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-Well thank all of you for being here.
We wanted to make sure the door was locked
so we had a captive audience here.
We're very excited about what we're going to describe here
in a little better detail with many of the guest speakers.
I want to acknowledge our friends
from the treatment community for being here.
We hope that the tools we're about to describe
become an asset for you to use.
I also want to recognize leaders in this space.
Council President,
Sarah Nelson and Council member Tanya -- Tanya.
I'm sorry, I was going to say Tanya Kim -- Tonya Woo for here.
In all seriousness, thank you for being here.
We know how passionate this city council is
about addressing the crisis of the day, the crisis of the hour.
The fentanyl and synthetic opioid crisis,
we know what it's doing.
It's killing people on our streets
every single day in our neighborhoods,
and it demands that we have tools,
cutting edge tools at our disposal to save lives,
and that's why we are here today.
A few interesting statistics that we have to face head-on
that our fire department/paramedics responds
more than 100 patients a week;
over 400 patients per month experiencing an overdose.
Last year, following the rapid rise in fatal
and non-fatal overdoses,
you may recall that I issued an executive order
to advance a dual public health
and public safety-focused approach to this issue,
including advancing innovative treatment solutions
to help people access services.
Again, that's why we are here.
One of the actions in the EO
was launching a post-overdose response team pilot
with a goal of responding in real time
to reverse overdose downtown and around our city,
and rapidly connect people
to treatment and recovery resources.
Given the early success of Seattle Fire's Health 99 Unit,
we're now experiencing the expansion of this program
so that the fire department paramedics can administer
buprenorphine in the field
and increase access to this lifesaving medication.
Buprenorphine, which is a word
I always struggle in saying is the generic term
of the medication
and is given to patients
who are treated for an overdose with Naloxone --
I'm not very good at my medical prescriptions.
I can tell you what high blood pressure medicine is
pretty easily. [background laughter]
But in all seriousness,
people are experiencing the painful
opioid withdrawal symptoms.
This works. This is a best practice.
Buprenorphine treatment is evidence-backed
and it's highly effective.
Research has found
that administering this medication after
a non-fatal overdose reduces the risk of another overdose
by 50 percent -- 5-0.
This program will help break the cycle of someone overdosing
and receiving Narcan
and then going right back onto the streets
to seek more opioids
and feeling again the severe pain of withdrawal.
We know what happens when they don't have an alternative
to their symptoms of withdrawal.
So, administering this medication
in a prehospital setting will also reduce the strain
on our emergency rooms.
And you -- we've gotten a lot of coverage
on the impact on our emergency rooms because of this crisis.
So, once again, the early success of the Health 99 unit
shows how the city is creating a supportive,
cohesive, and ecosystem
where people experiencing addiction can get the help
that they need to recover and lead healthier lives.
We believe this new program will complement our
upcoming post-overdose recovery facility of --
which is, of course,
a physical location for people to stabilize
and connect with services.
Again, we realize we are reacting
to a much deeper seeded problem.
And so, this does not certainly diminish the upstream work
that is, indeed, essential as to
why a user finds themselves in this position to begin with.
This allows us to save immediate lives.
Particularly for, again, the most vulnerable people.
This is not an arrest strategy.
This is, indeed, a treatment strategy and a humane strategy.
And we're very proud of, again, the partners in this room;
the partners standing with me to recognize
and validate this approach.
So, having said that,
you're going to hear from Seattle Fire
Chief Harold Scoggins
to speak more in depth about the pilot program.
Chief Scoggins.
[ Applause ]
-Well, good afternoon, everyone.
My name is Harold Scoggins,
the fire chief of the Seattle Fire Department.
I also want to echo some thanks to
our mayor for your ongoing support
of the Seattle Fire Department and all the things
that we really get out there and try to do.
For our council president --
Council President Nelson, thank you for being here today.
And Council Member Woo,
we really appreciate your support in being here today.
You know, it's accurate to say that likely,
every one of our thousand firefighters out there
has responded to an overdose.
Every single one.
Just let that sit with you for a second.
That's how significant this challenge is we're facing.
But it wasn't that --
that wasn't the case just a few years ago.
The fentanyl and synthetic opioid
epidemic is challenging us as a nation.
As we have all witnessed, we are seeing the impacts here,
locally in Seattle.
Emergency responders on the front lines of this epidemic,
and sadly respond to overdoses on a daily basis.
Let's take a look at the data.
In 2021,
the Seattle Fire Department responded to an average
of 4.7 overdoses per day.
In 2022 that number went up to 10.3 overdoses every single day.
In 2023 it skyrocketed to 15.4 overdoses every single day.
And so far in 2024 we are tracking at 14.2 overdoses
every single day.
These numbers are inclusive
of all suspected drug overdoses that we face.
That's a real challenge for us here in Seattle.
In July 2023,
we took an intentional step in launching
the Health 99 Post Overdose response unit.
The Health 99 unit is staffed with two firefighter EMTs
and a caseworker that respond to provide follow up
after these overdoses.
Overdose response goes out, Health 99 gets dispatched.
They get on-scene.
Person is revived and brought back.
They try to clear the scene a bit so then they can go to work.
And their work is pretty significant.
What they're doing is,
they're trying to connect with the person
to talk them into getting treatment,
so this doesn't happen again.
Because as you can imagine,
we see the same people over and over again here in community.
Our mobile integrated health program manager will share more
about the unit progress in the first six months.
And now we're gathered here today to announce
the next major initiative by the Seattle Fire Department
to help combat this opioid epidemic.
In late February,
after the Washington State Department of Health approval,
we began a pilot program equipping our paramedics
with the medicine called buprenorphine,
administering buprenorphine in the field
after naloxone overdose to patients,
provides us an opportunity to engage patients
in a conversation about treatment.
It's pretty important to note, overdose happens.
Naloxone is given.
Now we have another tool
that the person doesn't have to worry
about going into withdrawals right at that moment in time,
because now we can give buprenorphine.
And then our Health 99 team can go to work.
And that work is really important.
Most of these patients are transported to Harborview
to the emergency department.
But they're also transported --
they could be transported to the Hobson Clinic or Pathways.
And that's very important.
And like I mentioned earlier, this has just been in play
for just over three weeks, Dr. Sayer?
Just over three weeks. That's important.
So, we've gotten eight people to yes.
So, let me lay this out for you.
Eight people to yes in less than three weeks,
we're in service right now,
Monday through Friday from 9:00 to 7:00.
So, a limited response time,
we've gotten eight people to yes.
Eight people to yes to say, yeah, I want to make a change;
I want to make a difference.
That's why this is so important for our community.
Once a patient receives a dose of buprenorphine
during those hours I mentioned,
our Health 99 really works hard to do case management.
Many times, patients who have received buprenorphine
they're going to be transported to a hospital.
Part of getting them to a yes,
is getting them to the next place they need to be,
so now they can get connected with treatment.
That's why this is so important.
The idea of administering buprenorphine in the field
came from studying other successful programs
around the country from our medical and leadership --
and you're going to hear from Dr. Sayer in a minute --
and from Health One.
Our Health 99 team saw an unmet need.
That's where the idea came from.
It came from our Health One team.
They saw an unmet need after responding to these calls
day after day after day.
They worked with our medical director
to bring this idea to fruition.
And that's what we're here announcing today.
A special mention needs to go out
to our mobile integrated health program manager, Jon Ehrenfeld,
who's here with us today; you'll hear from him.
Our case manager, Riley De Hoog, is here with us today.
And I've got to tell you,
Riley has been on Health 99 every day
since we launched the unit.
And we have members of our Health 99 team,
Lt. Roger Weber is here, and Lt. Leo Castañeda is right here.
These are the members who have been riding, along with others,
who have been on this unit every day.
So, next I'd like to introduce Dr. Michael Sayer,
the Seattle Fire Department Medical Director, Dr. Sayre.
[ Applause ]
-Good afternoon.
I just want to go over a little bit about how this little,
tiny drug, buprenorphine, works.
It works by lowering the cravings
that people have for more fentanyl, and prevent --
and by preventing fentanyl from causing a person
to stop breathing.
Buprenorphine, also known as suboxone,
sticks very tightly to the opioid receptors
inside our brains.
It lasts -- after two of these little strips,
lasts 24 to 48 hours and helps to tide someone over;
give them a chance to do something different.
It causes just enough opioid action to prevent withdrawal.
But because it sticks so tightly to those opioid receptors
in the brain,
it prevents fentanyl from causing any harmful effects.
Like making someone too high or making them stop breathing.
So, it's protective from withdrawal
and protective from overdose; it works both ways.
Naloxone, or Narcan,
is an excellent drug to reverse the effects of fentanyl
in an overdose situation.
But in an overdose reversal,
patients who received enough fentanyl naloxone
to kick some of the fentanyl
off the opioid receptors in the brain,
that works to get the patient breathing again.
But when it's given in a nasal spray,
it takes five minutes to start working,
but the peak effect doesn't occur until about 20 minutes.
And then it lasts only one to two hours after
that nasal spray.
So, it wears off. The person is feeling terrible.
They go out and they use more fentanyl and sometimes they die.
Often though, the patient gets too much naloxone
and then they overshoot.
And when they overshoot, they're in severe opioid withdrawal,
which is quite painful.
We can treat that opioid withdrawal
with our Health 99 team and with our paramedics
by using buprenorphine.
So, that allows us to offer that patient something positive
and engage with them.
And we know that that dose lasts a lot longer
than one to two hours.
It lasts 24 to 48 hours to help prevent death
from subsequent use of fentanyl.
And that allows time
for the patient to connect with additional resources,
whether that's in the emergency department,
or in the clinic,
or if they don't want to go to the hospital,
to have someone come meet with them.
If they do go to the emergency department,
patients can get a prescription for one to two weeks
of more buprenorphine before they then connect to a clinic
where they may be able to get a shot form of the drugs
that lasts for anywhere from one week to four weeks.
So, that really helps to connect them to recovery.
In our initial pilot program,
about 10 paramedics were trained out
of our total workforce of about 60 paramedics.
And our ultimate goal is to extend this
through the whole fire department
and train as many people as want to learn
and are encountering people with overdose.
Our paramedics learned how the buprenorphine works in the body.
They also learned tips and strategies
which were developed by the Health 99 team
for how to engage with these patients successfully.
Next, I'd like to turn this meeting over
to Health and CM Services Director Kim.
Thank you.
[ Applause ]
-Well, good afternoon.
I'm Tanya Kim,
I'm the director of the human services department here
at the city of Seattle.
And I am so privileged
that the Human Services Department gets to partner
with Seattle Fire on this pilot.
Because as you've heard, we will save lives.
The Human Services Department has been partnering
with Seattle Fire since 2011
and we've been providing response to calls related,
typically in the past,
traditionally, with vulnerable, older adults.
But since 2019,
the Mobile Integrated Health Program has been critical
in the partnership not only across the city,
but across the city extending into the community
with our service providers in the county.
We're the connective tissue in some of that space,
and so it's so important that we're partnering
with our colleagues, and some of them,
again, aren't present here today.
On that note, with Health One, we've been able to --
as you've heard multiple times --
respond to the client's needs immediately but post follow up.
The connective tissue is
where then we can do the referrals
for longer term solutions to get folks into recovery
or the path that they choose.
With our case managers, Riley,
and other colleagues from the Human Services Department,
it is so important that we acknowledge the number
of the increase of substance use related calls
because of the opioid crisis.
And we've been able to pivot --
we've been in a really good position
to support this ongoing effort.
With the Human Services Department
we have access also to our aging and disability
services case managers and other resources on hand.
I will say that HSD, in support of this effort,
is providing immediate trauma-informed response
to people experiencing overdose to ensure
that they have safe and lower risk of future overdoses,
and what we're really trying to do here is prevent death.
By combining immediate medical treatment with social services,
again, that's our connective tissue here
at the human services department,
we want to ensure that individuals with substance
use disorder needs have the tools -- various tools --
and this is something
that we're really proud to help bring online.
And so now that I've talked about some of that bridging,
we're going to take it back to Seattle Fire with Jon Ehrenfeld,
who is program manager.
[ Applause ]
-Good afternoon.
I'm Jon Ehrenfeld, I'm the program manager
for Mobile Integrated Health at Seattle Fire.
Connections and warm handoffs
are the gold standard of the Health One Program.
Connections with our firefighters
and our case managers,
connections with housing providers,
community health clinics,
outreach workers in in-home care.
Warm handoffs to specialty teams,
to social workers, to nurses and behavioral health specialists.
Our ability to provide these has been the core of Health One
and the secret of our success.
When we started the Post Overdose Response Team,
or Health 99, last July, it was with a similar mission.
To foster these connections between people
experiencing opioid overdose
and a network of providers and supports.
So, eight months over 250 overdoses
and more than 200 unique clients later,
we have learned a tremendous amount.
How best to build a rapport with people
as they emerge from overdose.
How to understand
and endorse medications for opioid use disorder.
What our client's needs are five minutes, an hour,
or days after an overdose.
What it's really like to wake up on the street
surrounded by strangers.
And we've also learned better how to communicate
that opioid use disorder is not a moral failing
or an expression of criminality,
but rather a medical condition
for which there are medical treatments.
Sadly, we've also learned about many of the challenges
that we face achieving our shared goal.
Overcrowded EDs mean missed opportunities
for our patients to start medications for OUD.
The strained shelter system can leave them on the street.
Few clinical or therapeutic locations exist
that can accommodate them after an overdose.
Few long-term detox or recovery beds are often available.
Many first responders still need more training
on substance use disorders
and how to successfully engage overdose patients.
Polysubstance use, homelessness,
and system fragmentation work against them.
With that said though,
we see glimmers of hope for building out this network.
We advocated for EMS
buprenorphine to start medications
for opioid use disorder immediately
when patients are still in the treatment window.
We have that now
and are seeing promising results just a few weeks in.
We advocated for a dedicated space for individuals
who were medically stable after an overdose,
and this is on the horizon.
We are expanding
and strengthening our partnerships with providers
at Harborview, with community health clinics;
and with fellow outreach teams,
building towards a true system of care.
With thanks to stalwart leadership
from City Hall Counsel, from the Fire Department at HSD,
and from our labor partners.
And to our many clinical and social service colleagues,
I'm hopeful of this next period for Health 99
will see greater success;
more clients successfully set on the road to recovery.
[ Applause ]
-Thank you, Jon, that was an outstanding close.
Before I open it up to any questions, again,
I want to thank the people out in the field doing the work.
This is sometimes dangerous work; sometimes unhealthy work,
but work that we have to do, and we signed up for it.
Thank you.
The treatment providers,
thank you again for doing this phenomenal work.
Our partners here at Harborview
and our partners with the county
who have dedicated their professional lives
to this kind of work.
Thank you. Thank you. We're in this together.
And with that,
I'll be more than happy to understand any of the questions?
I'll try to -- I have my experts around me.
I feel confident when I have questions with experts
around me, so if there are any questions?
And if not, I'm going to count us down to three, two...
One Seattle.
Thank you very much.
[ Applause ]