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Pilot Program Allows Wisconsin Firefighters to Administer Naloxone

LA CROSSE, Wis. - Firefighter Jim Hillcoat knows the signs: slow, shallow breathing, shrunken pupils, weak pulse. Occasionally, even a needle nearby. A drug overdose - and it's becoming more common as heroin has infested this college town along the Mississippi.

But on a call with the fire department here, Hillcoat can't give the antidote he's sure will help: naloxone.

The drug, also known as Narcan, can quickly reverse the effects of an overdose, bringing a person from unconscious to complaining in a matter of minutes. Paramedics can, and increasingly have, used the drug. But timing is crucial, and paramedics are often not first to a scene. Officials here believe that by putting naloxone in the hands of firefighters - and perhaps police officers - they can save lives.

"Whether it's a minute or five minutes earlier, it helps," Hillcoat said. "The sooner you can give the antidote, the better."

It's been done in New York and Massachusetts, where cities have since reported decreases in overdose deaths. In Wisconsin, the La Crosse Fire Department is first in line for a yearlong pilot program to train firefighters to use naloxone. Minnesota officials are watching. Sen. Chris Eaton, DFL-Brooklyn Center, has been working with two state agencies to draft a bill that would make the drug more widely available.

In recent years, cities nationwide have been grappling with growing abuse of heroin and prescription opiates, including painkillers such as Vicodin and OxyContin. Bolstered by a key study earlier this year, experts believe that naloxone could be one inexpensive way to cut the death toll.

"This is a lifesaving measure, and having it where it's needed is a definite plus," said Dave Hartford, an assistant commissioner in the Minnesota Department of Human Services. Naloxone is nonaddictive, easy to administer and has few side effects, so "there isn't much of a downside to it," he added.

But how much training a person should have in order to administer the drug is still up for debate.

'Pounding on the door'

Every La Crosse agency seems to have a chart. On a recent afternoon, it took Fire Chief Gregg Cleveland just seconds to pluck his from the papers on his sun-drenched desk. A thick blue line shows a dramatic climb in the number of overdose incidents. In 2012, there were 98 - a 53.1 percent increase since 2009.

So far this year, his firefighters have responded to 86 overdoses, a number highlighted in red.

"We have an overdose issue in the city," said Cleveland, whose family snapshots sit below black-and-white photographs of mustachioed men who fought fires in the 1890s.

He has been eager to apply for a state pilot program that would allow his force, some of whom are trained as paramedics, to carry naloxone. Starting this week, he'll be able to: The application goes live Friday. "We've been pounding on the door," Cleveland said.

The pilot, set to start Jan. 1, will train and test basic EMTs, then track how often they use naloxone. If the program shows the drug is needed, the Wisconsin Emergency Medical Services Unit could expand the technicians' official "scope of practice" to include administering the drug, said Frederick Hornby, a paramedic and the unit's education coordinator.

National guidelines for basic EMTs, who have less medical training than paramedics, don't include naloxone, Hornby said. "Wisconsin is going above and beyond."

Proposed state legislation would go even further, allowing police officers and others to use the drug.

Paramedics with Tri-State Ambulance - which serves 2,200 square miles in Minnesota, Wisconsin and a small slice of Iowa - have carried the antidote for decades. But they've never used it more. Their chart shows paramedics being on track to give naloxone 195 times this year, compared to 124 times in 2010. Three-fourths of those uses were for heroin overdoses, Tri-State estimates.

Paramedic Nick Eastman regularly unzips a yellow bag, grabs a vial of naloxone and injects the drug either into an IV or the arm of a patient. Recently, he treated three overdoses in a single shift.

"And we're talking real overdoses," said Eastman, a shift supervisor. "I don't think people always understand how serious it can be. Not breathing - to that level."

Tri-State's director of operations, Tom Tornstrom, supports the idea of non-paramedics giving naloxone, especially in the rural reaches of the service area, where response times can be 20 minutes or more. "We don't see a lot of overdoses out there," he said, "but when they do happen, time is really of the essence."

But Tornstrom also wants first responders to keep focused on the basics, especially a patient's breathing. An overdose kills when too many opioids attach to opioid receptors - slowing, then stopping breathing. Naloxone blocks opioids from attaching to those receptors.

"A police officer is never going to show up to a heroin overdose, give them Narcan and leave," he said.

Drug available to public

On the second floor of a nondescript office building downtown, the AIDS Resource Center of Wisconsin runs a needle exchange. Boxes of clean syringes sit in a brown cabinet in a back room. Below them: naloxone.

The organization began offering the drug in 2006, because it felt "needle exchange programs had the best access to people at risk of overdosing," said Scott Stokes, director of prevention services.

People get training on how to respond to an overdose along with their prescription. Stimulate the person's breathing, call 911, put him on his side.

In 2008, just four people got naloxone prescriptions through the La Crosse office. In 2012, 44 did. That corresponds to the tenfold increase in needle exchanges over that time.

Nationally, some agencies are advocating for naloxone to be available over-the-counter. A nasal version of the drug has made it easier for people without medical training to administer. But dosing can be tricky. And patients who awake can be combative. So some professionals are wary of people using it without training.

Eaton, the Minnesota state senator, believes the risks are worth it. To her, the issue is personal: Her daughter, Ariel Eaton-Willson, died in 2007 of a heroin overdose in a Burger King parking lot. She was 23 years old.

Eaton is crafting a bill that would address what she believes were two failings in her daughter's death. The first was that, rather than immediately calling for help, Eaton-Willson's friend cleaned out the car, throwing two needles away. The bill would give amnesty to those who call for help in the event of an overdose. Second, the first people on the scene were police, who did not have naloxone. The bill would allow police to carry the drug.

Eaton knew her daughter was struggling and suspected she might be using. She took Ariel to see a psychiatrist twice a week and wished she could have done more.

"As a parent, there's not a whole lot you can do, especially if your son or daughter is an adult," Eaton said. "But at the very least, I could have made sure I had some naloxone in the house."

Jenna Ross · 612-673-7168



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