As a Madison County EMS, Garrett answers 911 calls and provides emergency medical care en-route to UVA Emergency Department and other local hospitals. After a news story about the Madison County opioid overdose rate and several overdose calls in a short period, Garrett decided to get more involved. Shocked that such a small region could be so affected by opioids, he wanted to see what he could do to help. Together with local partners, Garrett spearheads a project to reduce opioid abuse in Madison County.

I do what I do because I love to help people. All else aside, I love answering the calls and potentially making a difference in other people’s lives, even if it’s a small one.

– Garrett Taylor

Madison County combats high opioid overdose rate with limited resources

Despite its small population, Madison County has one of the highest fatal Fentanyl death rates in Virginia, rivaling many larger, more urban localities.

According to Garrett, Madison County does not have the same infrastructure, resources, and personnel available as most other jurisdictions. Madison County Emergency Medical Services (MEMS) has approximately sixteen full-time employees, including fourteen paramedics and two EMT Intermediates. Staff includes two to three ambulances during the day and one to two medics at night to supplement the volunteers. The team answers 1,000-2,000 calls a year. The County’s geography also poses a challenge; the long stretches of rural roads can impair EMS’s ability to provide fast service.

Garrett enlisted the help of community members and fellow EMS Hayden Pitchford to address these challenges in a community-wide project.

Project aims to reduce Madison County opioid overdoses

The project takes a four-part approach to try to reduce opioid deaths and overdoses in Madison County. This approach includes further distribution of Narcan, community outreach and education, altering the emergency response system, and making education and resources available by ambulance crews.

Garrett describes the project, which he calls “TRT Project” for Teach Respond Train. In his own words:

Distribute Narcan throughout Madison County

“Narcan distribution may save a life while the ambulance is on its way. The first challenge is finding a place to distribute Narcan within the community. While certain large pharmacies give out Narcan for free, there is no such pharmacy in the County. Madison’s only pharmacy is a local pharmacy, Madison Drug. After speaking with the pharmacist and owners, Madison Drug agreed to distribute the Narcan for free if I could provide the supply.

The next step in the process involves securing a supply free of charge before we start advertising the information with the community. I plan to reach out to larger pharmacies and possibly look into grants for a steady supply for Madison Drug.

I also met with Kathy Hatter, from the Virginia Health Department, regarding distribution in the County. The County currently distributes Narcan through the REVIVE program, but the classes are not a regular occurrence. I am working with Ms. Hatter to schedule more classes on distribution; I also plan to take a REVIVE training class.

Together with a local pastor, we will grow church involvement in the project. As a pinnacle foundation and support system to many residents of the county, church involvement will be critical. Through this partnership, we can get Narcan to friends and family of those who may overdose in their presence. At the least, we can publicize precious information to get someone the help they need.

The third area we plan to include in the distribution plan is the local nursing home. We hope to hold a training class there and place Narcan on location. These tactics will better prepare the nursing home in case patients have an adverse reaction to their narcotics or overdose.

Fatal Fentanyl Overdoses by Locality, 2017
Source: Virginia Department of Health, Office of the Chief Medical Examiner

Reach out to the Madison County community

“The second aspect of this project involves direct community outreach. As an initial outreach step, I served on a panel for Madison Strong, a community project that addresses current social issues in Madison County. The Madison Strong panel included a judge, foster mom, former addict, Culpeper detective, and myself. We answered questions from the public and told our stories, why they are important, and the effects they had on us. I spoke of how a single overdose can tie up between 50-100% of our resources. I also spoke about the average time spent on these calls and their impact on first responders.

After the meeting, we gathered great contacts and we hope to form a community coalition to help prevent overdoses. The coalition will involve various community members who are all trying to better the community and fight this problem with their own expertise. To publicize community resources and lifesaving information, we hope to feature a story in the local newspaper and put out a public service announcement. We also hope that the local rescue squad will include an overdose factsheet and emergency response tips with the next outgoing fund drive letters.

Finally, we are working to expand the prescription drug drop-off program with the Madison County Sheriff’s Office. We hope to work with the Sheriff’s Office and do educational outreach with the school. We aim to reach different citizens and to reach as many people as we can.

Reach out to others and work together. This problem is multi-faceted and no one person or expertise is going to solve it. It is going to take the joint efforts of the medical community, social services system, courts, law enforcement, and various other community resources working together.

Alter parts of the Emergency Response System

“One of the largest problems with opioid overdose deaths in Madison County is the extended response times. There are parts of the County where response times are greater than twenty minutes. We hope to alleviate this extended response time issue with a few different solutions.

First, implementing a first responder tone that sends an alert to EMS volunteers out in the field for calls greater than four to five minutes from the station. This alert could enable volunteer rescue squad and fire members to arrive much sooner. We hope they can provide lifesaving interventions including rescue breathing and possibly even Narcan distribution. Furthermore, we hope to involve the state police, who are sometimes at the far ends of the County when a call comes in.

One success so far: our animal control officers agreed to be trained and properly equipped by our department to respond to these calls. They are often in various parts of the County and their response could save twenty crucial minutes.

We hope that altering these aspects of our response system will involve many first responders and will provide earlier intervention and improved lifesaving services.

Distribute literature through ambulance crews

“Every EMT and paramedic class teaches the idea of the ‘teachable moment’. A teachable moment occurs immediately after something harmful has happened; it is when patients are most willing to learn essential lessons. Unfortunately, this moment is often wasted by ambulance crews. When speaking on the panel, I discovered that many family members and patients don’t know how to access the resources they need.

Finally, we hope to distribute a resource packet to households and patients after a call. These packets will include addiction hotlines, local addiction resources, and relevant lifesaving information. We hope that this information will not only prevent overdoses and deaths but will also get people the help they truly need.

Community collaboration makes all the difference

“I would consider this project a great success if we could save even one life. Hopefully, this project will be successful and implemented regionally. Our efforts are not complicated or money intensive—it would be simple for other rural departments to adopt our approach.

Perhaps the biggest takeaway from this is that we need to work together. Any one person or department could never handle a problem this big. I hope that through community involvement, we can make a difference in Madison County and impact as many people as possible.”

To support Garrett’s efforts to combat the opioid crisis in Madison County, volunteer and help spread the word.

Spread the Word

If you are seeking treatment for yourself or for someone else in the Madison County area, contact Rappahannock Rapidan Community Services at 540-825-5656. If someone is in immediate danger, call 911 for emergency services. The Blue Ridge Poison Center, located at the UVA Health System and staffed by Emergency Medicine personnel, can answer questions regarding medication mistakes and the consumption of other substances–the center can be reached at 1-800-222-1222.