First responders face dangers treating opioid overdoses

Despite all their training, responding to overdose is unpredictable


SAN ANTONIO – One of the riskiest situations for all first responders is an opioid overdose. Despite all the training they get, responding to an overdose is unpredictable.

San Antonio firefighter and paramedic Bob Beckett spends most of his time in the back of an ambulance. It's where he saves lives and risks his own.

"With the opioid overdose, the first thing we're going to do is breathe for our patients using an amni bag,” Beckett said.

His only choice is to get up close and personal.

"Right here in this ambulance, which is like a big closet, there's usually four or five people and a patient right here. You're right on top of them," Beckett said.

All opioid overdoses don't involve addicts, but Beckett says many do. The opioid of choice on the streets of San Antonio is heroin, which means needles are usually nearby.

"We sometimes will have police do searches on them to try to discover those kinds of things to not put us in danger and they do a good job of always helping us," Beckett said.

"If our members get stuck, we're at risk for hepatitis B, HIV, hepatitis C, which is a big risk for our firefighters and EMTs (emergency medical technicians)," Dr. David Miramontes, SAFD's medical director, said.

Miramontes is the Fire Department's medical director through UT Health San Antonio. He has very specific procedures in place for when responders are exposed.

"I have one whole nurse that all she does is infection control for the Fire Department," Miramontes said. "If they're exposed, the patient and the medic go to the same hospital. We test the patient, we test the medic for a baseline and we start the medic or firefighter on a three-drug cocktail of HIV meds."

"We've had many exposures, but thank goodness because of our aggressive treatment protocols no one has converted to HIV positive," Miramontes said.

It's mandatory for San Antonio firefighters and paramedics to have annual vaccinations. Police have a separate medical system, but response is almost identical.

For both departments, concern for safety grows along with the opioid epidemic. Many major cities have begun to see fentanyl abuse on their streets.

"Fentanyl is 100 times more potent than morphine or heroin. So yes, our responders, more importantly law enforcement, are at huge risk to exposure from the powder," Miramontes said. "We have actually very pure heroin as it comes right over the border. We're one of the first cut cities, so we don't have a huge problem with fentanyl in our area yet."

But Miramontes expects a much bigger presence soon. So for responders, class is constantly in session.

"It's coming and we're working on continuing education all the time to be prepared for those kind of things," Beckett said.

Whether the overdose is from heroin or fentanyl, Narcan is the drug that saves the patient. As a shot or nasal mist, it blocks the effects of opioids. Some police and all SAFD EMTs carry it with them.

"It's safer for us to use this, as a mist as opposed to having to deal with needles to where you might have some contaminants of blood or a needle stick that would be dangerous," Beckett said.

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In an even better situation, a bystander or loved one has already used Narcan on the person overdosing. You can get it by prescription or some pharmacies now sell it over the counter.

"We will not have to do as many procedures up front and personal with a patient if they've already been woken up with Narcan," Miramontes said.

"Try not to put them in jeopardy, and the public in jeopardy but at the same time we want to go home to our families too," Beckett said.

Every moment -- a risk. One Beckett promises, is worth it.

"I've been a firefighter for 20 plus years and I love it," Beckett said. "I love helping people. It's actually a pretty cool thing to see somebody that's overdosed and we can change that. We can do something about it."

He'll continue saving lives swept up by America's swelling opioid problem, gambling his own along the way.