City tackles first responders’ opioid compassion fatigue

The nationwide opioid crisis keeps first responders hustling to reverse overdoses, resuscitate the unconscious or, in the worst cases, pronounce victims dead. The work carries such a heavy emotional burden for frontline workers that one city set up supportive services to ensure its responders’ can better manage and process the trauma they regularly deal with on the job.

In Huntington, West Virginia, the Compass project gives first responders resources, services and activities to help them sustain their morale, job satisfaction, and physical and mental health. 

In the U.S., Huntington is known as the “epicenter of the opioid epidemic,” said Mayor Stephen Williams at a National League of Cities event earlier this month. He recalled one August day in 2016 when the city’s first responders grappled with 26 overdoses within a 4-hour window. 

But city officials were determined to flip Huntington’s image and become the “epicenter of the solution” to the opioid crisis, he said. The city stocked up on Narcan, cracked down on illicit fentanyl trafficking and ramped up its effort to divert substance users to treatment and recovery. But it wasn’t enough; the city’s efforts didn’t address the strain the crisis had put on its emergency personnel. 

Williams said that constantly being dispatched to treat overdose after overdose was taking a severe physical and mental toll on police and firefighters. “We started hearing [responders] say, ‘Let them die.’”

Ultimately, we had “a problem with compassion fatigue,” he said. 

Compassion fatigue among first responders is “the reduced ability to extend empathy, and it is resulting from frequent exposure to trauma,” said Amy Jefferson, wellness coach at Compass, in an interview with Route Fifty. It’s also referred to as secondary traumatic stress or vicarious trauma. 

Historically, there has been a stigma attached to first responders discussing their mental or emotional struggles while on the job, “so nobody speaks out about it,” she said. That culture can breed personal anguish, as evidenced by the high suicide rates among emergency personnel. And it affects families, as first responders also experience higher divorce rates, Jefferson said.

Plus, first responders can get discouraged by how they are treated by substance users, who sometimes lash out at them, said Austin Sanders, the city’s director of innovation, in an interview. People coming off a high from opioids, for instance, can feel angry or aggravated by a medical intervention and direct their resentment toward first responders at the scene. 

To help emergency personnel maintain their passion for their work, the Compass program offers participants a variety of ways for improving their well-being to ensure they are engaged on the job. 

Through Compass, responders can get, for instance, massage or acupuncture therapy to help them connect with themselves and foster more positive attitudes. The program also offers first responders and their families discounted vacations and classes for cooking or pottery-making.

Additionally, the city opened a First Responder Wellness Center where police officers and firefighters can take advantage of a workout area, a sauna, a yoga studio and a kitchen. Facility staff also offer services like nutrition and fitness coaching. 

The Compass program has two wellness coaches, with Jefferson serving as a mental fitness coach. In her role, she works with police officers and firefighters to help them speak about their experience and struggles. The project has also helped implement a critical incident policy, under which emergency personnel can flag a traumatic event, such as witnessing the death of a child while on the scene, and get mental health support to help them work through how they were impacted by it. 

The policy exists “to normalize talking about [trauma],” she said. It’s not a technical debriefing, where first responders are evaluated for their job performance or receive formal feedback. “It gives them an open environment to just say, ‘Man, that was tough.’” 

Jefferson also helps connect first responders to the right therapist so they can access the mental health services that can best help them. “I’ve met with these therapists personally and talk to them face to face. I want to make sure that if [responders] reach out after a critical incident or anytime, then I’m going to be matching them with someone that is hopefully going to be a good fit.” 

Program leaders are currently working on offering personnel six to eight months of free therapy services, depending on funding, Sanders said.

The other wellness coach, Amy Hanshaw, focuses on physical fitness and often participates in ride-alongs with police and firefighters to observe how they move and navigate the scene. Based on her observations, she can work with responders to decrease risks of injury through improved exercises and training. 

The Compass project is showing positive results. “We saw a 14.5-second faster response rate from fire stations that use Compass versus those that didn’t,” Sanders said. “We estimate that 22 lives are saved within city limits as a result of that faster response rate.” 

Plus, program data showed that self-reported job satisfaction doubled among police and fire personnel participating in Compass compared with those who do not, he added. It also helped improve relationships between first responders and their supervisors, as program leaders saw a 23% increase in employees’ respect for their bosses when they were able to leverage the Compass program. 

The project is an initiative funded by the 2018 Bloomberg Philanthropies’ Mayors Challenge, a competition that aims to encourage the creation of innovative solutions to improve communities. The city received a $1 million grant for the Compass project. 

“We’re in conversations now with a local sheriff’s agency just across the river in Kentucky about them replicating the Compass program,” Sanders said. “Its underlying models can be replicated in nearly any workforce, whether it be public safety, nursing [or] social work.”