There are those who will come to and curse out the very people who just saved their lives, angry that the shot of naloxone that reversed their overdose also blew a high they paid money for. And there are those who will get up and walk away, not believing they were seconds from death.
But for paramedic chief Andrew Billing, the most trying part of working on the front lines of B.C.'s unprecedented overdose crisis is seeing the same people over and over – often several times in a day.
"We probably have four or five people that we can fill out the form for before they even get out of the ambulance: name, birth date, CareCard number," Mr. Billing said. "[Naloxone] has almost become a Band-Aid. Everybody has it, so it's like 'Who cares what I do? I'm going to find my next high.' … You show up and you feel undervalued, useless. We call ourselves the red and white taxi all the time. It wears on you."
For first responders dealing with B.C.'s unprecedented overdose crisis, the stress of surging call volumes is matched by the risk of compassion fatigue. Characterized by burnout, traumatic stress and mental and physical exhaustion, it can affect standards of patient care and relationships. Serious mental-health effects of compassion fatigue include depression and post-traumatic stress disorder.
In response, BC Emergency Health Services (BCEHS) this year began offering training on psychological resilience.
The service has worked to improve critical-incident stress management for some time, but this is the first time they have targeted training to promote long-term mental wellness. About 500 members have taken the course; the goal is to have all 4,000 paramedics, dispatchers and call takers take it.
In 2012, BCEHS responded to an average of 838 suspected overdose or poisoning calls a month across the province; this year, it's grown to 2,082 – a 148-per-cent increase. The particularly hard-hit Vancouver Coastal Health Authority, home to the Downtown Eastside, has seen a 195-per-cent increase in such calls in the same five-year period.
At a recent training session in Richmond, Mark Davies, a psychologist with extensive experience working with first responders, discussed the effects of prolonged stress with a group of about 25 service members. Those effects include having a narrow focus, rigid thinking and a feeling of being locked down, and can make people feel jaded and cynical, he told the group.
Stress breaks, such as taking 20 minutes of anaerobic exercise, preventative visits with a psychologist and training one's willpower to override harmful urges, help develop a positive approach. "You've got to use intentional stress breaks to rethink how you do your job," Dr. Davies told the group.
An attendee interjects: "What if you don't know how to do that?"
"I will try and teach you today," Dr. Davies replied.
In years of working with first-responder communities, Dr. Davies said many police, soldiers and paramedics can still appear high-functioning on the job despite chronic stress and trauma.
"It's when they go home – it's the price you pay at home," he said. "You go home, they don't have a life. Depression, anxiety. Your loved ones really get hit hard."
BCEHS executive vice-president Linda Lupini said, as the overdose crisis worsened, management recognized a need for not just critical-incident stress debriefing for specific events, but also a way to build resiliency for the long haul. Much of the stress related to the overdose crisis is that responders are not seeing a light at the end of the tunnel, she said.
"In other situations, although we're moving a lot of patients because of wildfires, we know at some point the wildfires are going to stop. Flu epidemics that really task our work force – we know it's going to end," Ms. Lupini said.
"One of the hardest things that we all think about and talk about is: When are we going to see any kind of decline? … We talk a lot about the reliance on us to rescue people out of this problem but rescuing out of the problem is never going to be the answer. The answer's got to be much more upstream."
Renee MacCarron, a paramedic of 29 years, said the course highlights a stark culture shift from when she first started.
"The premise [back then] was basically like, 'If you can't stand the heat, get out of the kitchen,'" she said. "You didn't really talk about tough calls because if it bothered you, you were maybe not suited to be a paramedic.
"To have a course that addresses that issue and spells out, 'If you're feeling this way, it's a normal reaction to what you were exposed to' – it was so refreshing," Ms. MacCarron said.
Paramedic chief Mr. Billing said the course shows it's okay to be human. "When I get up in the morning I put this shirt on and it's like my armour: Nothing gets to me, nothing's going to hurt me, and I have to be that way to do my job," he said. "But what this course is telling me is that when I take it off at night, it's okay that I'm not okay."