"I Don't Know How Much Impact We Can Make": First Responder Perceptions of the System of Care and People Who Use Drugs

Background and Purpose: First responders (i.e., firefighters, emergency medical services [EMS], and police) are well-positioned to prevent recurrent overdoses, as well as improve opioid overdose response. However, behaviors, perceptions, and intentions of first responders in this role and with this profound responsibility remain largely unexplored and unaddressed. To examine first responder perceptions, we conducted a qualitative study with one overarching research question: What are first responders’ lived experiences on the frontlines of the opioid crisis? Answering the question involved inquiry associated with 1) various systems of care (e.g., emergency response; behavioral health; primary care) and 2) individuals who use opioids (i.e., PWUD) with whom first responders engage.

Methods: This qualitative study is part of a large mixed-method and multi-pronged study called First Resource - Bridging Response in Evidence-based Facilitation of Services or simply, FR-BRIEF. Participants were recruited from two major fire companies and one major law enforcement agency in central Arizona (n=17; 8 firefighters and 9 law enforcement). Participants were eligible if they self-reported having engaged with community members who used opioids within the last six months. Each focus group session was audio-recorded, and the audio data were professionally transcribed by a third-party. We employed Sort and Sift, Think and Shift methods to analyze the data. This technique involves a series of diving in and stepping back from the data to unearth stories. To examine the patterns across the three focus groups, a summary of themes derived from the transcripts were created and put into a matrix. A visual mapping of each topic was created and weaved together to convey the overarching story.

Results: Our findings reflect five major themes that capture what can be learned from first responders' interactions with PWUD and the systems within which they work. Clearly, first responders recognized that they operate within a system that is overburdened with need and that the system is not equipped to manage people at all places along a continuum of need (e.g., individuals using for the first time to suicide-intending overdose). Moreover, we learned first responders might not have all of the resources and skills to address the complex needs of community members, especially those who use drugs. Importantly, we found that first responders' feedback was related to community members who do not perceive a "helper" role, which could create cyclical bias. Lastly, we found that many first responders perceived community members as unwilling or unaccepting of services.

Conclusions and Implications: As future research addresses the root of stigma among emergency personnel, it is important to note that professionalism alone will not ensure competent care of PWUD. Creating a means for first responders to witness the possibility for change among community members will be an important step in addressing stigma associated with people who use drugs.