For the doctors and nurses who make up the overnight shift of the emergency room at Saint Francis Healthcare, opioid overdoses are a recurrent reality of the crucial roles they play to combat Delaware's opioid epidemic.
Delaware 105.9 was granted unprecedented access to the emergency room at Saint Francis Healthcare in Wilmington where healthcare professionals stand ready for situations that in mere seconds can mean the difference between life or death, and just 15 minutes after we arrived they sprung into action.
EMS notified staff of a middle-aged man in transport to the department suffering from cardiac arrest caused from a suspected overdose, at which time the entire department began preparations to treat the patient inside the emergency room's trauma wing.
The patient was brought in roughly 5 minutes after the call from paramedics who upon arrival informed Dr. Sandy Gibney, emergency room physician, that the man had consumed eight bags of heroin.
The man was found unconscious inside a home filled with children, according to paramedics who briefed Dr. Gibney as he was transferred from a stretcher to the trauma bed where nurses and technicians wasted no time hooking him up to the equipment that lined the walls of unit.
Roughly 45 minutes after his arrival, the patient was admitted to the Intensive Care Unit (ICU) for further treatment. He exhibited no signs of mental capability as Dr. Gibney and her staff worked to stabilize his condition in the trauma unit.
"We just had a 30-year-old gentleman coming from home, apparently by report of bystanders in the house, he had used eight bags of heroin. There was unknown downtime of being unresponsive, but eventually they did call 911," Dr. Gibney said. "When paramedics arrived, he had no pulse and was not breathing. He was not alert or awake, and they performed some acute resuscitative efforts and began breathing artificially for him, and tried to give him a reversal agent for the heroin without any success."
Dr. Gibney said the patient exhibited ominous signs of a lack of ability to regain brain function.
"He is unresponsive to every stimulus. His pupils are fixed and dilated, which is a very ominous sign of a lack of ability to have a return of cognitive function."
"At this time, it does not look like he is going to regain consciousness this evening, but we will wait and see. We will admit him to the ICU and continue supportive measures. He'll get a scan of his brain just to make sure we aren't missing any trauma or inter-cerebral hemorrhage, but it sounds as if unfortunately his prognosis is grim."
Elizabeth Romero, director of DHSS’ Division of Substance Abuse and Mental Health, encouraged individuals in Delaware to call 911 if they believe someone is overdosing. Under Delaware’s 911/Good Samaritan Law, people who call 911 to report an overdose and the person in medical distress cannot be arrested for low-level drug crimes.
“When someone overdoses from an opioid, naloxone must be administered within minutes,” Romero said. “That’s why it’s so important for people to call 911 immediately. We also urge people to have naloxone on hand if they have a loved one suffering from addiction. Naloxone saves lives.”
Keith Pettiford, engagement specialist with Brandywine Counseling, sits inside the emergency room and waits for doctors to give him the go-ahead to speak with patients who exhibit signs of substance abuse disorder. His job is to talk those patients and help direct them to treatment.
"We try to get a better understanding of what brought them here, so we can understand how we need to best serve them," said Pettiford. "Is it through a detox program or a long-term program. So, it's basically trying to figure out what services would best fit their needs to provide optimal enhancement to recovery."
In Delaware, there have been 106 deaths from suspected overdoses through May 27 of this year, including three since Friday, May 25, according to preliminary reports from the Department of Safety and Homeland Security’s Division of Forensic Science.
In March, the Center for Disease Control and Prevention (CDC) released their Vital Signs report, which examined emergency room visits data in 45 states, visits for suspected opioid overdoses increased 30 percent nationwide from July 2016 to September 2017.
Of the 16 states participating in enhanced data surveillance, Delaware reported the second-highest percent change for suspected opioid overdose emergency room visits during that time period of (105 percent).
Of the 2,075 suspected overdose-related emergency room visits, 1,529 (74 percent) were in New Castle County, 355 (17 percent) in Sussex County and 191 (9 percent) in Kent County.