As paramedics minister to their unresponsive patient, Philadelphia Emergency Medical Services Lt. Steve McCloskey reassures the man who summoned them – like the man they’re working on, a heroin user – that he did the right thing by calling for help.
“There’s only two things that save lives out here,” McCloskey says. “Jesus and Narcan.”
That’s the popular brand name for naloxone, the opioid overdose-reversing drug that paramedics in Philadelphia administered nearly 4,000 times last year. Medics have just shot a 2-milligram dose through the nose of the victim, a middle-aged African-American man who was found unconscious across a pair of cellar doors under Kensington Avenue.
As the naloxone hits his system, his chest begins to steadily rise and fall. Eventually, his eyes open.
It’s 4 p.m. on a brisk, late-October afternoon. McCloskey has been following ambulances to the scene in his fire-engine red SUV since shortly after dawn. He insists that it’s a remarkably slow day for a ride along. After all, there have been “only” six calls for ODs since midnight.
Last year, the Philadelphia Fire Department dispatched its ambulances across the city 260,000 times; just 14,000 of those trips were overdose-related. A small fraction, to be sure; nevertheless, the practice has become so routine that in mid-June, the Fire Department implemented a new response code for opioid-related overdose calls. When a “3018” chirps across the radio, paramedics ready the naloxone.
It is difficult to imagine how high the city’s body count would be without EMS’ line of defense. Spurred by ultra-potent synthetic opioids like fentanyl, overdoses claimed 906 lives citywide in 2016, and this year is on track to reap more than 1,200 such fatalities.
City agencies from behavioral health to the coroner’s office are all bearing the burden. But Philly’s paramedics and EMTs stand on the front lines of the crisis every day — and at every step, they see where the system fails.
“The easy part is responding and giving people Narcan,” Jeremiah Laster, EMS’ deputy commissioner, tells Philly Weekly. “The tie-in for us is, how do we get these people to treatment?”
No EMS station sees more of the opioid crisis than Medic 8, whose service area covers the heart of Kensington. Each day, these medics witness the same scene play with increasing frequency. In 2008, there were 33 fatal overdoses in the ZIP code that covers this part of the neighborhood; in 2016, there were 140.
But when Medic 8 successfully reverses an overdose, the battle is only half won.
After using naloxone, state law requires medical personnel transport overdose victims to the nearest hospital for evaluation. From their current dispatch on Kensington Avenue, the gothic spires of Temple University’s Episcopal Hospital are visible less than a block away.
The emergency room is packed. Medics wheel the latest overdose victim into triage on a gurney. A bleary-eyed supervisor approaches and asks, “Do you want to see a doctor?”
The patient shakes his head, and the doctor walks away.
At that, the patient gets up and returns to the Avenue. The entire affair, from Naloxone to the emergency room, took about 20 minutes. It still may have cost taxpayers thousands.
On average, an ambulance transport gets billed for $1,200, according to a Fire Department spokesperson. Transports for overdose patients alone cost more than $4.5 million last year, and many of those suffering from addiction remain uninsured.
“You’re paying for it either way,” Laster says of the cost to the city. “You’re paying for it in a jail cell, a hospital bed or a 911 emergency response.”
Then there’s naloxone. The cost of a single dose of the life-saving drug has unmercifully tripled in recent years. Between dispatches, McCloskey stops by the Fire Department’s storage warehouse in the Hunting Park neighborhood, where he stocks up on more of the antidote. A one-week supply — hundreds of doses — takes up an entire shelf in the warehouse.
Just a few years ago, a 2-milligram shot of naloxone came with a $13 price tag. Now the city, even with a bulk discount, is paying about $38 a hit. From 2016 to date, the Fire Department has purchased 858 boxes of 10 (8,580 doses of Narcan) for a grand total of $325,063.
But for EMS officials, the real struggle is in this recurring process. The hospitals, medics say, are not properly equipped to serve as bridges to recovery. But they have to keep bringing them in anyway, even if their patients just walk out.
Those in the throes of heroin addiction sometimes refuse the ambulance ride after receiving naloxone. According to department statistics, the figure rose from 79 refusals in 2013 to 309 in 2016.
“Sometimes we pick up the same person overdosing twice in the same week or sometimes the same day,” said one medic, whose name is being withheld because they were not authorized to speak on the matter.
Laster, who helped advise Mayor Jim Kenney’s opioid task force, is optimistic about change.
He says he wants to reform the way that EMS can put overdose victims on the path to treatment. He’s talking about a partnership with leaders at Prevention Point, the city’s primary harm reduction nonprofit, to intervene with the overdose victims who refuse hospital transport. “We need a warm hand-off,” he says.
Asked about the controversial but increasingly popular idea of safe injection sites, six EMTs and paramedics in Kensington who spoke on condition of anonymity said that they either supported the idea or had no opinion. At the end of the day, overdoses were taking away time and resources from other emergencies. (About 45 medics work each shift, serving a population of 1.5 million people.)
In the parking lot of Episcopal Hospital, ambulances come and go from various precincts around “the triangle” – shorthand for the six medic units, including Medic 8, that work in the area from Girard Avenue to Castor Avenue west of the Delaware River.
Each run they do tells a different story. Early in the morning, a call came in for an overdose on a porch in Frankford. By the time medics arrived, the victim allegedly regained consciousness and fled the scene. On a later call, a 24-year-old Allentown man was found unconscious with $500 worth of heroin in his car on Allegheny Avenue; he was eventually charged by police after receiving medical attention.
In the meantime, EMS is also responding to the full range of medical crisees that happen daily in Philadelphia. Gun violence, cardiac arrest, car accidents, even toothaches — no call goes ignored. The average wait-time for an ambulance is less than 10 minutes, according to the Fire Department, but that’s not always the case, emergency or not. So, a friendly PSA to Philadelphians: In non-life threatening situations, it is safer (and faster) to find another way to the hospital.
McCloskey checks in on the medics who wait to be dispatched to the next call. It’s only a matter of time.
Their rapport is jovial, but at one point, McCloskey pulls aside one of the medics to reprimand them for using the term “junkie.” He’s of the camp that believes the term dehumanizes those in addiction.
He tells the medic: “Look at it like their mom or kid is there with you watching them die, saying ‘please help.’”