When does it stop being a party and start becoming a problem? Is there a way to steer clear of addiction? Every Wednesday, Mike McGowan, host of the podcast "Avoiding the Addiction Affliction," explores substance use disorders with expert guests. The podcast series is sponsored by the Kenosha County Substance Abuse Coalition.
Original cover art created by
Kelly P. of Kenosha, Wisconsin
Division Chief of Emergency Medical Services for the Kenosha, Wisconsin Fire Department
When the worst happens and a loved one is unconscious, not breathing, overdosed, and close to death, the Emergency Medical Services (EMS) team responds. Nick Eschmann discusses the role of EMS in the ongoing health crisis caused by substance abuse. Nick is the Division Chief of Emergency Medical Services for the Kenosha (Wisconsin) Fire Department. He is passionately committed to giving people one more chance at life. Emergency Medical Services in Kenosha can be contacted at https://www.kenosha.org/departments/fire-department/divisions/emergency-medical-services. If you need help with your substance misuse or that of a loved one, help is available. As Nick says, “No one needs to die from this disease.” To contact the Hope Council on Alcohol & Other Drug Abuse, call 262-658-8166, or explore their website at https://www.hopecouncil.org.
[00:00:00] [Jaunty Music]
[00:00:11] Mike: Welcome everyone to Avoiding the Addiction Affliction. This series is brought to you by the Kenosha County Substance Abuse Coalition. I'm Mike McGowan. We've discussed so many topics on these podcasts about substance abuse and everything that can happen. And today we're gonna have a conversation about what happens, when the worst happens.
[00:00:31] I'm pleased to have as our guest Nick Eschmann, who is the Division Chief of Emergency Medical Services for the Kenosha Wisconsin Fire Department. Welcome Nick.
[00:00:42] Nick: Thanks for having me, Mike. I'm excited to be here.
[00:00:44] Mike: Yeah, well, that's, it's really nice you to do it first. I, I assume everybody knows, but it, for those that don't, could you start with a conversation, just tell us a little bit about what EMS does.
[00:00:54] Tell us about your work.
[00:00:56] Nick: Yeah, certainly. The EMS division of the fire department represents about uh, oddly in municipal fire departments nowadays emergency medical services represent close to 85% of the work. So we basically are the entity that responds when you call 9 1 1. So in Kenosha here, we have five advanced life support ambulances that are basically capable of providing very close to the first half hour of emergency room care for pretty much any reason right in your home.
[00:01:29] Mike: Wow. Yeah. Well, let's talk numbers. How many calls do you get? Per month? Per year?
[00:01:36] Nick: Yeah, so, we respond to right around on average, we have busy weeks and slow weeks obviously, but we respond to on average about 220 calls a week. So that breaks down to ballpark 31 a day 30, 31, 32 a day.
[00:01:54] In 2021, we responded to just over 11,500 calls. And made just about 13,000 patient contacts.
[00:02:05] Mike: Wow. I didn't think about this until you just said that, but did your numbers go up or down during the pandemic
[00:02:12] Nick: During the pandemic they actually dropped. I think the messaging for people was if you're if you have sniffles or flu, stay home. If you're sick and can't breathe, that's when it's call 9 1 1. And honestly it got to the point where the hospitals became so stashed with folks that were suffering from a more serious versions that that there really wasn't a place to take them. And so ultimately the messaging got kind of out there that people sort of curled up and stayed in their homes and as a result, our calls dropped a little bit and I would say to put that in perspective you know, maybe instead of 32 a day, maybe, I don't know, 25 a day, so not, not trivial, but you know, a little, little bit.
[00:02:58] Mike: When you respond to everything from what, automobile accidents, to mental health crises and everything in between right?
[00:03:05] Nick: Yeah. So just in, just in your head think about anything that you dial 9 1 1 for we effectively basically we're perfectional problem solvers. If that makes sense. People tend to call us when they're in a situation that they can't get out of. You know, a good example is somebody who is, you know, 65 years old.
[00:03:28] And is getting out of a shower and slips on a bathroom floor and just can't get turned around or get up and you know, maybe not hurt, but just, [laugh] just, just stuck. And so as a result, we'll respond to that. And a lot of times we we'll help those folks up and kind of you know, just sort of take care of 'em for a minute there and make sure there's nothing terribly out of place.
[00:03:50] And a lot of times we'll just end up leaving 'em right in their homes. But yes responding to motor vehicle crashes. The other thing that's somewhat interesting is that anytime there's an actual structure fire, so an actual fire, our med unit, the first arriving med unit actually is the primary search and rescue group.
[00:04:08] So they actually are making entry into the house and doing or into the structure and doing the primary search, looking for anybody who's still in the property. So. We cover quite a spectrum.
[00:04:20] Mike: And beyond the firefighter training, you need additional training to be part of EMS. Right?
[00:04:26] Nick: Right. So firefighter training is pretty intense in and of itself.
[00:04:30] Then we have EMT basics, EMT basics in the state of Wisconsin require 180 hours of education. And you typically do that through like a technical college here in Kenosha. We use Gateway but MATC, all the Wisconsin technical colleges all offer a similar program. And then there are services that basically don't have the call volume or the ability, the money to be a fully advanced life support service. And so they'll do something called an advanced EMT and that class is right around $250 on top of the EMT basic, and that covers things like taking care of diabetics with IVs and sugar. It, it covers kind of like entry level advanced medicine, EMT advanced.
[00:05:19] I mean, it's, it is what it sounds like. And then on top of that, there is an EMT paramedic, and that is basically a 1200 hour class that has about 600 classroom hours and about 600 clinical hours.
[00:05:35] Mike: Wow.
[00:05:35] Nick: And those clinical hours are spread between emergency room, OB surgery, every specialty of the hospital, respiratory therapy.
[00:05:46] And then there's also quite a hefty ride along component where they're working with medics out in the field. And they're, so they, they get their skills put to the test in just about every situation so that they're able to handle problems as they come up.
[00:06:00] Mike: You know, you mentioned diabetes a minute ago and I wanted to get into the opiate stuff because that it's fascinating to me.
[00:06:07] So you get a call and somebody's out, they're unconscious. Talk about opiates for a minute, like my first question is always, how do you know what they've taken?
[00:06:19] Nick: Yeah. So, I mean, it's kind of a good question. I know in prior conversations we chatted a little bit about you know, things like overdoses, but the reality is we don't really make that assumption.
[00:06:30] You know, when you have somebody who's unresponsive, there, there [laugh] are a lot of things that could make unresponsive. It could be a cardiac event, it could be a stroke, it could be sugar. It could be diabetes. Boy, there's, there's a it could be an allergic reaction. It could be a drug overdose, right?
[00:06:46] So it, it is so how we deal with that is we approach every patient effectively the same, right? So we check we check to make sure they're breathing and if they're not breathing, we fix that problem. If we if we check their heart rate and if that, if their heart isn't beating, we fix that problem.
[00:07:05] So once you're past breathing and a heartbeat, then we start to look into second tier stuff, which is checking your blood sugar and taking a look at that. We basically have the whole assessment process in place. And one of the things that's unique to opioid overdoses is that pupils, your, your eyes, your pupils are effectively.
[00:07:27] They look exactly like the dot on the end of a pencil. It, they, they're just very pinpoint very pronounced effect on the pupils. And we will administer Narcan in those situations, but not typically big doses. We typically are just focused on trying to get you breathing again so that we can continue our assessment without any sort of you know, some of the side effects that tend to come along with Narcan.
[00:07:51] Mike: Do you use a needle or do you use spray?
[00:07:54] Nick: Uh, most of the time we'll we'll do intranasal Narcan only because it's the easiest at that point. So we get our Narcan slightly different than the ones that we're dropping in our leave behind program. But they're basically in syringes and we have a piece that [inaudible] air in your nose. and we'll typically just bump it in just little bits until we see a reaction.
[00:08:19] Mike: Wow.
[00:08:20] Nick: Mm-hmm.
[00:08:20] Mike: And how long does it take after you do that? Before you get a reaction?
[00:08:24] Nick: Narcan works on opioids typically within 5 to 10 seconds, it works quick. Although you know, as [laugh] I guess it's not very different from human history. So human history says, you fight with the neighbors. And then one of the neighbors gets a club. So the other neighbor gets a bigger club and then you know, fast forward through history and somebody gets a musket and somebody gets a higher power weapon that can load faster.
[00:08:51] You know, fast forward all the way to nuclear weapons. Right? So I, I would say in the drug story kind of the same is true. So we're at we're into narcotics now we're into drugs, opioids, not nowadays that back, you know, 10, 15 years ago just maybe 0.25 or 0.5 milliliters of Narcan would be enough to make a response.
[00:09:14] And we, we, there are cases now where they'll need, you know, 5, 6, 7 milligrams of Narcan in order to come back. So that's not actually even a function of the individual taking it. It is more of a function of the potency of the medication. So once again, they're just continuing to try to take medications that can circumvent the current therapies.
[00:09:37] Mike: It's, it's gotta be a surreal experience taking somebody who's literally out of it, just totally out of it. And then give them a little puff and 5 to 10 seconds later. What, what do they like? What do they say?
[00:09:51] Nick: Most of the time they come to and to be totally honest with you when you take somebody whose blood sugar is like 20 and they're unresponsive and you put an IV in their arm and you start running sugar in, within say three seconds to a minute, they kind of sit up and they start looking around and they have this confused dazed look on their face and they are trying to process why you know, what seems to be about a minute ago they saw the the world go dark. And now here, here they are with you know, six giant humans all circled right around them or, you know, whatever the case. Honestly it is, is probably very disorienting because you, you know, you're in one situation and then instantly you wake up in another.
[00:10:38] For anybody who's ever had surgery you know, I mean the same applies, right? They give you a medication that helps you sleep a little bit, and then you wake up and wow. You don't have an appendix. [laugh]
[00:10:49] Mike: [laugh] Yeah. And, and for me, I always want a chocolate shake, I'm not sure why that's the case. But, you know, we've had people on here, Nick, who have said they, they were hoping not to wake up from opiates. That you would think that they would stay away from the fentanyl, but we've had numerous people on here who have said, nah, it's kind of deliberate.
[00:11:11] And if I don't wake up, oh, well, so are they always pleased that you bring 'em out?
[00:11:17] Nick: No. Certainly if they spent their last you know, $20 on whatever it is that they took and I come along and ruin it in less than 10 seconds that's a tough deal. And you know, the interesting part about that is at least from the EMS side, Yeah.
[00:11:34] Sometimes they're not very happy with us. Sometimes they are you know, suffering from a host of problems, but the reality is you know, I mean, somebody falls over with a heart attack and I'm gonna deal with that. I'm gonna convert that. I'm gonna bring it back to the best of my ability. And you know, if they felt like that was the end. It, it doesn't really for a lack of better way to say it.
[00:11:57] It doesn't really impact my operations. We're, we're, we're going to provide emergency treatment in any situation regardless. Right.
[00:12:06] Mike: Well you must see some of the same people, especially when it comes to opiates over and over again.
[00:12:14] Nick: We do we tend to see folks, especially in you know, in a geographic area you'll actually come across the same individual three or four times in three or four different places.
[00:12:25] But the truth of the matter is we have a fellow that lives out on the west side of town here. Who has advanced lung disease, advanced C O P D. And that guy he, he chain smokes himself right into an asthma attack and he calls us and I would say we see him a couple times a week. So you know [laugh], I mean, once again, when people say, well, you're choosing to do drugs, I don't know.
[00:12:50] I mean, the argument is that you. Other people are choosing to smoke. Other people are choosing to eat sugar covered cookies and donuts. Other people are choosing to eat you know, lots and lots of bacon and things with very high cholesterol that all lead to their own health problems. So yeah, you do see people all the time, but you just have to keep it the context.
[00:13:11] When I see folks that feel like, you know, I kind of wish I didn't wake up. The reality is that if we don't wake them up they'll never have a chance to [inaudible] somebody who can show them the importance of why they wake up every day and put them on a track in life. You know, sends 'em down the right path.
[00:13:29] I mean, how many times [laugh], how, how many times do you you know, I mean, how many times do you bump into people at the gym who are like, [inaudible], I had a heart attack and now I'm here on the treadmill every day. And how, you know, how many diabetics do you bump into that are you know, no, now I have this thing on my arm that monitors my sugar on 24 hour basis.
[00:13:52] And I just look at my phone, it tells me what I can eat. You know, there's a lot of advances in medicine. And this is just another one of those problems. I mean, honestly you know, one of the things that gets a little bit tough that I didn't share earlier is that, you know, when you have somebody who's unresponsive, you absolutely have to avoid the urge to stereotype or you know, jump to conclusions because.
[00:14:20] Honestly there, there are a lot of reasons people could be unresponsive and an overdose is simply just one of them. So you have to be a little bit careful that you don't get pulled into a, this is your problem, I'm gonna fix this problem. What, what happens if that turns out to not be your problem?
[00:14:35] You know, a great example is when people, when your blood sugar gets a little bit low, that looks an awful lot, like a stroke. And if you don't think to check the blood sugar, And you start treating somebody for a stroke. It can have horrible consequences because you're not fixing the underlying problem.
[00:14:52] So you know, it's a it's a, it's a crazy journey.
[00:14:55] Mike: And, and the underlying problem for people doing drugs many times, I mean, or concurrent, I should say problem is there's a lot of mental health issues as well.
[00:15:05] Nick: For sure. Yep.
[00:15:06] Mike: You know, I was thinking before we talked about this, If somebody let's say overdoses or whatever, and you bring them back, you may see some people only once, but you'll forget about them I would think. You know, the people who get it, who, who turn it around right away, you don't get to see again. So you do get to see the people who seem to recur. How do you keep your folks and yourself from becoming jaded?
[00:15:38] Nick: Yeah. You know, the reality is that somebody has a heart attack and we get to their house and we strap some big pads onto 'em and we defibrillate them a couple of times and do a little bit of CPR and we start an IV and give 'em some different medications. We take 'em to the hospital and we never see them again.
[00:15:56] Mike: Right.
[00:15:56] Nick: I don't know, maybe they lived, maybe they died. I mean, I don't wanna be, I don't wanna be cold about it, but the reality is we don't really have a good mechanism to follow up on patients collectively. And so really what it becomes is you just keep going out and doing your same job every time, and you do it for the best of your ability every time.
[00:16:18] And it's why people sign up to do this. It's people sign up to do this. To be part of the solution. And your part of the solution is taking care of people in a situation. So that's regardless of, you know, race, color, creed, sex, I mean, that doesn't matter who you are. We don't get into the whole debate about you know, whether or not you're a citizen or not a citizen.
[00:16:41] It doesn't matter. You're a human and we're just going to take care of humans. There, there is no debate.
[00:16:46] Mike: You'll never know if, if you make a difference the first time, fourth time, 20th time, 40th time that that person turns their life around. So you have to try to maintain some sense of optimism when you go to the same address over and over again.
[00:17:01] Nick: Yeah. So we on occasion we'll get some sort of feedback loop that says, you know, remember Tim that we used to see twice a week in the basement of that house over there you know, you, you bump, I bumped into Tim the other day at the grocery store. Tim is living in an apartment on the south side.
[00:17:18] Now he's got a girlfriend. I mean, you, you know, it's that kind of thing. And those sort of stories you know, I mean you show up at a house and you get somebody's heart going again. And they show up at the fire station with their family and their family's standing there crying. Thankful that we gave them more time with dad, mom, grandma, sister, brother.
[00:17:41] Those are just super energizing stories.
[00:17:43] Mike: They are.
[00:17:43] Nick: And they keep you going. Those are nice. But the reality is that you go out and you're trying to do the best that you can do every day, regardless. So it's not you know, we're not, no, nobody here is looking for that kind of reward or that sort of satisfaction.
[00:17:59] You just gotta keep your head in the game and continue to take care of people in the best way that you can. Use your training and equipment and hope for the best in every situation.
[00:18:10] Mike: You know, when we were talking, you, even though opiates dominate the headlines and all the discussion, I, I think I'm remembering this correctly.
[00:18:18] Weren't you telling me that even though opiates are all in the headlines, alcohol has a many more calls than opiates, which I guess shouldn't surprise us here in Wisconsin. Right?
[00:18:28] Nick: Yeah. So I mean, something that I could share with you just as we, as I was thinking about our conversation a couple weeks ago. I came back and I generated a bunch of numbers that I thought you might find interesting.
[00:18:39] So our patient care record software is incredibly powerful. There's a giant report writer function with it. And so I was able to isolate out of almost 13,000 patients in 2021, I searched for alcohol withdrawal, behavioral psych, alcohol abuse, opioid related, or drug overdose. Okay.
[00:19:02] So basically what happens is when somebody gets to one of those calls, they. Are just kind of making determinations on the fly about what it seems more to be like, if that makes sense. So a lot of times we can't immediately identify it as an opioid. And so those get lumped under like a drug overdose.
[00:19:24] But as you know, there are a gazillion substances out there and so it's not always . But anyway, to put it in perspective under alcohol withdrawal, we had 73 patients. Under alcohol abuse, 233. Under opioid related, we had 12, right? So 12 would be attributed directly to opioids. But most of those are gonna get clumped under the drug overdose, which is a 194, a 194 patients last year that we saw that fit into that category, but even more interesting is the behavioral type category, which could be, oh my goodness.
[00:20:06] That's sort of like a repository of I feel like we have to call it something, but it doesn't fit cleanly into any other category. We had 275 of those last year.
[00:20:16] Mike: Wow.
[00:20:17] Nick: But to put that in perspective we had. 2,500 falls. Right? We had 2100 respiratory problems. We had 1900 cardiac problems.
[00:20:33] So in the grand scheme of things, while this is important honestly it's not making top half.
[00:20:41] Mike: And you said before, I, I think you dropped it in and I didn't, I wanted to circle back to it and we can kind of close this. You said when you leave a scene where opiates were involved, did I hear you say something about you leave a package behind a leave behind package?
[00:20:58] Nick: Yeah. So, I mean, I could share a little bit of a story with you. So my predecessor, super passionate about this problem in particular the problem of opioid overdoses and overdoses in the community in general he attended this coalition meeting and this, apparently this lady stood up.
[00:21:17] And she looked at this room and she said, my son is dead and I didn't know about a single one of you people. Wow. I had no idea that these services existed. I had no, I, I didn't know who to reach out to for help. And my son is dead now. There is no help for him. And that was so moving for Jim. That he actually got with our medical examiner and they put a packet together.
[00:21:45] It's just, just an envelope. The funny thing is that envelope led to another initiative that I'll, I'll share with you in a minute, but in that, in that envelope, we put in contacts for the county. Folks that can help you. We put in contacts for counseling, we put in like here here's, here's a packet.
[00:22:04] And on, on the label, on the front of it it says the, the, the contents of this packet could save your life.
[00:22:11] Mike: Hmm.
[00:22:11] Nick: And so whether you look at it or not, maybe mom looks at it, maybe brother, sister, dad, uncle, cousin, looks at it and says, wow, I'm gonna just reach out to one of these people. And you know, see if they have any suggestions about what I might do next or what the family might do next.
[00:22:28] And so it was really a creative idea to say, Hey, we're gonna leave these packets at the scenes of overdoses for people to have a resource to, to get help. And, and Jim's statement at the time was, I don't want anybody ever to address a crowd like this again and say, I didn't know you existed.
[00:22:45] Mike: Yeah.
[00:22:46] Nick: And I can't make you, I can't make you reach out for the help, but I can at least show you that the help is there. And so I had the opportunity to attend a presentation at the national association of [inaudible] out in San Diego. And as you know, Ohio is really suffering from opioid related issues.
[00:23:06] There are counties in Ohio where this is just really a tragic problem. And so they searched out better ways and it's still really in its infancy, but effectively they worked out the, the legalities to be able to leave Narcan right at scene. And so I started looking into it and in the state of Wisconsin, I got back here and I'm like, ha I'll bet you, I could order some little bags off of Amazon and just drop a couple of uh, Narcan in with this packet.
[00:23:37] So I started talking about it with the medical examiner and we got the county on board and the county is providing the Narcan and fentanyl test strips. And we're, we're taking the same, basically the same packets making sure they're updated. We've learned to uh, put a, a version number on the bottom so that we know that they're always current numbers.
[00:23:57] The last thing I'd want you to do is reach out for help and find a number that's no longer in service. So so anyway, we have these little bags and we drop in two Narcan and two fentanyl test strips in addition to the packet and leave those at at scenes. And so we have a card in there that explains how to use the Narcan and you know, here's, here's my logic to it.
[00:24:21] My logic to it is it's like a vaccine, you know, we have the technology, we have the capability. There is no reason to have people dying from this. No reason. So here, here's some, here's a way for you to actually literally save your life in this home. Right. And so we're, we're dropping these packets right in people's homes that have Narcan and fentanyl test strips in in addition to the all of the contact information.
[00:24:49] So I've added a box to our electronic patient record that asks if Narcan was administered prior to arriving. So I have that, I, I do capture data on it and I'm excited to see how it comes out. I think I think putting a a treatment option, right, right. In the places where people are choosing to do this.
[00:25:11] You know, can only be a positive thing, right? So across the nation, there are maybe about a dozen EMS services that are doing what, what are called leave behinds. And they've had just crazy success with it. [inaudible] fourth EMS service in the state that's doing an actual Narcan leave behind. And I would guess that based on.
[00:25:35] The initial data that's coming back. If that holds you'll see this grow dramatically because you know, I mean everywhere USA is trying to solve this problem.
[00:25:44] Mike: Yeah.
[00:25:45] Nick: Everywhere USA. And so. Getting like-minded people in a room and talking about, Hey, look, we tried, you know, we tried this and it didn't work.
[00:25:54] And we tried this and we had a lot of success with it. And so you can take these ideas and you can kind of hybrid them into your area work out your own legalities and away you go. So you know, just that collaborative effort I think is incredibly helpful and. You know, I'm fortunate to be in a a community that has a pretty strong effort to to deal with overdoses in our, in our community.
[00:26:20] You know, the, the county health folks and the opioids [inaudible] initiative and the coalition are all this is a great thing. These are all collaborative people that are all representing their, their view of it. You know, I mean the big joke is you see an elephant in a room, but you can only see your side of it.
[00:26:38] You can only see part of the leg. So it's very helpful to talk to somebody who is sitting on the other side, who sees the other leg. You know, this is particularly true in because we see this snapshot in time, the police department sees a snapshot You know, and I, I guess maybe I'd always made the assumption that there, there are folks like you behind the scenes trying to, trying to help this out once trying, trying to help this individual out at once.
[00:27:03] We get past the initial hurdle, but I, I don't know that I don't know what happens next. And so the the opportunity to see a bit more of the machine that was working hard for people. It's humbling, honestly.
[00:27:17] Mike: Well, that's a great place to leave it. And, you know, part, part of the reason for having you on Nick is one, it was a part of the story that we hadn't talked about yet, but, you know, second, your photograph, your picture of the issue is not the prettiest one. [laugh]
[00:27:31] You know, when you come on, it's the, it can be the end of the end, but. You know, the passion, the non-judgment the, like, as you said, everybody's human just comes across and I know people thank you a lot, but you know, I'll thank you on behalf of everybody, for you and everybody that you work with for doing your job.
[00:27:51] We appreciate it very much.
[00:27:54] Nick: It, it is absolutely my pleasure to serve. And I would, you know, it's always funny when kids ask me what should I be when I grow up? Always joke with them that you use a Venn diagram and you write what I'm good at what I enjoy and what somebody will pay me to do.
[00:28:10] And right in the center, there is right where you belong in life. And. I'll be honest while I've had some, some difficult ones out there. I've never worked a day in my life. I just love what I do. And I'm very passionate about it.
[00:28:24] Mike: That's great. My Venn diagram included center fueler for a professional baseball team that, that apparently that, that didn't cross any other, other things that I'm good at.
[00:28:34] Nick: [laugh]
[00:28:34] Mike: Well, thank you for being with us and for those of you listening, you know, thank you again for listening.
[00:28:39] Please listen in next time. You know, we're gonna talk about more issues around substance use disorders. We look forward to sharing the air with you then, and until then stay safe. And if you can't stay safe, get the help that is out there and available.
[00:28:52] [END AUDIO]
The Kenosha County Substance Abuse Coalition’s mission is to support networking, encourage education, explore gaps, and realize solutions to improve treatment and reduce alcohol and other drug abuse in our community with a primary focus on families.