Dealing with drug overdoses takes toll on first responders

The woman sat slumped over the kitchen table. Her lips blue, her breathing shallow. On the table, a needle. She had overdosed. The paramedic injected her with Narcan. He managed to get her breathing again.

Three days later, he was back.

The paramedic, Greg Miglino, knows the woman. They went through the Bellport schools together, from elementary to high school. It frustrates him to see her like this, that she doesn’t get help.

But it’s the same story with other addicts. Miglino and his fellow first responders on Long Island keep saving them again and again. Sometimes, a dozen calls to the same address. Sometimes, a death. Last year, an estimated 600 deaths islandwide, according to Nassau and Suffolk medical examiners.

Eyewitnesses to overdoses virtually every day, first responders are seeing the opioid epidemic affect their own lives. The feelings of disappointment, discouragement. The extra work. Some are finding different jobs. Miglino has seen a few of his own crew go.

“It takes a toll,” said Miglino, 50, chief of the South Country Ambulance, which covers areas that include Brookhaven, Bellport, East Patchogue and South Haven. “You come home and you wonder what’s happening to society.”

At its worst, the distress leads to a kind of emotional burnout that makes a first responder forget that behind the addict is a human being, said Patricia Smith, who has written four books on what experts call compassion fatigue.

“They feel ‘I’m working hard, with my heart and soul, and it never gets better,’ “ said Smith, a former journalist who lives in Washington state and founded the Compassion Fatigue Awareness Project , which trains responders to recognize the problem. “They’re getting worn down. They lose touch with the work, they lose the compassion.”

Miglino said he remains strong and caring. But he doesn’t hide how some of these calls bring him down. The first time he responded to the woman he knew from school, he and the woman talked on the way to the hospital. She cried about her life. He gave her $200 out of his own pocket.

“She used the money to buy drugs,” Miglino said.

The high price of pressure

First responders pride themselves on their ability to handle anything, from a heart attack to a car crash to a shooting.

But their toughness makes it hard for them to see that they are burned out and that they need help themselves, Smith said. And their inability to see the problem makes it difficult for the experts to determine how many first responders suffer compassion fatigue.

“They build that armor,” she said, “but they need to let that armor go and be vulnerable.”

Responders who don’t deal with the pressure can pay dearly: Some quit their job, others have problems in their marriage, Smith said. There have even been cases of suicide.

For all their training, many responders don’t understand addiction and the ways it can control a person, said Jeffrey Reynolds, who heads the Family and Children’s Association, a Mineola-based nonprofit that provides counseling and outpatient drug rehabilitation treatment.

The responders, at the most basic level, see addicts harming themselves and they are baffled by it, Reynolds said.

“They should be frustrated. If they don’t care about a guy they see 10 times in a month, they are burned out,” he said. “It demonstrates their humanity.”

They just need to recognize when the stress becomes too much, Smith said.

“Caring too much can hurt,” she said.

The home front

The firefighter knew where to go. Right to the basement. He had been there a half-dozen times before.

He passed the parents, seeing the tension and sadness in their faces.

The young man was keeled over on the floor, out like a light. The firefighter, Smithtown chief Michael Landrigan, watched as one of his paramedics gave the man a dose of naloxone, more commonly known as Narcan. Within two minutes, he came around — angry. One of the common side effects of naloxone — combativeness.

“What are you doing here? I’m all good,” he said and started shoving Landrigan.

Landrigan had a few things to say to the young man: “Look what you’re doing to yourself. Look what you’re doing to your mother.”

The responders took the addict to the hospital, knowing they would probably see him again.

Burnout comes with the territory, and turnover isn’t uncommon, the chief said. The opioid epidemic has made it worse.

“We lose guys all the time,” he said.

A glimmer of hope

Sometimes a repeat appearance pays off.

Suffolk County Police Officer Matt Siesto responded to a call of a heroin overdose at Centereach Mall. The woman was in a pickup truck in the parking lot.

A few weeks later, he revived her again after she OD’d in her home in Centereach.

“How many times do you think I can keep saving you?” Siesto recalled telling her.

“Nobody told you to save me,” she answered.

They talked some more. He left hoping he made an impression.

The woman recovered, then relapsed. Eventually, she turned her life around, Siesto said, and she credited him with helping her to make a new start.

‘We will be there’

Mike Merolle can get called to an address two times, three times. No matter how many times, he will go and he will do whatever he can to save that life.

Addicts are sick and his job is to help them. In his nine years as a Nassau County police medic, Merolle figures he has administered Narcan more than 100 times.

“We are here for these people. If we get called to help these people six days in a row, we will be there.”

Merolle thinks his concentration is what keeps him from getting burned out.

“I’m focused on the job. I am not focused on my personal beliefs. I’m focused on the person I’m helping.”

Still, he feels for everyone at the scene. The user. The parents. The kids. Their struggles.

“It’s not like a broken bone. It’s not a one-time thing. Once I get you on your feet, I usually feel like I can leave and everything should be OK,” Merolle said.

“That’s not the case here.”

Talk, talk and talk some more

John Priest knows both sides of the story. He lost his 22-year-old son, Rob, to a heroin overdose six years ago. And he saw the stress when he was chief of the East Meadow Fire Department — first in the 2000s during the epidemic’s infancy, then for a year or so around the time his boy died.

When Priest was on the job, he saw how the EMTs and firefighters handled stress. Today, he is a volunteer firefighter and they still handle it the same way: They talk to each other.

“We’ll sit down over a cup of coffee,” Priest said. “It’s not formalized. It’s just the camaraderie, the kindred spirit there.”

At the Nassau County Fire Police EMS Academy, recruits learn about addiction so they understand it is a disease, said academy administrator Paul Divver. They find out that addiction has what Divver describes as “a significant physical component.”

Knowledge, it is said , fosters tolerance, he said.

Still, Divver emphasized the importance of having an in-house culture that encourages responders to talk about their feelings.

“Airing it out, venting, can do so much,” he said. “Sometimes they just need an ear.”

The telltale signs

The 911 call came in as a man down.

So Luis Salinas and his crew from South Country Ambulance sped through Brookhaven to a quiet street in East Patchogue.

They found the man — tattoos covering his arms and legs, a black ball cap on — slumped against a tree. He seemed dazed.

A Suffolk police car pulled up. The man stood up and told the officer that he had fallen off his bike. He mentioned his neck hurt. The responders put a neck brace on him.

The officer looked inside the man’s glass case. A pair of glasses — and a cheap hypodermic needle.

Later, Salinas said he had a sneaking suspicion the man had been high.

And that he would see him again.