rolls up in front of 2 King St. Firefighters focus on the alley next to 2 King St., a frequent spot for overdoses, they say.
Firefighters pass three men walking toward the street, another six or more milling around out back, but no victim, no one on the ground. A bystander tells the firefighters there was someone ODing, but someone gave him something, he got up and walked away.
It’s a moment like this that shows a possible bad side effect of the growing availability of Narcan. Absent contact with trained first responders, the victim could wander off, the Narcan could wear off, and the victim be far worse off, alone and in serious trouble.
“That was technically an overdose,” Petty said. “We didn’t see it, but everybody there said it was an overdose and they gave the guy Narcan, he popped up and walked up the street.”
“A month ago he probably would have (still) been there,” Dio said.
A few minutes later on Queen Street, searching for the original victim, Engine 4 rolls up on someone fitting his description. The 57-year-old Hispanic man is incredulous when Petty asks him if he’s on heroin. “No.”
“Did you take anything today?” Petty asks.
Within minutes, paramedics arrive, the man tosses his bag into the back of the ambulance and, after a brief delay when he jokes about having a gun, he’s off to the hospital.
The woman on the bike path mentioned at the beginning of this chronicle was transported to the hospital. For the crew of Engine 4, the task was done.
“Sometimes you’ll get people … I’ll say, ‘Where are you from?’ ” Petty said. “And they say, ‘I’m from Marblehead,’ or ‘I’m from Gloucester,’ or ‘I’m from Leominster.’ You might not see them again. But if they’re from around here and you see them one time on an overdose, there’s a very good chance that you’ll see them a second time, if not a 10th time.”
Petty then recounts an incident from the previous day.
Engine 4 was called and when it arrived, firefighters found a man “giving CPR to a cousin or family member.” After the ambulance took that person away, “This guy walked two streets over and shot up again, and someone else called for him on the side of the road,” Petty said. The man, who Petty had seen just two weeks earlier, had used the rest of the heroin.
“As far as a solution to the problem, we’re not it,” Petty said. “We’re the temporary solution. We’re not the solution to the heroin epidemic. We’re the solution to people dying. We’re just there for that instant. We’re there to bring them back at that moment. The solution to the epidemic lies somewhere down the line.”