Boston-area paramedics on front lines of U.S. opioid crisis

Boston-area paramedics on front lines of U.S. opioid crisis

Everett, United States Photography by Reporting by
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The paramedics find them everywhere - slumped over car steering wheels, barely breathing in doughnut shop bathrooms or dead in derelict apartments and expensive mansions.

For the Cataldo Ambulance Service crews outside Boston on the front lines of the U.S. opioid epidemic, the flood of overdose calls is a grim daily reality, despite expanded access to overdose reversal drugs.

. Chelsea, United States. Reuters/Brian Snyder

"When I started, this was a rare thing. You did one or two here and there. Now, we do quite a few," said Dave Franklin, 44, a supervisor at the private service that contracts with cities who has worked in the field for more than 20 years.

In Massachusetts, EMS opioid overdose calls hit 20,978 in 2016, up from 8,389 in 2013, according to a state report.

. Salem, United States. Reuters/Brian Snyder

Amid wider use by bystanders and police of naloxone, a drug that reverses overdose symptoms, state figures showed a small drop in opioid deaths in the first nine months of 2017 compared with 2016. But Franklin does not yet see a turning point.

"It's not going away anytime soon. People are still dying regularly," he said.

In the United States, deaths from drug overdoses have surpassed deaths by firearms and motor vehicle crashes, according to a 2017 Drug Enforcement Administration report.

President Donald Trump has declared a public health emergency over opioid abuse, promising to increase treatment but initially dedicating no money for it.

. Malden, United States. Reuters/Brian Snyder

Opioids, primarily prescription painkillers, heroin and synthetic drugs like fentanyl, a pain medicine 50 to 100 times more powerful than morphine, are fuelling the crisis. Opioid-related overdoses kill 91 people in the United States each day, the Drug Enforcement Administration said.

On Thursday, the Centers for Disease Control reported, based on the latest available figures, that the U.S. rate of drug overdose deaths in 2016 grew 21 percent from the prior year.

"It's hard to watch, and it's devastating," said Domenic Corey, 27, who has seen the evidence up close working as a Cataldo paramedic.

Mornings before starting his shift, another Cataldo paramedic, Andrew Simpson, grabs his stethoscope, intravenous supplies, scissors and pen light.

. Malden, United States. Reuters/Brian Snyder

At the ambulance, he checks to make sure there is enough naloxone. They carry more than double the amount they once did because stronger opioids mean that multiple doses of naloxone are often required for someone who is barely breathing.

Simpson, 34, works at least two 24-hour shifts a week in a high-turnover job that can be stressful and where pay starts at $14 an hour. Just touching Fentanyl can send an EMS worker into overdose.

. Malden, United States. Reuters/Brian Snyder

Simpson's radio crackles with calls. Difficulty breathing. Person down. Unresponsive. Overdose. They turn on the lights and roll. From experience, they know it might be a man who overdosed into unconsciousness while driving, a teen or elderly user passed out in a park or an already stiffened corpse in a hotel room strewn with needles and powder.

On arrival, they spray naloxone up the nose or inject it into the user, pump oxygen into lungs and wait. Some respond gulping for air or vomiting and confused.

. Malden, United States. Reuters/Brian Snyder
A 41-year-old man found unconscious after overdosing on opioids in the driver's seat of a car, with the engine running and the transmission in drive, lies in the back of a Cataldo Ambulance.

“Why are you in my house? What's going on?” Simpson recalled as a common question from recipients of his aid. Some people are grateful and repentant, crying, shaking hands and promising to get treatment. Others deny they took drugs at all.

The calls often come in waves when fentanyl too potent for users hits the streets. Time of day matters, too.

. Salem, United States. Reuters/Brian Snyder

"If it's in the afternoon, there's a much better chance they are still alive," he said. "If we get the call at 7 a.m., they probably shot up the night before."

The paramedics say they often see families torn apart in front of their eyes or bereaved parents.

"You see the parents, they're crushed; just the look of defeat, you know? They lost the most important person in the world to them. I can’t even imagine. But you see it over and over again," Corey said.

. Salem, United States. Reuters/Brian Snyder

The cost of naloxone has risen with demand, eating into the service's budgets, Franklin said. But they are also using their steady overdose runs to help some cities map drug hotspots and for police to visit users to urge them into treatment.

"In the back of the ambulance, you talk to them and hope they get treatment," Simpson said, explaining that most agree they need to get help. "But then at times I'll see the same person three months down the line and they have overdosed."

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Slideshow

A full syringe, empty syringe and spoon sit on the roof of the car in which a man in his 20's overdosed on an opioid in the Boston suburb of Lynn, Massachusetts.
. Lynn, United States. Reuters/Brian Snyder

A full syringe, empty syringe and spoon sit on the roof of the car in which a man in his 20's overdosed on an opioid in the Boston suburb of Lynn, Massachusetts.

Cataldo Ambulance medics Rick Yunker (L), Derek Travers (C) and Timothy Stahl revive a 38-year-old man who was found unresponsive after an opioid overdose in the parking lot of a Walgreens drug store in the Boston suburb of Malden, Massachusetts. The man was revived with 4mg of naloxone.
. Malden, United States. Reuters/Brian Snyder

Cataldo Ambulance medics Rick Yunker (L), Derek Travers (C) and Timothy Stahl revive a 38-year-old man who was found unresponsive after an opioid overdose in the parking lot of a Walgreens drug store in the Boston suburb of Malden, Massachusetts. The man was revived with 4mg of naloxone.

Cataldo Ambulance EMT Matt Tavalone takes notes as a 42-year-old female kicks the roof of the ambulance after she was revived with 8mg of Narcan given to her by a housemate before EMTs arrived on the scene in the Boston suburb of Lynn, Massachusetts. The woman who overdosed on an opioid showed signs of withdrawal caused by the Narcan in the ambulance.
. Lynn, United States. Reuters/Brian Snyder

Cataldo Ambulance EMT Matt Tavalone takes notes as a 42-year-old female kicks the roof of the ambulance after she was revived with 8mg of Narcan given to her by a housemate before EMTs arrived on the scene in the Boston suburb of Lynn, Massachusetts. The woman who overdosed on an opioid showed signs of withdrawal caused by the Narcan in the ambulance.

Cataldo Ambulance third rider Wayne Taft arrives at the hospital with a 61-year-old man who was found unresponsive in the doorway of an apartment building after an opioid overdose in the Boston suburb of Somerville, Massachusetts. When the medics returned to the hospital hours later with an unrelated patient, they were told the man who overdosed had still not fully woken up.
. Somerville, United States. Reuters/Brian Snyder

Cataldo Ambulance third rider Wayne Taft arrives at the hospital with a 61-year-old man who was found unresponsive in the doorway of an apartment building after an opioid overdose in the Boston suburb of Somerville, Massachusetts. When the medics returned to the hospital hours later with an unrelated patient, they were told the man who overdosed had still not fully woken up.

A bystander holds open the door as Cataldo Ambulance medic Rick Yunker checks on a 34-year-old man who reportedly overdosed on an opioid in the bathroom of a donut shop in the Boston suburb of Everett, Massachusetts.
. Everett, United States. Reuters/Brian Snyder

A bystander holds open the door as Cataldo Ambulance medic Rick Yunker checks on a 34-year-old man who reportedly overdosed on an opioid in the bathroom of a donut shop in the Boston suburb of Everett, Massachusetts.

Cataldo Ambulance medics Ricky Cormio (left) and Luke Magnant take a 40-year-old woman out of a grocery store where she was found unresponsive in the store's bathroom after overdosing on opioids in the Boston suburb of Malden, Massachusetts. After medics revived the woman with 10mg of naloxone on the floor of the bathroom, police found out she has been arrested in the past for charges including assault and battery.
. Malden, United States. Reuters/Brian Snyder

Cataldo Ambulance medics Ricky Cormio (left) and Luke Magnant take a 40-year-old woman out of a grocery store where she was found unresponsive in the store's bathroom after overdosing on opioids in the Boston suburb of Malden, Massachusetts. After medics revived the woman with 10mg of naloxone on the floor of the bathroom, police found out she has been arrested in the past for charges including assault and battery.

Cataldo Ambulance medics take away on a stretcher a man in his 40's who was found unresponsive after overdosing on an opioid in the Boston suburb of Salem, Massachusetts. The victim received a total of 12mg of naloxone. Nurses at the hospital recognised the man, saying he was brought in the day before after overdosing.
. Salem, United States. Reuters/Brian Snyder

Cataldo Ambulance medics take away on a stretcher a man in his 40's who was found unresponsive after overdosing on an opioid in the Boston suburb of Salem, Massachusetts. The victim received a total of 12mg of naloxone. Nurses at the hospital recognised the man, saying he was brought in the day before after overdosing.

Cataldo Ambulance medics and other first responders revive a 32-year-old man who was found unresponsive and not breathing after an opioid overdose on a sidewalk in the Boston suburb of Everett, Massachusetts.
. Everett, United States. Reuters/Brian Snyder

Cataldo Ambulance medics and other first responders revive a 32-year-old man who was found unresponsive and not breathing after an opioid overdose on a sidewalk in the Boston suburb of Everett, Massachusetts.

Cataldo Ambulance medics and EMTs, and firefighters, revive a man in his 40's who was found unresponsive after overdosing on an opioid in the Boston suburb of Salem, Massachusetts. The victim received a total of 12mg of naloxone. Nurses at the hospital recognised the man, saying he was brought in the day before after overdosing.
. Salem, United States. Reuters/Brian Snyder

Cataldo Ambulance medics and EMTs, and firefighters, revive a man in his 40's who was found unresponsive after overdosing on an opioid in the Boston suburb of Salem, Massachusetts. The victim received a total of 12mg of naloxone. Nurses at the hospital recognised the man, saying he was brought in the day before after overdosing.

Cataldo Ambulance medic Jenn Mercouris delivers naloxone through an IV in the arm of a 54-year-old man who was found unresponsive and not breathing after overdosing on opioids in a bedroom in a house in the Boston suburb of Malden, Massachusetts. The man was revived with 8 mg of naloxone.
. Malden, United States. Reuters/Brian Snyder

Cataldo Ambulance medic Jenn Mercouris delivers naloxone through an IV in the arm of a 54-year-old man who was found unresponsive and not breathing after overdosing on opioids in a bedroom in a house in the Boston suburb of Malden, Massachusetts. The man was revived with 8 mg of naloxone.

Cataldo Ambulance medic Paula Gageiro drives to a reported drug overdose in Revere, Massachusetts.
. Revere, United States. Reuters/Brian Snyder

Cataldo Ambulance medic Paula Gageiro drives to a reported drug overdose in Revere, Massachusetts.

The used needle sits on the roof of the car where a 41-year-old man was found unconscious after overdosing on opioids in the driver's seat of the car, with the engine running and the transmission in drive, at a gas station in the Boston suburb of Malden, Massachusetts.
. Malden, United States. Reuters/Brian Snyder

The used needle sits on the roof of the car where a 41-year-old man was found unconscious after overdosing on opioids in the driver's seat of the car, with the engine running and the transmission in drive, at a gas station in the Boston suburb of Malden, Massachusetts.

Cataldo Ambulance medics Paula Gageiro (left) and Al Driscoll (right) take a man in his mid-40's, who was found unresponsive and not breathing in his car after overdosing on opioids, to the ambulance in the Boston suburb of Revere, Massachusetts. In response to repeated questions from the patient about what had happened, Gageiro replied, "You made a bad decision, you were dead."
. Revere, United States. Reuters/Brian Snyder

Cataldo Ambulance medics Paula Gageiro (left) and Al Driscoll (right) take a man in his mid-40's, who was found unresponsive and not breathing in his car after overdosing on opioids, to the ambulance in the Boston suburb of Revere, Massachusetts. In response to repeated questions from the patient about what had happened, Gageiro replied, "You made a bad decision, you were dead."

A woman identified as the victim's wife watches from the front porch as Cataldo Ambulance medics take to the ambulance a 54 year-old man who was found unresponsive and not breathing after overdosing on opioids in a bedroom in a house in the Boston suburb of Malden, Massachusetts. The man was revived with 8 mg of naloxone.
. Malden, United States. Reuters/Brian Snyder

A woman identified as the victim's wife watches from the front porch as Cataldo Ambulance medics take to the ambulance a 54 year-old man who was found unresponsive and not breathing after overdosing on opioids in a bedroom in a house in the Boston suburb of Malden, Massachusetts. The man was revived with 8 mg of naloxone.

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