After an overdose, response time is critical

  • A Concord EMS crew moves an unconscious man into an ambulance Dec. 10. ELIZABETH FRANTZ / Monitor staff

  • A Concord EMS crew moves an alcohol intoxicated unconscious man into an ambulance on Saturday, Dec. 10, 2016. (ELIZABETH FRANTZ / Monitor staff)

  • A Concord fire engine turns onto Fort Eddy Road in response to a call about an unconscious person in the Market Basket parking lot as seen from a responding fire department cruiser on Saturday, Dec. 10, 2016. (ELIZABETH FRANTZ / Monitor staff)

  • A Concord EMS crew responds to a call in downtown Concord on the evening of Dec. 6. ELIZABETH FRANTZ / Monitor staff

  • Concord firefighters respond to what turned out to be a minor traffic incident on Route 106 in Concord on Dec. 6, 2016. (ELIZABETH FRANTZ / Monitor staff)

  • Concord firefighter and paramedic Stephen Lorenze speak with a patient inside an ambulance following a call Dec. 6. ELIZABETH FRANTZ Monitor staff

  • Battalion chief Aaron McIntire talks on his radio after responding to a what turned out to be a minor traffic incident on Route 106 in Concord on Dec. 6, 2016. (ELIZABETH FRANTZ / Monitor staff)

Monitor staff
Published: 12/17/2016 11:06:52 PM

The radio crackled as the call came in: a report of a person passed out in their car in the Fort Eddy Market Basket parking lot. 

Concord fire Lt. Ian Holm didn’t hesitate.

He pressed his foot onto the gas pedal of the battalion chief’s cruiser and the maroon Ford Explorer revved up, flying down South Street and onto Loudon Road with its lights flashing and sirens wailing.

Within a couple minutes, Holm was pulling into the parking lot; a Concord fire engine, ambulance and another commanding officer in the fire crew were already there, forming a blockade around a parked SUV. In emergency calls, time matters.

The big trucks and flashing lights were a rude awakening for the person the fire crews had been called there for – a man who was simply taking a nap in his car but was mistaken by a passerby as someone overdosing on heroin.

With New Hampshire in the throes of a heroin and fentanyl crisis, false alarms that bring out a small army of emergency responders are increasingly common. Firefighters may grumble that callers should first check for themselves if a person is dozing rather than unconscious, but emergency responders still treat every call that comes in as a life or death situation.

Concord fire Chief Dan Andrus said heroin doesn’t have as bad a grip on his city as it does on neighboring Manchester. But Concord is far from unscathed. 

Concord fire crews have responded to 129 overdoses so far this year; last year they responded to a total of 151. By comparison, Manchester sees six times as many.

For firefighters and EMTs in Concord and around the state, each response to a potential overdose is a race against time. After three minutes, irreversible brain damage can occur in someone who has overdosed.

Ambulance response times in Concord are fast, but they can’t make every call within that amount of time.

On average, it took emergency responders three minutes and 42 seconds to respond to calls involving a drug overdose this year. In 2015, the average response time was four minutes and 12 seconds, according to Concord Fire Department statistics.

Response times in the city’s more rural areas like East Concord and Penacook can take longer than in the city’s core, Andrus said.

Emergency dispatchers often will coach callers on how to perform assisted breathing and CPR until emergency crews can arrive, Andrus added.

Once emergency responders arrive on scene,  overdose victims are quickly evaluated, given oxygen, and a shot of the revival drug Narcan to bring them back. Depending on how many drugs the person has taken, it can take several doses of Narcan to reverse the overdose. 

When Concord firefighters and EMS crews wake someone up with Narcan, the person’s first reaction is to deny they were using heroin or fentanyl, even if there’s a needle sticking out of their arm.

“They’re immediately coming up with excuses,” said Ron Palmer, a firefighter and EMT who is a part of the city’s Broadway Station crew. “Continually telling you why they’re fine.”

The badge on the Broadway fire station crew’s coats is embroidered with the Roadrunner. The cartoon character is a nod to the fact that their ambulance is Concord’s busiest; it covers several neighborhoods to make up for another station’s lack of an ambulance. 

Statistically, Narcan administrations in Concord are down nearly 40 percent.

Concord firefighters and EMTs administered the drug to wake someone up 106 times in 2015. So far this year, they’ve used it 56 times.

Emergency crews see different drugs cycle in popularity.

“It seems to come in waves for us. It’s very cyclical,” said Stephen Lorenze, a firefighter and paramedic who is a 20-year veteran of the Concord Fire Department.

A few years ago, emergency officials were mostly responding to calls for people overdosing on synthetic drugs known as ‘spice.’ Methamphetamine has also had its turn as the city’s drug of choice; in fact, that drug seems to be making a comeback, according to Andrus.

Still, heroin and its deadly cousin fentanyl are the biggest concern right now.

For one thing, drugs are more potent nowadays. Synthetic fentanyl is often mixed in with batches of heroin or sold as heroin; it can be 50 to 100 times more potent and can kill someone the first time they use it. The drug is credited with New Hampshire’s skyrocketing rate of fatal overdoses.

It used to be that “if you pushed a full two milligrams (of Narcan), that was a bad overdose,” said Concord Fire Department Battalion Chief Aaron McIntire. Now, his crews regularly give patients six to eight milligrams before they start to wake up.

The main priority of EMTs, paramedics and emergency room doctors is to keep someone alive and breathing, whether they are suffering from a drug overdose, cardiac arrest or choking on their food. 

If a basic neurological exam is done in the emergency room, it might not catch changes in behavior or cognitive function unless a more stringent test is done. 

“You’re really focused on saving their life,” said Dartmouth-Hitchcock Medical Center neurologist Dr. David Nierenberg said. 

(Ella Nilsen can be reached at 369-3322, or on Twitter @ella_nilsen.)

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