Brian Twaites long ago lost count of the number of cardiac arrests he’s reversed in his almost forty-year career as a Vancouver paramedic.
He’s used to what he will face upon arriving at the scene of an overdose: often it’s a patient who looks past the point of no return.
“These people are clinically dead. They are not breathing and do not have a pulse… They’re blue in the face. For all intents and purposes, they look dead when you show up,” said Twaites.
In 2016, British Columbia declared a public health emergency in response to a massive increase in opioid related overdoses. Since then, more than 10,000 people in the province have died from a drug overdose, according to the BC coroner’s office. More than 1,200 died in the first six months of 2023.
Those numbers are staggering, but what’s not appreciated by the public, paramedics say, is the thousands who would have died if it weren’t for their interventions and the toll this live-saving work takes on first responders.
“Paramedics have faced increasing stress, demand and pressure over the last five to ten years,” says Dave Deines, president of the Paramedic Association of Canada.
Explosive growth in overdose calls
Since BC’s health emergency was declared, paramedics in the province have seen a 75 per cent increase in overdose calls, according to Twaites. In a single day in 2017, Twaites was involved in resuscitating 22 overdose patients. Two patients weren’t able to be revived.
A common misconception is that drug abuse is concentrated in Vancouver’s downtown eastside. However, the statistics show another side. In June 2023, 47 per cent of overdoses occurred in private residences, and 34 per cent occurred in other indoor areas such as homeless shelters and hotels, according to the coroner’s office.
“It’s behind the white picket fence,” said Twaites. “It’s everywhere.”
To mitigate against the risk of overdosing alone, British Columbia has embraced the Lifeguard app, as Canadian Affairs recently reported. It allows users to set a timer before ingesting their drug. When time is up, the user hits a button which sends the message they haven’t overdosed. If they don’t hit the button, emergency services are sent.
‘They’re really complex calls’
In addition to a high volume of calls, paramedics are facing cases of increasing complexity.
At the beginning of Twaites’ career in 1986, heroin was the most popular recreational opioid. When someone overdosed, it could take as little as five minutes to revive someone by administering the opioid antagonist naloxone.
Now, with synthetic opioids such as fentanyl and carfentanil, paramedics may have to work on the patient for up to 30 minutes and use as much as five times the amount of naloxone.
But it isn’t just synthetic opioids that are making overdose treatment more difficult. A whole host of synthetic additives, everything from Valium to Xylazine — known as tranq on the street — are often taken in combination with opioids.
“We may be able to reverse the fentanyl aspect of the overdose with Naloxone. But then we’re still dealing with a patient who’s deeply unconscious because the other substances are in their system,” Twaites said.
“They’re really complex calls.”
An overburdened hospital system also adds to the challenges.
“There’s a lot of offload delays that are occurring,” said Lindsey Boechler, a former advanced-care paramedic in Saskatchewan.”You can’t leave your patient until you transfer care, so oftentimes paramedics are caught up in back hallways, waiting to transfer care because there’s no available beds.”
Overdose crisis takes a mental toll
“When I was practicing, sometimes I would visit the same patient twice in a single day to reverse an overdose. That kind of redundancy does sometimes result in compassion fatigue,” said Boechler.
“Most paramedic services in Canada are working at or over 100 per cent capacity normally,” says Deines. “[This] impacts mental health and wellness on the provider side: moral injury and compassion fatigue are on the rise.”
The heavy workload takes a toll.
“Often [we’ll] miss lunch hours or breaks, which doesn’t seem important. But when you’re in such a high stress environment, I think those are really important for balance and longevity of your professional practice,” says Boechler.
In response to the mental strain on paramedics, BC Emergency Health Services started the Paramedic Resilience Program. The program has paramedics meet with psychiatrists to discuss and work through the traumas they face on the job.
Paramedics in BC also just signed a three-year collective agreement that brought in wage increases and benefits, says Twaites.
But ultimately money is one small factor.
When mentoring younger paramedics, Twaites encourages them to note down every time they reverse a cardiac arrest and save someone’s life. He says that will remind them how vital their work is.
“I’ve delivered babies in the backseats of cars, in people’s homes. The most rewarding thing for me is cardiac resuscitation,” he says. “You go to a scene and these people are clinically dead, they are not breathing and do not have a pulse. And you and your team are able to resuscitate someone.”
“You only have to do that once in your career to make it worthwhile.”
