Spice takes toll on Anchorage’s emergency responders

Widespread use of the drug Spice is testing the limits of Anchorage’s emergency response system. With calls for help and emergency transports staying frustratingly high, the drug is exacting a toll not just on users, but paramedics and firefighters, as well.

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Around 10pm on a recent Saturday, Battalion Chief Mark Monfore raced from emergency to emergency across the Municipality as his radio crackled with updates on cardiac arrests, seizures, and car crashes. He turns off the sirens and slows the truck after news comes in that a self-inflicted gun-shot victim has been pronounced dead at the scene.

Monfore’s job is overseeing the Fire Department’s emergency medical services–the paramedics, ambulances, and dispatchers responding to 911 calls on just about every accident and catastrophe you can think of, including the wave of spice-related overdoses slamming the city since July. He kept an eye on a screen near the dashboard displaying information on the city’s ambulance fleet.

“Currently, we have two available out of nine,” Monfore said, pointing out which were with patients versus en route or idle. On this particular day, AFD flagged 11 calls as possibly Spice related. That’s about average since this summer, when the Department started keeping track through an internal coding system. On particularly bad days, though, AFD will bring more than 30 patients to the hospital for treatment. The high volume, coupled with extreme medical reactions, is stressing the already taxed emergency response system.

Ian Burness is a 37-year-old fightfighter-paramedic, 11 hours into his 24-hour-shift, seated in a spare conference room at Station One in downtown Anchorage, AFD’s busiest shop.

Buness has a reputation as a work-horse, which he attributes to his upbringing in Wrangell. He’s worked downtown for six years, making him an anomaly: Most new firefighters get stationed downtown, and then move to a calmer post in a different part of the city after a year or two.

“The large majority of our calls are to the homeless population, to the public inebriates, and now certainly over the last six, seven months it has been the spice,” Buness explained.

Compared to alcohol or even heroin, Spice calls are unpredictable. The designer drug is a constantly changing chemical cocktail. Doses vary wildly. It’s cheap, and sold to a vulnerable population. All of which leads to a lot of bad reactions to the drug.

“Initially, they might just seem like they’re high–like they’re on marijuana,” Buness said of a typical patient during a Spice call. “Next thing you know you turn your head and they’re unconscious, they’re seizing, they’re vomiting, basically they’re not breathing anymore.”

To keep people alive, firefighters are performing more dramatic interventions, like field intubations, which were done 24 times between mid-July and October 12th, according to AFD.

But it’s rarely certain if Spice is even the culprit. Someone on scene might say a patient smoked it, but most of the time responders are stuck looking for a murky set of clues and symptoms: Finger-tips with stains or burns, dilated pupils, irregular body temperature, or  a machine-gunning heart-rate.

“I’ve seen it up to 150, 160 on some of these folks,” Buness said.

To hedge their bets, the Fire Department transports cases that might be spice related to hospital emergency rooms, which leads to vastly more work: Loading the ambulance, drive-time, monitoring vitals, writing up a report. Compared to calls on other substances, a basic transport for Spice-use can quadruple the response time.

“Do that math in your head: You’re busy 18 to 20 hours out of those 24,” Buness started. “That means I slept for like two-and-a-half hours total, broken up over three to four different times.”

Of the 5,346 patients across Anchorage brought to the hospital by AFD between July 15th and October 19th, 665 were suspected of having used Spice based on the Department’s criteria, or 12 percent of all transports.

Buness is seeing more work and diminishing morale at Station One. He had his hardest day of work on a recent Sunday when he ran on 22 calls, 18 of which resulted in transports. He recalled 10 to 12 involving “altered mental states.” Afterwards, he turned off all his alarms and collapsed into a spare bedroom at the station.

There’s also a psychological toll stemming from the frustration of responding multiple times to the same person.

“There’s a guy that in 12 hours I personally saw twice, and took to the hospital twice,” Buness said. According to figures from the Department, one individual has been transported on for Spice-related emergencies on 11 separate occasions.

The effects are spread across the emergency response system, though not evenly. Hospitals have also been slammed.

“We’ve definitely seen an increase in the number of people presenting with altered an mental status related to substance abuse, and we presume a certain amount of that is related to the Spice outbreak,” said Dr. Daniel Safranek, who directs the Emergency Unit at Providence Hospital. But it’s still within the boundaries of what his staff are prepared to handle. “It just ads more patients to the mix and that creates some problems.”

Safranek is cautious about not hitting the panic button over Spice. His ER is busy, yes–but it’s always busy.

City leaders, however, call the situation “unsustainable.” That is partly because the services are costly, but also because it’s wearing out first responders–who already face a steady stream of exposure to trauma, according to AFD Assistant Chief Erich Scheunemann, who oversees guys like Buness.

“We’re finally starting to realize that it is a major crisis,” Scheunemann said during an interview, referring to a growing awareness among first-responders nation-wide that years of stacked exposure to trauma can exact a heavy psychological toll. “We’re seeing a lot more suicides in the fire service. It’s just been one of those silent things that’s pushed under the rug and has never been really addressed. If you had issues, you just didn’t bring it up in public around your peers.”

The Fire Department is trying to change that stigma. A group called Alaska Firefighter Peer Support, modeled after a similar program in Illinois, is training fire staff to step in when a colleague is struggling. The Alaska Fire Chiefs Association voted in September to include AKFFPS under it’s non-profit status.

The Anchorage Assembly is set to consider a proposal by the Mayor’s Administration that would criminalize Spice use and possession, which would give law enforcement more tools to build cases against sellers and manufacturers. But as for the ongoing surge in Spice cases, few at the Fire Department see any immediate signs of relief.