Rural EMS agencies fight the drug scourge as they lose workers

Rural EMS agencies respond to, and train for, more drug-related calls. But they can’t always get people the help they need.

In northwest Pennsylvania, Elk County EMS has had training sessions to learn more about drug use as a disease and how to use overdose-reversal drug naloxone (also known as Narcan).

Tyler Bender, basic life support supervisor and paramedic for Elk County EMS, has seen how opioid overdoses have made life harder in Elk County and Fayette County, where he worked temporarily.

“The opioid epidemic was crazy down there,” Bender said. “Every day, multiple patients for narcotic drug use. But when I started thinking about it and realized back home in rural Pennsylvania, it’s growing too.”

Pennsylvania had more than 5,400 overdose deaths in 2021 and the state estimated that 300,000 residents have an addiction.

Rural agencies have fewer staff on call and larger areas to cover, which lengthens travel times. A long wait can be deadly.

“Our numbers of deceased because we have longer response times – patients are unresponsive for longer – deaths from this is growing like crazy,” Bender said.

While some places may only cover part of a county, Elk County EMS has a different challenge: it responds to calls from nearby counties, too.

To lessen the risk of serious injury or death, EMS agencies have started to leave Narcan with people who overdose.

Groups like Strategies to Coordinate Overdose Prevention Efforts (of the University of Pittsburgh) provide training to EMS agencies and supply them with Narcan to give to the public. The state also has a program to send out the overdose-reversal drug: since 2017, the Department of Health has given 1.2 million doses to first responders, with 500,000 of them distributed in the last two years.

Since 2018, state data shows that EMS workers have used naloxone on almost 90,000 people.

“Whenever we respond to a call, if the patient signs a refusal, doesn’t go to the hospital or even if they do, we can leave a kit with a family member so they have it,” Bender said.

Someone refusing to go to the hospital, or getting angry with EMS workers, is common.

“When you Narcan someone, you’re putting them into withdrawal and it’s very common for them to be combative and confused,” Bender said. “They don’t know what’s going on so they’re scared. They just want us to get out of their house, almost every patient that’s very, very common.”

First responders are taught to take that anger in stride.

“It’s not that they don’t want you there – they’re scared and they need that one person to say ‘hey, we can get you help,’” Bender said. “Or, even if it is, you leave that card behind with that information … that one person might be their next step into recovery.”

Offering to help can have major effects in a place like Elk County: it has the 5th-highest overdose rate in Pennsylvania.

Those overdoses are more dangerous in rural Pennsylvania.

“Rural overdose victims were more likely to die than urban overdose victims,” the Center for Rural Pennsylvania noted in March.

While 84% of urban residents survived an overdose in 2022, only 76% of rural residents did so.

Beyond the drug problem, other issues threaten to wear down EMS agencies, be they rural or urban: it’s become much harder to hire and keep first responders.

“It’s burnout – EMS and healthcare itself is growing at its max lately,” Bender said.

Other jobs offer a controlled environment, better scheduling, and less physical stress. First responders moving on is “very common,” he noted.

Working EMS also isn’t thought of as a career for many workers, either.

“It’s a resume builder for them to go on to PA school, MD, even physical therapy, sports medicine,” Bender said. “They get patient contact hours and move on.”