FORSYTH COUNTY -- It’s Thursday afternoon in Winston-Salem. I'm (Erica Stapleton with WFMY News 2) and I did a 12 hour overnight shift with Forsyth County EMS. The goal was to track overdoses, which happens, but inadvertently I also have new insight on how a paramedic sees the world.
"We’re more than just ambulance drivers," explains paramedic Chris Nichols. "I think that’s the one thing that irritates our profession more than anything is that we get called ambulance drivers and we’re not just ambulance drivers. We can handle anything from bringing life in or being there when someone is dying.”
He says they run anywhere from 6-9 calls in a 12-hour shift. He's been working in this field since 1994.
"The heroin in the last what - about 2 years? I would say has gone up drastically. We’re seeing more and more of them."
State data shows that an average of 5 people died every day from an overdose last year in North Carolina. Forsyth County ranked in the top 10 of heroin-related deaths over the past two years. Neighboring Guilford County ranked number two.
"I’ve seen it all the way from business executive type people to homeless people," says paramedic Scott Haithcock. "There’s no limits to it and it’s sad when you look in the eyes of a 26-year-old and they feel like they have nothing left. They feel like nobody cares if they live or die."
That's the grip addiction has and first responders often have a front row view of the crisis.
"Some of the people I talked to, they call it the heroin hug," Scott explains. "And they said you know, the first time you do it, you just get this secure feeling. It’s almost like a warm embrace, like a hug from your grandma. That’s the way it’s been explained to me. And they said once you feel that you crave it constantly. I can’t imagine being under the control of having to have that."
There was a time when overdose calls were few and far between, but now they've become routine not just in North Carolina but across the country. If you ask a first responder about them, they'll likely have a story for you. Or two. Or three. It's not stopping.
"A 70 year old woman who overdose in the gas station parking lot with her dog in the car," says paramedic Jolene Buyna as she remembers some of her recent calls. "A woman who overdosed in the gas station parking lot with all of her children in the car and she passed out on the floor and they were all crying hysterically and it broke my heart."
Scott tells me about a time where it seemed like every ambulance they had was running an overdose call. "It was like overdose after overdose after overdose. It was a bad batch of heroin hitting the streets in high point sold to whoever, to whoever to whoever, ended up in Forsyth county and we were like my gosh, not another one. "What is going on here? We couldn’t get a handle on it because we were running so many back to back and I don’t remember how many we had that night but it was several."
Overdose call in Winston-Salem
I can’t take you with me inside that house where the overdose is happening but I can walk you through what I’m seeing. We first go inside, we go upstairs, there’s police and firefighters already there. I look down and I see a woman carrying two kids, so there are kids in the house. The patient is awake and alert when we get there. As it turns out, his girlfriend gave him Narcan. That's probably the reason he's alive at this point. The patient tries to tell the paramedics he took a Tylenol and fell asleep but they know better than that. It's suspected he as using heroin, possibly cut with fentanyl. The patient doesn't want to go to the hospital.
"We don’t invite ourselves to these calls," Scott explains later. "We are there because we’ve been dispatched to these calls. So, we come in with the patients best interest in mind and whatever the situation is, we’re there to help mitigate that situation."
Back in the house, a police officer finds a syringe and a bag of white powder. Some of the family members are freaking out. They don't want anyone to get in trouble, but this guy seriously needs help. The first responders try and give him more Narcan, but he refuses. Eventually, he signs a waiver saying he refused care. We have no choice but to leave.
"Typically, if they’re not going to go to the hospital they don’t get that charged up," Scott debriefs once we're back in the ambulance. "It’s usually nah, I don’t want to go. But that was extreme. Bystanders complicate things a lot."
As it turns out, patients can refuse treatment, so long as they're in a state of mind to do so. The paramedics will text cognitive function to gauge their orientation level.
"Do you know who you are? Where you’re at? Who’s the president? Can you count and add properly? Do you understand the implications of your actions? Do you understand that you may die?" Jolene tells me.
They admit it seems like a strange concept for someone outside of the field.
"We did everything we could," Jolene says. "We had PD on scene, we had family try to convince him. We called the medical director to talk with them and let them know of the situation. We can’t kidnap anyone. If he’s oriented, he can refuse, unfortunately."
Before we go on, let's talk about Narcan. Most, if not all, first responders in Forsyth County carry it, including police officers. It's a medication that reverses the effect of an overdose. Sometimes people need more than one dose to revive. The reason the paramedics wanted to give the last patient more Narcan is because the half life of fentanyl is very long. Jolene explains to me that it's a lot longer than Narcan, so there's potential the Narcan could wear off and the drugs he ingested could kick back in. They explain it would have been ideal to have him be monitored by a medical professional after the overdose. I asked Scott what it's like to administer Narcan.
"What typically goes through my mind is: If I don’t do what i’m trained to do, this person probably will die. And at that moment in time you’re going to follow your protocol and you’re going to give the medications but also on a personal level it’s as you’re pushing that medication you’re thinking this is going to save this person’s life. And you push it and they wake up and they’ll be sitting up talking to us."
This isn't like what you might imagine from a movie. A person doesn't just snap out of it. Depending on the person, it can take about 5 to 10 minutes to wake up from an overdose. And it's probably not going to be pretty. This person was just knocked out of their hight and jolted from death. They'll likely feel sick, angry and confused.
"Or you have a patient look up at you and say how bad was I this time?" Scott tells. "And you say you’re breathing six times a minute. You’re grayish blue color. You’re just about to die. And they go, 'Oh.' And then you say 'Have you done this before?' And they say, 'Oh yeah, but I’ve never been this bad.'"
Cardiac call in Winston-Salem
We pick up an older woman from a nursing facility. She had chest pains, but then tells the paramedics she hurts all over. She tells Scott her pain level is a 10 on a scale of 1-10. They try and give her some baby aspirin, but she won't swallow them. The woman says she hasn't really eaten all day. They try to put an IV in her, but she's too dehydrated for them to find a vein. We take her to Forsyth Medical Center. Scott tells me afterward she likely had drugs in her system.
"Just like our first guy, when you look at her pupils, her pupils were at 2 millimeters so that means they’re pinpoint. You’re pupils aren’t pin point. Mine aren’t pinpoint so her’s are pinpoint for a reason because of the pain meds that she was given at the nursing facility."
"So you don’t have to be completely zonked out to be overdosed?" I asked.
"It hadn’t affected her respiratory yet, but just her general appearance. Her sluggishness, repeating the same things, saying she hurt all over."
Throughout the night I see a lot of examples of what paramedics have to deal with on a day-to-day basis.
"It affects us," Scott says plainly. "I firmly believe that the human brain is not designed to see, hear, smell or taste the things that we have to deal with. "You definitely see the other side of society that you don’t see like anywhere else."
He explains to me that due to privacy laws, they usually don't get to find out how things end for a patient. Once they leave a scene or drop someone off at the hospital, they move on to the next call. They can't follow up.
"The trauma, the blood, the guts, the whatever, it doesn’t really get to me," Scott says. "It’s the after the fact and you sit back and you go 'Wow. I just did this this and this, I just saw this this and this and whew.' But then you don’t know the ending and to me that’s the worst part."
"The frequency of seeing people doing things to themselves, doing things to each other. The violent stuff we get to see, does have an affect on fire, police and EMS," Chris says. "I'm not afraid to talk about a call that has bothered me. I’ve got friends, I’ve got family. I would say my brother is probably my biggest release. He used to be a fire chief up in New York."
Chris says he needs to have an outlet outside of EMS to de-stress himself.
"I enjoy hunting and fishing, spending time with my family. Anything to do away from here."
"You an kind of lose touch with quote unquote normal, whatever that may mean," Scott adds.
I ask what his coping mechanism is.
"I have a farm and we have horses and we have miniature donkeys. So, I’ll go home and if I’ve had a bad shift and my kids are at school and my wife is at work and I can’t talk to them about this stuff anyway but the one person I can talk to who is not going to judge me and is guaranteed not going to tell anybody anything is my horse. Standing there and just taking a breath of my horse's neck and when I exhale it just kind of flows away. It is truly amazing."
Last year in North Carolina, the number of lives saved by Narcan was higher than the number of people who died from overdoses, but the number of overdose calls is on the rise. North Carolina healthcare leaders have a plan in place designed to reduce overdose deaths 20% by 2021. It includes expanding treatment options, cutting back on prescription opioids and making Narcan more widely available.