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Two weeks after getting her PCP licence she responded to her first overdose

Paramedics have been on the frontlines of the opioid crisis since it began more than five years ago. BCEHS paramedics now regularly respond to more than 100 overdose patients every day in B.C.
Paramedic Michelle Cowan stands in front of a BC Emergency Health Services ambulance
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​Paramedic Michelle Cowan.

For Overdose Awareness Day (August 31), we asked a new paramedic what it was like to attend and care for their first overdose patient. 

Here’s the poignant response of Michelle Cowan, a primary care paramedic currently working at Station 303 in Ashcroft.

How long have you been a paramedic and what inspired you to become an emergency responder?

I was hired in February of this year as an emergency medical responder (EMR) and completed my primary care paramedic (PCP) licensing in June. I am stationed at 303 in Ashcroft. 

Becoming a paramedic has been a pretty drastic mid-life career change for me. I worked for years as an accountant, boring me to tears and bringing me no fulfillment. 

After the birth of my twins in 2014, and some considerable soul searching, I made the choice not to return to the corporate life. I wanted a job where I was making an impact, but really had no idea what that would look like.

After years of saying I wanted a change. I finally took the leap and registered for a last minute EMR course (I registered on a Thursday; class started on the Monday). 

I had no idea what to expect. I was terrified and excited all at once, as this was way outside my comfort zone. I had no grand plan; I was just dipping my toe in the water to see if I wanted to (or could) do this. After the first week I was hooked. I got licensed right away as an EMR, but also registered right away for PCP training.

How long were you on the job before you answered an overdose call?

Two weeks after I received my PCP license, I picked up a couple of coverage night shifts at Station 248 in Vancouver’s Downtown Eastside. I figured if I was going to make a go of this, I had to jump in the deep end. 

Most of my calls on those nights were overdoses, and I became quite proficient with naloxone administration in short order. 

Can you walk us through the experience, from arrival on scene to patient outcome?

My very first call was to the third floor of an SRO, for an unresponsive male. As we pulled up someone was motioning us to the entrance. The street was busy, but most people were paying no attention to our presence, which was very surreal to me. 

It appeared as though this was such a regular occurrence, no one in the vicinity even batted an eye to the fire truck and ambulance on scene. 

My partner and I grabbed our  jump kit and oxygen tank and headed up to assess the patient. Fire first responders had already begun bagging the patient and administered the first dose of naloxone. It was a tight space and not much room to move. 

We quickly assessed and took a BGL (blood glucose level), which was normal. We were getting good air entry so continued bagging for a few minutes before a second dose of naloxone. After the third dose, the patient began to rouse a bit. He started coughing and spit out his OPA (airway breathing tube). The patient continued to cough and heave, so we quickly turned him on his side so he wouldn’t aspirate. 
It took a lot of convincing to have the patient come with us. He was unable to stand or walk on his own, so with the help of firefighters we took him down three flights of stairs on the stair chair to the ambulance and began transport to the hospital. En route the patient became unresponsive again, so a fourth dose of naloxone was administered.

Can you share how the experience impacted you, or your understanding of the overdose crisis?

Before these night shifts, I thought I was well informed about the overdose crisis. That was clearly not the case. 

I knew it was significant but seeing firsthand the exorbitant number of resources from fire, police, paramedics, nurses, and doctors to deal with this during the course of two nights was eye-opening. I don’t know what the solution is, but it is not going to be an easy fix. 

How was responding to an overdose patient different from what you had been taught? Did you feel prepared? 

It is one thing to try and visualize your surroundings during simulation training, and another entirely being immersed in it. 

I felt prepared with the process of what interventions I needed to do, and comfortable with my training and knowledge, but nothing prepares you for some of the locations you find yourself in.

What is something you want to share with the public based on what you experienced, and see, in terms of overdoses?

Something that really struck me and will stay with me are some of the patient stories. 

While a lot of overdose patients get up and take off once they wake up, the ones that didn’t shared tragic stories that brought them to this point of overdose. They have goals, but they feel helpless in their life.

Overcoming addiction is a monumental feat when you have a home and a support system to help. I can’t even fathom the strength and courage it would take for someone without those supports, or living on the streets, to take the steps to get clean. 

They need a massive shift in resources and help, perhaps, long before they get to the point of turning to opiates for their support. 
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