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October 3, 2022

Interview with Chris Rosa, Deputy EMS Administrator

Tell us about your career with Ventura County EMS:  when did you start, what was your first role and is it different from what you’re doing now?

I was hired as the EMS Deputy Administrator in May of 2010.  Prior to that I was a Paramedic Supervisor with American Medical Response and a volunteer flight paramedic with the Ventura County Sheriff’s Aviation Unit / SAR Medical Team.  In all, I have spent my entire 23-year EMS career here in Ventura County, starting as an EMT with American Medical Response in September of 1999.

It’s been great seeing the EMS system develop from where we were in the late nineties to now.  It makes me feel happy to know that I’ve played a role in helping the system grow and adapt to the changing needs of not only the community, but also to the changing needs of our prehospital personnel.

What year did EMS response begin seeing fentanyl overdoses in Ventura County?

It was 2017, where we began to hear more about fentanyl and other powerful synthetic opioids that were in our communities.  There were anecdotal reports coming to us from prehospital personnel advising that there were situations they were using more naloxone on individual patients.   At the same time, we were seeing and hearing the same types of reports in our opioid task force meetings during briefings from law enforcement and behavioral health leaders.

What was a key indicator that fentanyl was surpassing heroin as the most common street opioid?

The easiest way to tell is the number of repeat naloxone administrations we see by personnel in the field.  In some cases, we are seeing five or six or more administrations, versus prior cases where one or two administrations was enough to bring respirations above 12 per minute – a key threshold for prehospital personnel.

The highest number of administrations that I have seen to date is 15+ doses for a single patient.  Prior to fentanyl being introduced into the community, that situation would be unheard of.  It’s also important to note that this number doesn’t take into account the incidents in which law enforcement or members of the public administered naloxone prior to EMS/Fire arriving on scene.

The graph below highlights the number of incidents in which prehospital personnel administered 3 or more doses of naloxone to a single patient.

What percentage of EMS calls are attributed to overdose response in 2022 vs previous years?

Overall, the number of incidents being dispatched with a call type of overdose/poisoning is relatively low (about 2%) when compared to all other types of incidents.  Also, there are many ODs that are dispatched with a variety of other call types as well (cardiac arrest, altered level of consciousness, behavioral emergency, unknown medical problem, etc.).  It’s also important to remember that due to the nature of emergency medical dispatch protocols and call-types, there are other types of overdoses in this category, in addition to cases of poisoning or accidental ingestions.  This makes it somewhat difficult to determine a true number of opioid overdoses just using call-type alone, which is why we usually try to stick to a more definitive data point related to understanding the opioid problem.  That data point continues to be naloxone administration. Going back to your original question, the number of incidents dispatched with a call type of overdose/poisoning YTD, versus prior years, is outlined below:

With the advent of COAST, what are some elements you have found beneficial that weren’t available prior to the collaboration?

For me, it’s been the increased sharing of information and ideas from one discipline to another.  When we first started, it seemed that everyone in the room knew there was a problem, but nobody really knew what was being done to combat the issue or what resources were available.  Having the ability to get everyone on some sort of common ground - whether it be elected officials, agency heads, or members of the public, is one of the greatest things we can do as a group.  If the folks who are tasked with trying to decrease this trend don’t have a strong understanding of the problem at hand, how are we supposed to educate others on how to do the same?

EMS is saddled with many responsibilities including mass casualty response, natural disaster response, and day to day medical calls.  What are a couple of recommendations you would give the public to prevent opioid/other substance overdose?

I think awareness is so important.  Awareness of resources (COAST dashboard, Naloxone rescue kits, needle exchange sites, BH access line) that are available to any person or family/friend that is dealing with addiction.  Awareness that this problem is not going away anytime soon.  Awareness that there are teams of dedicated professionals doing what they can to help combat these problems and get people the help they need.

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