Missouri Paramedics Launch Overdose Treatment Referral Program

By Paul Gaita 03/16/18

The program helps link patients in need with after-care options and helps combat the compassion fatigue felt by many first responders.

female paramedic sitting in ambulance and looking at clipboard

In Missouri's third-most populous county, paramedics and other first responders have faced an ever-increasing number of emergency calls for prescription opioid- and heroin-related overdoses, which have risen from fewer than 200 per year in 2008 to more than 600 in 2016.

Faced with these rising numbers and cases of "compassion fatigue"—a sort of emotional exhaustion experienced by caregivers who treat the same cases over and over—one area paramedic established a program to link individuals suffering from opioid dependency and/or overdose with a network of support and treatment agencies.

The initiative—known as the Substance Use Recovery Response Team (SURRT)—has shown promise in its first year, with 104 individuals agreeing to meet with an assessment counselor for treatment options.

SURRT is the brainchild of Lisa Cassidy, a paramedic with the St. Charles County Ambulance District (SCCAD), who became aware that her fellow emergency medical services (EMS) workers felt overwhelmed by the physical and emotional toll waged by responding to opioid-related calls.

"When you hear crews constantly saying, 'I ran another call for an overdose. I ran another overdose. We ran another one today,' suddenly people are thinking, 'What's going on?'" said Cassidy. 

In addition to the sheer frequency of overdose calls, EMS also faced a host of related issues, from combative patients to difficult call scenarios, including conflict with bystanders and locations. Most significantly, paramedics faced the reality that for every patient that refused hospitalization, there was a chance that they would encounter them again, or on multiple occasions, in their next call.

To that end, Cassidy and SCCAD assistant chief Dave Lewis established a system that would link patients with after-care options following an overdose call. If a person suffering from an overdose was conscious and could communicate, first responders would ask them if they wanted help beyond the initial call.

If the patient agreed, a specially-trained paramedic would then contact them 24 to 48 hours after the incident to discuss treatment options. From there, patients were given the option to participate in inpatient or outpatient programs at area hospitals and counseling centers. Cassidy and Lewis were able to secure beds for SCCAD-referred patients, regardless of their ability to pay.

Patients who refused to go to a hospital after being treated by EMS are offered an injectable dose of the opioid overdose reversal drug naloxone. All patients treated by SCCAD paramedics, including those who refuse follow-up help, were given an information packet containing a list of treatment resources available to them. The district also offered free kits containing two doses of the nasal spray form of naloxone to families of individuals with opioid dependency issues.

So far, the first year of SURRT has enjoyed modest success: between March and December of 2017, 166 individuals opted into the program, while 137 declined to participate. Of the 166 who agreed to seek additional help, 104 met with an assessment counselor. An additional 100 naloxone kits were given to area families.

For Cassidy, who was named Paramedic of the Year by the Missouri Emergency Medical Services Association in July of 2017, the program's goals are simple. "It's saving a life until this person is ready to get treatment, and that's what we are trying to do," she explained. "To get these people into treatment, and you can't do that if they're dead."

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, Amazon.com and The Los Angeles Beat, among many other publications and websites.