Soaring overdoses strain emergency crews from neighboring cities

Record-breaking drug overdoses are causing a chain-reaction problem for emergency crews in Montgomery County — as one city’s first responders are called for help, neighboring communities scramble to fill in.

“We’ve hit the limiting factor,” Dayton Fire Chief Jeffrey Payne said. “We only have so many medic units, so we’re having to bring in medic units from as far away as Brookville and Beavercreek.”

Dayton Fire Department paramedics handle an average of 10 overdose incidents per day with seven medic units, increasing the need for help from other area departments — called mutual aid.

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The city more frequently relies on mutual aid from neighbors, who in turn are seeing increased run volumes of their own and seeking help from their neighbors. In this way, the opioid epidemic is touching every community large and small through increased emergency services time and costs.

Kettering Fire Chief Thomas Butts agreed there is more frequent mutual aid coming from further away.

“It’s just a chain reaction,” he said. “I don’t know that we’ve peaked yet.”

In 2016, Dayton Fire Department had its busiest year in five years, Payne said. Already in less than half of 2017, “we’ve surpassed that,” he said.

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“We’re doubling our overdoses each year over the last three years,” he said.

The department had treated more than 1,600 overdoses as of May 21.

Dayton’s numbers would be even higher, but they aren’t able to handle all the calls in-house.

‘Domino effect’

Mutual aid agreements between cities have been around for decades, but the current crisis has caused what Payne called a ‘domino effect’ in which municipalities further away from the city are subsidizing Dayton’s operations.

“Kettering’s coming so much into Dayton that Washington Twp. has to go into Kettering, and so on and so on,” Payne said.

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Some worry that departments could refuse to provide mutual aid.

“We can only send so much equipment, but we have to maintain our city as well,” said Kettering’s Butts. “We have responsibilities to protect our citizens.”

He said Kettering and Dayton have a great working relationship and no plans to sever their mutual aid agreement.

Politicians have secured federal and state funding to help the area with the opioid crisis, but fire chiefs say their costs haven’t been addressed.

“It’s all about treatment centers and making Narcan available,” Payne said of the epidemic response.

No one is helping the cities with their finances, he said.

Montgomery County recently received $670,000 in federal money to address opioid overdoses, but it is earmarked for new treatment options, including outpatient and in-home options.

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No plateau in sight

Overdoses aren’t the only kinds of emergencies that fire departments are seeing more of, but they are the one factor that is soaring without any end in sight, Payne said.

“It’s really exploding,” he said.

As many as 5,000 Ohioans may die of opioid overdoses this year, according to predictions by intervention specialists at a heroin summit for journalists held in March.

That compares with 4,553 in 2014-15 combined – the most recent years for which statewide data are available, according to the Your Voice Ohio/Ohio Media Project, a collaborative effort of more than 20 state news outlets that are reviewing death data to pinpoint hot spots and work with communities on solutions.

The data show that the epidemic’s highest death rates – that is deaths as a percent of the population — begin in the Miami Valley and stretch south and east along the Ohio River to Portsmouth.

Montgomery County’s coroner has predicted more 800 deaths here before the year is out. The county has had approximately 385 accidental overdose deaths as of June 22.

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No community untouched

Several attempts at analyzing nationwide data by media outlets have ranked Montgomery County among the worst for overdoses per capita of all counties in the U.S. A full analysis of 2016 numbers hasn’t been possible due to states and counties not having official, finalized numbers to report.

Urban areas see larger volume of overdoses, but no community has been untouched.

Washington Township Fire Department, which also serves Centerville, went from handling seven overdose incidents in 2010 to more than 50 last year. In the first five months of 2017 they responded to 44 overdoses in their jurisdiction and have gone on two mutual aid runs due to overdoses in neighboring communities.

Trotwood’s calls for service are up 20 percent over 2016, said Chief Richard Haacke.

Annual response stats show Trotwood EMS runs have climbed to more than 5,000 each of the last three years in a town that was seeing fewer than 3,500 per year pre-2005.

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Kettering’s chief said the city’s numbers are up across the board — fire calls, EMS runs and overdoses treated. And they’ve been providing much more mutual aid to Dayton in particular.

Kettering provided mutual aid to Dayton 170 times in 2012. By 2016 the number was up to 299 times. So far in 2017 they’ve assisted Dayton 162 times. Kettering has surpassed last year’s totals for mutual aid given to Beavercreek, Bellbrook and Riverside.

Double-digit doses

Adding to the time and stress on departments is the need to keep vehicles stocked with enough nalaxone — commonly referred to by brand name Narcan — to revive patients on more powerful drugs.

The more potent drug fentanyl is now more commonly found in the system of overdose patients than heroin.

“When I came on the job, if you had an overdose of heroin you could do one dose of Narcan, two milligrams, and it would bring them right back,” Payne said. “Now we are seeing double digit doses to get a person back because the fentanyl is so strong and so effective.”

Dayton’s record is 20 doses, 40 milligrams, of Narcan to one patient.

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And once a paramedic uses the Narcan stocked in their drug bag, they have to go to a hospital to get the bag restocked even when the patient, as often happens, refuses to be transported, Butts said.

“There’s time incurred for the crews that have to go all the way to the hospital to exchange their drug bag,” Payne said. “The engine crew can’t go back in service.”

In theory that means a fire engine from Riverside that provides mutual aid for an overdose in Huber Heights would have to drive to the hospital in Dayton and get a new drug bag before going back in service in Riverside.

Huber Heights is looking for a way to stock a supply of Narcan closer to their fire stations so their crews won’t have to drive to the hospital for new drug bags, said Battalion Chief Keith Knisley.

This newspaper is your best source for information on Ohio’s opioid crisis. Our reporters are committed to covering every aspect of the problem, from the personal toll on families to the financial toll on taxpayers. Recent coverage has included an exclusive interview with Lt. Gov. Mary Taylor, who opened up about her sons’ drug problems, and a look at federal funding to fight opioids secured by local governments.

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