HCA Healthcare
May 21, 2019


SOURCE: Asheville Citizen Times
AUTHOR: John Boyle

Narcan kits are used to reverse opioid overdoses. (Photo: Jennifer Bowman)

Today’s batch of burning questions, my smart-aleck answers and the real deal:

Question: When someone is treated by the fire department for a drug overdose of either a legal or an illegal substance, what kind of followup is there if the individual survives the event? How many overdoses does the AFD treat in a month?  

My answer: Yeah, just not going to go for humor here.   

Real answer: Let's start with the numbers first.

Asheville Fire Department spokeswoman Kelley Klope provided a chart with month-by-month statistics, but an explanation is required. The table showed how many overdoses AFD was dispatched for each month last year.

"That is how dispatch coded the call based on the information obtained from the 911 caller," Klope said. "That does not always mean we arrive to find an overdose. We have different treatments depending on the type of overdose."

For opiate overdoses, AFD uses Narcan, which can reverse the effects of an overdose. So the chart also showed how many times AFD administered Narcan.

Here's how it broke down for 2018:

  • January:17 Narcan administrations, 43 overdose dispatches.
  • February:11 Narcan administrations, 47 overdose dispatches.
  • March:24 Narcan administrations, 80 overdose dispatches.
  • April: 14 Narcan administrations, 41 overdose dispatches.
  • May:16 Narcan administrations, 69 overdose dispatches.
  • June:23 Narcan administrations, 79 overdose dispatches.
  • July:15 Narcan administrations, 44 overdose dispatches.
  • August:21 Narcan administrations, 57 overdose dispatches.
  • September: 19 Narcan administrations, 60 overdose dispatches.
  • October: 26 Narcan administrations, 57 overdose dispatches.
  • November: 22 Narcan administrations, 45 overdose dispatches.
  • December:23 Narcan administrations, 68 overdose dispatches.
  • Total for 2018:231 Narcan administrations, 690 overdose dispatches.

Now, about followup.

Buncombe County sheriff's deputies prepare a Narcan kit as part of training school resource officers Wednesday, Sept. 6. (Photo: Jennifer Bowman)

"There is no follow up from AFD," Klope said. "We relinquish all medical calls to either (Buncombe County) Emergency Medical Services or the hospital after initial care/treatment."

At Mission Hospital, spokeswoman Nancy Lindell handled the question.

"For those patients in whom the overdose was clearly or potentially intentional, a full assessment is provided by psychiatry intake and appropriate patient specific care is pursued," Lindell said. "For those patients in whom the overdose was determined to be unintentional, the first step is to ensure medical stability. Once that is achieved, the patient’s interest in treatment is determined."

Several paths are possible.

"If they are interested in substance use disorder treatment, emergency department social work is consulted in order to assist with linking them to appropriate services," Lindell said. "For those not interested in seeking treatment, engagement services are offered through RHA’s Comprehensive Case Management Team or Sunrise Community for Recovery and Wellness’s Community Opiate Outreach Peer Engagement Specialist."

Those are other companies with operations here.

Buncombe County EMS does not offer followup services, according to Director Jerry VeHaun.

Some departments use a program called "community paramedics" in which paramedics periodically check on the elderly or others with recurring medical problems.

"We have proposed that a couple of times, but it never got funded," VeHaun said. "It would take two or three people to do that program."

With salary and benefits, a paramedic costs the county about $83,000 annually, so for three staffers doing this job, 'you're looking at a quarter million dollars," VeHaun said.

This is the opinion of John Boyle. Contact him at (828) 232-5847 or by email