“It’s Pretty Sad If You Get Used to It”: A Qualitative Study of First Responder Experiences with Opioid Overdose Emergencies

Abstract

Background

First responders play a vital role in the United States opioid drug overdose crisis, a public health emergency that has claimed many lives.

Objective

We sought to investigate first responders’ experiences and attitudes toward opioid overdose emergencies and the ongoing crisis, as well as emotional effects, coping strategies, and support systems.

Methods

A convenience sample of first responders (n = 18) at the Columbus Fire Division, with experience responding to opioid emergencies, participated in semi-structured telephone interviews between September 2018 and February 2019. Interviews were recorded, transcribed verbatim, and analyzed using content analysis for themes.

Results

While almost all participants described overdose emergencies as routine, they recalled some as memorable and emotionally impactful. Almost all respondents were frustrated by the high rates of overdose among their patients and the lack of sustainable improvements in outcomes, yet expressed a strong moral commitment to caring for patients and saving lives. Themes of burnout, compassion fatigue, and hopelessness emerged, as did themes of increased compassion and empathy. Support for personnel experiencing emotional difficulty was either lacking or underutilized. Further, many felt public policies should prioritize more permanent resources and improve access to care, and believed that people who use drugs should face greater accountability.

Conclusion

First responders perceive a moral and professional duty to treat patients who overdose, despite their frustrations. They may benefit from additional occupational support to cope with the resultant emotional effects of their role in the crisis. Addressing macro-level factors contributing to the overdose crisis and improving patient outcomes could also positively affect first responder wellbeing.

Acknowledgments

The authors would like to thank the first responders who agreed to be interviewed, the members of the Columbus Division of Fire, and the Department of Bioethics at the National Institutes of Health Clinical Center.

Author Contributions

CH, DW, and CG conceived the study and designed and reviewed the interview guide. MP facilitated recruitment of participants and CH handled participant intake and conducted interviews. KP, CH, SH, DW, and CG were all involved in data analysis. KP drafted the manuscript and all authors contributed to substantive revisions.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was funded by the Department of Bioethics at the National Institutes of Health Clinical Center and the NIH intramural research program. The views expressed herein are solely the authors’ and do not represent the position or policy of the NIH, DHHS, or the US government.