A Day in the Life of the SPFD

District Perspectives, St. Paul City Council Ward 2

The woman next to me brushed tears from her eyes, and stared gloomily ahead as we rushed toward United Hospital.

We were in the back of an ambulance and the woman had just been resuscitated from a near-fatal fentanyl overdose in the bathroom at the Dorothy Day shelter. 

She weepily told us that we should have just left her at the shelter, that when she was released from the hospital, she would have nowhere to go and no one to be with. The St. Paul Fire Department medics were calm, professional and as comforting as they could be as they placed electrodes to monitor her heartbeat and asked her age and medical history. She was 40 years old, I noted – just a year younger than me. 

This was just one of three medical interactions I observed during a three-hour ride-along with the St. Paul Fire Department. I wanted to see up close the issues we talk about in the abstract at our Council policy and budget sessions, and I wanted to understand the challenges our fire crews face every day, how they fit into the overall social safety net that we’re struggling to weave more tightly. 

We toured downtown fire station station #8, just across from the Penfield apartments and the soon-to-be-complete Pedro Park, met the staff and learned about their complicated shift schedule (24-hours every other day for four days, followed by a break). We saw the engines and the ambulances, termed “medic rigs,” and the new equipment we’ve invested in to protect firefighter health, like an industrial-grade washer to remove carcinogens from firefighting uniforms.

The name “Fire Department” is actually a bit antiquated. The department does respond to fires, but the vast majority of its calls today are medical emergencies.All firefighters in St. Paul are either paramedics or EMTs. On our ride along we saw three incidents, all medical. 

In the first, an elderly man who spoke only Korean complained of whole-body pain and light-headedness. The medic crew used Google translate to gather basic information on his symptoms, and transported him to the Regions emergency department. They informed us that he was someone they saw often, that he was staying in a shelter and receiving dialysis. 

Almost immediately after transferring him to Regions, the team jumped back on the ambulance to respond to the second call. This one took us to the Union Depot light rail platform where a young man was experiencing severe fentanyl withdrawal – nausea, pain and profuse sweating. He also had a garish scar under his right leg that had been treated two days ago but wasn’t healing properly. It was clear why – though the hospital had discharged him with a plastic bag full of bandage supplies and ointments, the man had nowhere safe to sleep and heal. 

In addition to fluids and anti-nausea medication through an IV, the medic crew was also able to give this man Suboxone – a drug that makes patients feel well without needing to get high and that blocks the effects of fentanyl so a patient can’t get high even if they tried. Our fire department has been piloting Suboxone since last year at the request of the City Council. It’s a more sustainable approach to fentanyl addiction than Naloxone, or narcan, because it gets patients feeling well enough to accept transport to the hospital and actually consider treatment. 

This man, too, was brought to Regions where we hoped he’d accept a longer-term dose of Suboxone, one that would last 28 days (rather than the 24-hour dose we’d given in the ambulance) and give him a fighting chance to get long-term treatment.

Each call left me full of anxiety and questions. How did these people get into the situations they were in? What would happen to them next? How have we failed them so badly? What can I do to address these failures? And how do our firefighters manage to go from call to call to call, often seeing the same person over and over, while maintaining their composure, their compassion and their hope? 

One of the medics who rode in back with us told us why she’d chosen to be part of the team:she wanted to help people, she liked medicine and she wanted to be a small part of the solution to the much bigger problems she’s seeing. 

“I tell myself that I will be a comforting, compassionate presence for the 20 minutes I’m with someone,” she said. “There are much bigger issues going on in their lives that I can’t address, but I can be kind to them while I’m with them and that is what I do.”

The final call was for a cardiac arrest which turned out to be the woman who had suffered the fentanyl overdose at Dorothy Day. When we reached the hospital emergency department, the medic team would relay the woman’s vital statistics to the attending medical staff while transferring her to the ER’s gurney, sanitizing the one she’d been one, and preparing to answer the next call.