BC Emergency Health Services (BCEHS) is the sole provider of out-of-hospital emergency care and inter-facility transfer in British Columbia, and is the largest emergency medical service in Canada.
BC Emergency Health Services (BCEHS) paramedics continue to be called to an incredibly high number of overdoses across the province. In 2019 that amounted to 24,166 overdose calls, or an average of 66 calls each day for a potential overdose.
BCEHS has been monitoring the overdose crisis since it began in 2016 by tracking the number of 9-1-1 calls we receive and respond to for a potential overdose.
Between 2004 and 2015, overdose calls in BC fluctuated from 10,000 – 15,000 a year. But in 2016, BCEHS saw a dramatic increase in overdose call volumes and by 2017 it amounted to more than 23,000 calls a year.
The experience of BCEHS mirrors other provincial health agencies, including the BC Coroner Service, which reported a spike in illicit drug deaths in 2016, and an increasing trend of illicit drug deaths where fentanyl was detected.
For the last three years the total number of overdose calls BCEHS paramedics attend has remained steady – but this steady volume of overdose calls (now, more than 24,000 calls a year) is double what it was before the overdose crisis began.
Opioid Overdose, Paramedic Practice
When the overdose crisis began, BCEHS worked closely with the BC Centre for Disease Control (BCCDC) and our health authority partners to develop best practice guidelines for paramedic response to opioid overdose.
Practice guidelines included a major update to the dosing regimen for naloxone. Specifically, due to the presence of substances such as carfentanil and other fentanyl analogues, BCEHS elected to begin with a standard dose of 0.4 mg naloxone for the first and second doses, and double for the third and subsequent doses to a maximum single dose of 10mg. In most cases, patients respond to doses of 0.4 or 0.8mg and the high doses are rarely needed.
However, the primary objective of paramedics for patient care in an overdose setting is to focus on airway management and early oxygenation.
Paramedics on the Front Lines
Christa Zaganas is a paramedic at Ambulance Station 248 in the middle of Vancouver’s Downtown Eastside. Zaganas regularly responds to overdoses. “I can tell you there is no typical overdose patient. This crisis is affecting people from all walks of life.”
The BCCDC has distributed more than 100,000 take home naloxone kits to the public and paramedics now find many potential overdose patients who have already received naloxone before they arrive on scene, and in many cases the patient has begun recovery from the overdose.
Paramedics also deal with complications from an overdose including aspiration, trauma, frostbite, withdrawal symptoms and other effects.
As a result of the crisis, BCEHS paramedics have become community advocates supporting access to overdose prevention sites, access to take home naloxone kits, bystander and first responder education and harm reduction.
Importantly, paramedics in BC now have access to referral pathways for opioid overdose patients to receive ongoing clinical care, management of chronic disease, provision of opioid agonist therapy, addictions support and rehabilitation, mental health support or financial support for food or housing.
Paramedics provide care and service to prevent future overdoses and support access to programs to manage addictions.
Efforts to prevent overdoses in Victoria
In Victoria, BCEHS paramedics have been full-time staff members at the city’s overdose prevention site, The Harbour, since 2018. At The Harbour, paramedics work alongside allied health care workers, including staff from Vancouver Island Health Authority.
Of the more than 40 overdose prevention sites in BC, this is the only one employing full-time BCEHS paramedics.
In its first year, paramedics at The Harbour reversed more than 200 overdoses at the site and prevented about 196 ambulance responses.
Four BCEHS paramedics, on rotation covering seven days a week, respond to about 25 potential overdoses a month.
Paramedics on site also provide their expertise in identifying serious illness and injures and providing early medical intervention and medical referrals for the site’s clients.
It’s a privilege, said one paramedic who works at the site, to see clients regularly. “It’s something you don’t get when responding to a series of medical emergencies.”.
With contributions by BCEHS staff:
Joe Acker, Director, Clinical & Professional Practice
Shannon Miller, Communications Officer