♪♪
-Thank you everyone for being here this morning.
We have some exciting people here
that are enthusiastic about what we want to share about the pilot
we've been working on.
As many of you know, our city,
we're very proud of this based on the fine work
of the people standing with me,
to be a national leader in a health focused approach
to combat the crisis that we all know way to well.
And that's the fentanyl crisis.
We're the first city in the country
where fire fighters and EMT's can administer buprenorphine,
which is of course a lifesaving medication
for opioid use disorder.
So far 11 fire fighters,
EMT's and 38 paramedics
have completed the training needed to administer
this medication and it has been administered to,
my earlier note said 47 patients,
but as of yesterday 48 patients,
in the field through the end of November.
This is lifesaving and life correcting work
that we are doing collectively and we are very proud of this.
We realize this is the kind of effort
and the kind of policy
and the investments indeed again to save lives.
This pilot program gives our first responders another tool
to save lives,
bringing treatment and care right to
where people need it most
and reducing the strain on our emergency rooms.
You will hear a little bit more about that
from some of our speakers.
We know that by alleviating a person's
painful withdrawal symptoms,
the program can also create an opportunity
to engage these human beings in a conversation
about treatment services.
Getting them on a path to recovery.
We build relationships with people who are in need of help.
Research has found that administering buprenorphine
after a non-fatal overdose
reduces the risk of another overdose by over 50%.
Research from John Hopkins found
that administering buprenorphine in pre-hospital settings
was associated with a nearly sixfold increase
in the odds of engagement with treatment,
within 30 days of an overdose.
That's why it's so critical to administer this
during these situations.
Following the executive order that I issued in spring of 2023,
the city has been advancing a dual public health
and public safety approach to the fentanyl crisis
through efforts like the Health 99 post-overdose team
and planned post-overdose recovery center,
investments in new mobile medication units
and dedicated detox beds.
Our 2025 budget continues this work
by tripling our investments in public health approaches,
like expanding access to treatment and funding
and additional unit for the Health 99 post-overdose team.
You've heard me say on many occasions
that we don't treat a health crisis
with an arrest public safety strategy.
That we people who are sick and in need with a health approach.
So speaking next is our Secretary of Health,
Dr. Umair Shah. Dr. Shah,
I just want to personally thank him
for his leadership and service to our state,
especially during the COVID-19 pandemic and
vaccination rollout. He is a committed leader
and we are very fortunate to have him in this state
doing this kind of work.
Dr. Shah. Hiding from me, Dr. Shah.
-Thank you Mayor Harrell.
Thank you so much for your leadership
and for your continued dedication to
not just the people of Seattle,
but in this community for everybody involved.
And I just can't say enough about being here today,
with colleagues at this fire station.
It just reminds us of the ever importance
of health and well-being for people
and that is the most important piece of this.
My name is Dr. Umair Shah.
For those that don't know I am the Secretary of Health
for the great state of Washington
and I can tell you from 2018 to 2023,
in just five years, the opioid crisis claimed over 9,000 lives.
Nine thousand people across Washington
who are no longer with us
because of this challenge in our state.
And Mayor Harrell is right to say
that we have to do everything to work together,
to bring people together and to have the policies
and the resources to connect all of those dots
so we can do everything to move things forward.
Our department is grateful
to the incredible counties and fire departments and teams,
for joining the pilot program
and for helping to reach more Washingtonians today.
The expansion today that we're talking about
is not just paramedics,
but also to include EMT's by Seattle Fire,
is such a critical part of this ongoing effort.
As the mayor has said,
this is not just about Seattle and our state leaning forward,
this is also showing a path forward for other communities
across not just our state,
but across the country.
I'm really proud of being part of this effort,
mayor, thank you so much.
As you know the program has the potential
to reduce the burden on our hospitals
that are already concerned
and also the difficulties that emergency services play
as we try to give medications to treat not just opioid addiction,
but opioid use disorder, OUD as it is known.
We know that medications for OUD, such a buprenorphine,
are some of the most effective interventions
to save lives from overdoses
for people across not just our state,
but across the country.
So this pilot aims to really bring the medications
not to have people come to the medications,
but for us to bring the medications to people.
And I can't say enough about Seattle Fire and Chief Scoggins,
whose going to be speaking next, as well as Dr. Sayre and others
who just have been so instrumental in thinking about
how we can move this work forward.
This is one of many efforts and as you know,
Governor Inslee in this administration,
has really made it a priority to recognize
not just behavioral health issues,
but also the real concerns
that we have with opioid use disorder across our state.
It's important for us to continue to work together.
As you also know that I made an announcement recently
that I will be stepping away as the Secretary of Health,
effective January 15th.
And as I leave I look back on this incredible work
that we have accomplished to date,
including our Be Well Washington initiative,
that really reminds us of the importance of
not just the physical health and the nutritional health,
but also the emotional and spiritual health
that all of us as Washingtonians have to be working together on.
And we'll also recognize
that this takes an incredible amount of teamwork
and I can't say enough about our programs
and our teams at the Washington State Department of Health,
who came to me and said,
"This is something we need to be doing."
And I said, "Absolutely we need to be doing this."
Because we have great partners on the ground, thank you mayor.
Thank you to your teams
and also recognizing the absolute importance
of working together as we continue move forward.
So, I did want to just close by saying one other thing which is,
that we have a number of counties across the state
that are engaged in different activities,
but I will tell you that Seattle Fire and Seattle
and King County,
have been leaders that have been recognized across the country.
We want to continue to work with them
to pilot these kinds of programs,
but also recognizing
that ultimately we have to work together.
This is not an issue
that is going to go away immediately or very quickly.
This is an issue that's only going to be addressed
if we work together.
So with that, let me introduce Chief Scoggins.
Thank you.
[ Applause ]
-Well good morning.
My name is Harold Scoggins,
and I'm honored to be the fire chief
of the Seattle Fire Department.
And I'd like to welcome all of you to Fire Station 10.
And just so you know,
this is the busiest station in our system.
Our fire fighters at this station
and all of our stations work extremely hard,
serving the community each and every day.
You know, part of our vision
is we're a national leader in the things
that we do n we do it with excellence.
And what you're seeing today is a bit of that,
this ties into our Medic One program,
which is the first, you know, in the nation.
Our Energy Response team
that we launched just a couple years ago.
And this is another program
that we believe is really going to make a difference.
I'd like to start by welcoming our Washington State Secretary
of Health Dr. Shah, welcome to Fire Station 10,
which is home to our department hazmat team.
You see the vehicle back there.
So we do a lot in our different fire stations.
To Mayor Harrell,
thank you for your continued support
of the Seattle Fire Departments mission,
to provide the best possible care to the community.
And mayor, this really ties in with our One Seattle vision,
because it wasn't one department ta made this happen,
it was many partners around the community
that makes this happen.
As the mayor and secretary mentioned,
we are here today to announce the expansion
of our buprenorphine pilot. In February of this year
we announced ta our fire fighter paramedics,
had approval to begin administering buprenorphine.
And since then the Washington State Department of Health
has authorized the Seattle Fire Department
to expand this pilot to our fire fighter EMT rank,
making us the first in the nation with a program in place
to allow fire fighters EMT's
to administer this medication in the field.
And you need to know that's significant.
I want to personally thank Secretary Shah,
for his leadership
and prioritizing the health of the state
and for providing the Seattle fire department authorization
to expand our lifesaving, by the use of this medicine.
Seattle fire fighters and EMT's and fire fighter
paramedics are responding to on average,
14.2 overdoses every single day.
So it's significant.
As the mayor mentioned,
we currently have 38 fire fighter paramedics
that are trained to give this medication
and now we have 11 fire fighter EMT's,
which are now trained to give this medication,
for a total of 49 in the department.
And we're already seeing a difference.
Through December 9th,
48 patients have been treated by the Seattle fire department
with this medicine, buprenorphine.
And as the mayor mentioned,
our most recent case was just yesterday, given by our EMT's.
So we know it can make a difference.
Three of the 48 doses were administered by EMT's.
High level statistics are important to share,
but so too are the personal impacts
we've seen this medication have on our patients.
I'd like to share a testimonial from the field.
Our post-overdose response unit, Health 99,
responded to an overdose for a young man
with a history of prior overdoses in the past.
Upon assessing the patient and finding him in withdrawal,
Health 99 requested a medic unit.
The fire fighter paramedics arrived
and administered oral buprenorphine.
The patient was subsequently transported to the hospital
for further treatment. Following the response,
Health 99 team coordinated with the provider
and social work team at Harborview,
to remain engaged in the clients care.
That means they reached out,
they followed up
and they wanted to continue the connection point.
The following day,
Health 99 outreached the client in the community
and transported him to a clinic
where he received a substance use disorder evaluation
and a long acting injectable form of buprenorphine.
I think that's about 30 days. So the first dose got him there
and the second dose allowed things to continue to happen.
Thanks to the stability provided by the long acting medication,
the patient was able to secure stable housing
and now secure employment.
That's a difference we want to make.
This is one example of the many
that demonstrate the effectiveness of this medicine
on a person's outcome in life.
The case managers and fire fighter EMT's
who work on our Health 99 unit
are specially trained to deal with scenarios such as this.
And I'd be remiss if I didn't acknowledge, you know,
the team that actually launched the program in the field.
Riley whose here is one of our case managers,
riding on Health 99 on day one
and Lieutenant Roger Webber and Raul Demming.
fire fighter Raul Demming who couldn't be here today.
But when we launched this program,
they were the ones who drove the vehicle out
and responded on the first emergencies.
Since its launch in July of 2023,
the Health 99 post-overdose response unit has responded
752 times in the field.
Of those, 629 were for overdoses.
They've distributed more than 600 doses
of naloxone and leave behind kits to patients,
friends, and bystanders. The work of Health 99 team
is critical to improving the health of those
in our community,
whose struggled with this substance use disorder.
I thank each and every one of our members
who do this highly emotional and taxing work.
We were pleased to see that the additional Health 99
was approved in the 2025/2026 budget.
I want to thank our mayor and the city council,
for your ongoing support.
And next I'd like to introduce Dr. Michael Sayre,
who is a doctor in the emergency room
at Harborview Medical Center.
But most proudly he's our medical director here
in the Seattle fire department.
Dr. Sayre. -Thanks Chief Scoggins.
And I want to echo the thanks to the Secretary of Health,
to Dr. Shah and to the mayor of making this program happen.
But really it's about the crews on Health 99
and the fire fighter paramedics
who are responding to work with these patients every day.
As has already been noted, buprenorphine is a safe
and effective medicine for patients
who are suffering from opioid use disorder.
It works by tightly attaching to brain cells,
to eliminate the cravings that patients experience for fentanyl
or other opioid drugs.
Regular use of buprenorphine cuts deaths in half
among people who are addicted to fentanyl.
A big challenge for people who are using fentanyl
is that they have to take the drug multiple times a day
and that means that getting started on buprenorphine
is tough, because it will cause severe withdrawal.
And that reality is a big barrier to initiating treatment.
Seattle Fire and Medic One EMT's and paramedics
evaluate 10 to 15 patients, as you heard, every day,
who have received naloxone to reverse a fentanyl overdose.
That naloxone commonly causes sudden
and severe opioid withdrawal, with vomiting,
sweating and other symptoms.
Our crews can measure the severity of the withdrawal
just using a simple scoring system,
and if that score suggests
that the patient is in fentanyl withdrawal,
then that's a perfect opportunity
to start buprenorphine,
because the buprenorphine can effectively treat
the withdrawal symptoms.
If the patient agrees to try buprenorphine,
our trained EMT's and paramedics give 16 milligrams,
which is two strips,
under the patients tongue along with a piece of sour candy.
We make sure that they tell us which flavor
they gave the patient,
so that just shows the attention to detail.
And that generates a bit of spit to help dissolve the strip.
That buprenorphine is absorbed rapidly,
travels to the brain through the bloodstream
and then tightly attaches to the brain cells,
kicking off the naloxone and treating the acute withdrawal.
Within five to ten minutes the patients start to feel better.
Our crews then reassess and if necessary give
a third dose of the buprenorphine at that point.
Unfortunately this window of opportunity
to start buprenorphine does not last long.
The naloxone is pretty much gone by 45 to 60 minutes
and that window closes.
So if the EMT's or paramedics
are not able to start buprenorphine treatment,
the patient is usually out of withdrawal
by the time they arrive at the emergency department.
If on the other hand,
patients take just one dose of buprenorphine,
they're protected from overdose for 24 to 48 hours
and we count that as a win.
When patients have the buprenorphine in their system
they're not craving more fentanyl
and a conversation can take place,
about potential for long-term treatment.
And while not everyone will agree to long-term treatment,
some patients as you heard,
are willing to go and get into a treatment program.
We're continuing to work closely
with Public Health Seattle King County,
to measure longer term outcomes for our patients
that have been treated with buprenorphine.
We're confident
that this program will change lives for the better.
Thank you.
And I'd like to introduce Brad Finegood,
from Public Health Seattle King County.
Brad.
-Hello everyone, my names Brad Finegood.
I'm with Public Health Seattle King County.
What you see behind you and in this room today,
is leadership and courage.
Just a huge thanks to Mayor Harrell
whose never wavered in his approach
to treating the overdose epidemic,
leading with a treatment evidence based approach
to be able to help people.
What you're hearing about today
is what is truly a public health approach to our overdose crisis.
What we've attempted to do in partnership
with the whole community, with medical providers,
with treatment providers,
is build out the continuum of services
that are appropriate for people
who are suffering with substance use disorder.
We have bold medical leadership in our community
that has really built out this approach.
As the mayor said,
a number of months ago we were just down the street
at the former DESC
that is soon going to be a post-overdose receiving center.
So when people get started on buprenorphine,
they'll have a place to go. What we've continued to see
is by being able to build out this approach,
this evidence based approach, we will continue to see success.
Just recently earlier this year, the first of this year,
we started our 24/7 buprenorphine hotline
where people can call and get access to medication on demand,
removing barriers.
Since the beginning of the year we've had
over 500 people get started on buprenorphine medication,
just by a phone call.
This is the next step in the continuum
of eliminating barriers,
bringing services closer to people.
So when people are seen in the field
they can get access to lifesaving medication.
And then as Dr. Sayre said, in his anecdote,
then people can be connected to the next level of service.
So on behalf of Public Health Seattle King County,
we greatly appreciate the partnership with the city
and the county,
bringing services like the post-overdose receiving center,
like the crisis services that will be stood up,
the crisis care centers
that will be stood up over the next couple of years
to the individuals of this county
so we can continue to reduce the overdoses
that we've started to see this past year.
Thank you very much.
[ Applause ]
-Do your Q&A. -Okay, yes. Hi, good morning.
My names Jon Ehrenfeld.
I'm the Program Manager for Mobile Integrated Health
with Seattle Fire, I oversee the Health One programs.
And I of course want to echo our deep thanks to Dr. Shah
and the department of health for their approval
and their partnership on this.
Human services department, the mayor's office of course,
for their leadership.
IAFF Local 27
and their membership and Public Health King County,
as well as our many community partners.
We'll shift in just a moment to Q&A,
but I do want to quickly say, you know,
we get asked a lot, you know, "Why EMS?
Why is the fire department in this role,
as opposed to a healthcare organization
that's hospital based, an outreach provider,
a substance use treatment provider?"
And we think the answer is that fire has as certain niche
that it can fill in this crisis. We know where the overdoses are,
we know when they're happening and where they're happening,
we can get there very quickly. As Dr. Sayre mentioned,
there is often a very short window of time
to start this medication
and so Fire EMS is particularly well positioned
to give this first dose of buprenorphine
when clients are in that immediate withdrawal period.
And then from then on, pass it to a partner.
And I think it's very important to think of this program
as one link in a larger chain.
So we talk a lot about cascades of care.
Historically often this area has been very fragmented
and very broken in terms of silos
and I think what we are building now is a larger system
that can really wrap around our clients,
our patients, you know,
and deliver them both the immediate service
that Fire is well positioned to,
as well as longer term services from our partners
in homeless outreach and housing and SUD treatment, et cetera.
It's also a very evidence based program working
with our partners at Harborview
and at Public Health Seattle King County.
We are instituting what we think is a really evidence based
approach to immediate treatment of substance use disorders.
And then you know,
as Brad and Chief Scoggins and Dr. Sayre mentioned, you know,
on the horizon for us is working more with our partners
and with the city in DESC on the proposed overdose center.
We hope soon to be working with the ORCA Center.
We're going to be fielding a new follow-up element in this team,
a case manager who can go out 24 hours after the overdose
and continue that engagement with the patient,
as well as partners, such as Valley City's DESC
and many others working out there.
So I just wanted to reiterate again my thanks
to all of our partners
and also particularly our team members on Health 99,
who are out there in the field
doing this incredibly valuable work on a day-to-day basis.
Thank you. -Thank you Jon.
And thank you our partners at the county,
they mean a lot to us.
They're out in front saving lives
and Dr. Sayre and Dr. Shah,
thank you so much for being with us.
And right now we'll close it out unless there's some questions.
Again, we're very proud of this work
and again I want to double down on our thanks
to the fire department. I sort of screwed up.
I have a coat that the fire department gave me,
I should have worn that coat this morning.
I apologize for that.
But if there are any questions, again thank you for being here.
Yes sir?
-My question is for Dr. Sayre or Dr. Shah,
can you talk a little bit about
how buprenorphine is used in this kind of acute situation
as compared with uses of maintenance medication
that people take daily or weekly for a long period of time?
What is the indication for it?
-Yeah so, basically what we're doing is just getting
them started on the medicine.
And we're giving a pretty high dose to start with,
of 16 milligrams.
Because there's so much fentanyl in many
of these patients systems,
they really need a lot of buprenorphine.
So over time they may continue to need a high dose
and then slowly get it tapered.
Some people really may be on the medicine for years.
It's a bit like having high blood pressure.
You know, you get the high blood pressure
and maybe if you exercise and lose a ton of weight
you might not need medicine anymore,
but most of us aren't that lucky
and you're on medicine for many years.
So I think what we're doing is beginning this journey,
just trying to think about
how we can help patients get on the medicine.
-Thank you. Just a follow-up.
Is the goal to keep them on some kind of --
on this medication on a maintenance basis?
Or is there value in a one-time dose in that setting?
-So we think there's definitely value
in the one-time dose.
So in the sense that it's going to be in the patient's body
for a day and if they use more fentanyl,
they're not going to overdose, because the buprenorphine
will actually protect them from overdose
in addition to reducing the withdrawal cravings.
But, what we really want of course is
for some patients to get into a clinic
and get on long-acting type treatments,
either an injectable form or the strips under the tongue.
-Are you finding a lot of buy in from people
who are overdosing with fentanyl.
I mean I know the stat was 48 people received it.
What kind of buy in did you get from those 48 people
who came in versus how many people kind of said, "I'm good."
-Of course there are many patients that are not ready yet.
Sometimes people overdose accidentally.
They didn't know they had fentanyl mixed in
with their other whatever they were using, cocaine,
methamphetamine, something else.
So they're not truly addicted to fentanyl
and buprenorphine may not really be needed for them.
Other patients, it's maybe they're not quite ready
and one of the real skills that our Health 99
team is developing and one of the reasons
I'm so excited to partner with them,
is they're getting really good at helping the patient get to
"yes" on being willing to accept this medicine.
It's pretty scary.
Imagine, you know,
you're outside and all of a sudden you wake up
and it's raining and you feel terrible
and you really don't know what you're there.
Because you're a regular user of fentanyl,
you've used it hundreds of times
and all of a sudden you're unconscious
and all these people are standing around you in uniforms,
it's pretty scary. Many people just want to bolt.
They just want to run off.
And our teams have developed real good techniques
for helping that patient feel reassured
that we're here to help them and to help them get to
"yes" to take a dose of medicine.
-This might be for Dr. Shah.
What were some of the regulatory and legal hurdles
to getting this approved.
Why is Seattle so far the only department to do this?
-Yeah, and thanks for that.
And Dr. Sayre I just wanted to add one quick thing
to the previous questions which is,
that sometimes these are the first and only opportunities
you have to connect with an individual
who has a substance use disorder.
And so it's really important
for us to then be able to connect them into care
and I think that's a really important piece of this,
is that this is that element oftentimes
that we don't get in the healthcare system.
So what you're seeing here is that notion of
how do we connect in the healthcare system
on a first approach that's happening on the streets
or in a neighborhood or in a community?
As for your question,
I think that has been one of the challenges that we have,
is that we do have for the important reasons,
a number of regulations that come in play
that our team had to work through in order
to be able to provide a pilot program to advance the work.
And what we want to do is really one, to see the effect and also,
and this is why Seattle Fire is such a great leader and partner
in this, to be able to monitor what's happening.
We're obviously working
with Public Health Seattle King County as well.
You already heard from Brad about this,
is how do we continue to see the value proposition here?
As we see that value we now are then comfortable
to being able to approach this with other communities
and other counties.
Now, there is a process that other communities can go through
and they know how to do that.
We've been working with some of, as you know,
paramedics in other communities across the state as well.
But it's really about the regulations that are in place
to be able to protect people
while we're also trying to advance
the innovations that allow us to impact the health and well-being
of people as we will.
And I wanted to, Mayor Harrell I forgot to do this earlier,
I did want to give you a Be Well WA apple.
It's not one to eat,
but it's one to actually squeeze for a little bit of that stress,
because part of that emotional well-being
in spiritual health we have as well.
And I also wanted to thank Lacy Fehrenbach and Kristin Peterson
on both our prevention and policy teams.
Their teams
who many are here who have done such an amazing job, mayor,
to work with our community partners and partners
at Seattle and King County.
And I just want to thank you for your leadership,
your teams and everything you've meant.
This is really an opportunity for us to continue to progress
and advance the work and recognizing
that every single life saved is a life
that can then live for another day tomorrow.
And so we're really appreciative of all your leadership.
-Thank you Dr. Shah, thank you very much.
Thank you very much.
Thank you very much for being here.
Alright, this will conclude our press conference.
Thank you very much. [ Applause ]