TEDWomen 2018
Jan Rader: In the opioid crisis, here's what it takes to save a life
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As a fire chief and first responder, Jan Rader has spent her career saving lives. But when the opioid epidemic hit her town, she realized they needed to take a brand-new approach to life-saving. In this powerful, hopeful talk, Rader shows what it's like on the front lines of this crisis -- and how her community is taking an unusual new approach to treating substance-abuse disorder that starts with listening.
Double-click the English transcript below to play the video.
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For the past 24 years,
I have been a firefighter
I have been a firefighter
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in Huntington, West Virginia.
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As firefighters, my team and I
are tasked with saving lives
are tasked with saving lives
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and property
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from such disasters
as car wrecks, house fires
as car wrecks, house fires
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and also life-threatening
medical emergencies.
medical emergencies.
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I am a woman leading a department
in a male-dominated profession.
in a male-dominated profession.
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And 10 years ago,
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I decided to increase my medical knowledge
and I received a nursing degree.
and I received a nursing degree.
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That was because it became clear
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that the next big threat
facing not only my city,
facing not only my city,
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but other cities around the country,
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was not the one-and-done disaster,
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where you can ride in
like the cavalry, as a firefighter,
like the cavalry, as a firefighter,
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put out the fire and leave,
feeling like you have made a difference
feeling like you have made a difference
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and everything is OK.
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The next big disaster in my city
was and is the long, debilitating
was and is the long, debilitating
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and lethal disaster
known as opioid addiction.
known as opioid addiction.
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We now call this a health epidemic,
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and we have replaced the name "addiction"
with "substance use disorder."
with "substance use disorder."
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To give you some perspective
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of how significant
this epidemic has become,
this epidemic has become,
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in 2017, in my county of 95,000 people,
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we saw 1,831 overdoses
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[and] 183 deaths from overdose.
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This is the job of my firefighters,
as well as other agencies,
as well as other agencies,
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to respond to that.
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(Coughs)
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Excuse me.
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So, watching this epidemic
unfold for several years,
unfold for several years,
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I developed some insight.
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For this disaster, we need to redefine
our job as a first responder.
our job as a first responder.
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We need to be more than just the cavalry.
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We need to do more than just save a life.
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We need to find ways to rebuild that life.
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And it's going to take
a lot of people to do that.
a lot of people to do that.
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And that is exactly
what we are trying to do
what we are trying to do
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in Huntington, West Virginia.
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Now, let me give you some insight
as to what we do.
as to what we do.
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First, this is what happens
when somebody overdoses.
when somebody overdoses.
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Imagine you are somebody who is suffering
from the brain disorder of addiction.
from the brain disorder of addiction.
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You are fragile.
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You're embarrassed, you're ashamed.
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And you overdose.
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Maybe a friend
or a family member calls 911.
or a family member calls 911.
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And then all of a sudden,
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you are awakened by five or six
total strangers in uniform.
total strangers in uniform.
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And they're rubbing your sternum,
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and they're saying, "Wake up, wake up!
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You overdosed, you could've died."
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Now, would you not be defensive and angry?
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Because I know I would be.
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And on top of that,
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those strangers gave you
a dose of naloxone,
a dose of naloxone,
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which has sent you into withdrawals,
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or what is better known
as "dope sickness."
as "dope sickness."
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Dope sickness makes you feel
absolutely horrible.
absolutely horrible.
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Some say it's like the flu, times ten.
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Nausea, vomiting, diarrhea, body aches.
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So not only did we,
as strangers, wake you up,
as strangers, wake you up,
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but we also made you feel really sick.
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So in turn, you, the patient,
are not going to be very kind to us.
are not going to be very kind to us.
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And you're going to refuse
further medical treatment.
further medical treatment.
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OK, well, then that's going to frustrate
the heck out of us,
the heck out of us,
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and we're going to be mad,
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because you're ungrateful
that we just saved your life.
that we just saved your life.
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This is not a good dynamic here.
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What we are dealing with
is a brain disorder
is a brain disorder
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that changes your thinking.
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It convinces you
that you don't have a problem.
that you don't have a problem.
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So, this might have been not only
the first time you've overdosed,
the first time you've overdosed,
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it might have been the third,
fourth or fifth time
fourth or fifth time
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that we, personally, have revived you.
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This is not a good situation.
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Second,
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first responders do not receive
much education
much education
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on what substance use disorder is.
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Neither does the medical community.
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We're not trained how to deal with those
suffering from substance use disorder.
suffering from substance use disorder.
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I am trained to put out
many different types of fires.
many different types of fires.
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I am trained to save a life in the moment.
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But I am not trained to deal
with the intricate interaction
with the intricate interaction
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between first responders,
the health care community,
the health care community,
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social services
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and the wider community that is necessary
to save a life long-term.
to save a life long-term.
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Thirdly,
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and this hits home.
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As a first responder,
I consider myself the cavalry.
I consider myself the cavalry.
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We're knights in shining armor.
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We want to swoop in, do our job
and leave feeling satisfied
and leave feeling satisfied
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that we've made a difference
in somebody's life.
in somebody's life.
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But that just doesn't happen
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when we're dealing with somebody
with substance use disorder.
with substance use disorder.
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We leave feeling frustrated and useless.
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We deal with the same people
over and over again,
over and over again,
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with no positive outcome.
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And you know what?
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At some point, I realized
that it is up to us as first responders
that it is up to us as first responders
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and as a community
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to solve this problem,
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to find better ways to deal
with those that are suffering.
with those that are suffering.
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So what I did is I started
observing more on overdoses.
observing more on overdoses.
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I started talking
and listening to my patients.
and listening to my patients.
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I wanted to know
what led them to where they are.
what led them to where they are.
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What exactly are they experiencing?
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What makes their situation worse?
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What makes their situation better?
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I began experimenting with my words
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and paying attention to my own actions
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and how it affected those of my patients.
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The education that I have received
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and continue to receive
on a street level in Huntington
on a street level in Huntington
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has been both eye-opening
and life-changing for me.
and life-changing for me.
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So, in Huntington, West Virginia,
we have come together as a community,
we have come together as a community,
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and we are changing the way that we treat
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those that suffer
from this horrible disease.
from this horrible disease.
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We have started many programs,
and it's making a difference.
and it's making a difference.
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I'll tell you about just a few of those.
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Last year, we started
a Quick Response Team,
a Quick Response Team,
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QRT for short.
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The team consists of a paramedic,
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a police officer,
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somebody in the recovery community
and somebody in the faith community.
and somebody in the faith community.
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As a team, they go out
and visit people who have overdosed
and visit people who have overdosed
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within 72 hours of that resuscitation.
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They talk.
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They listen.
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They build a rapport with that patient,
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and they offer them treatment options.
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Right now, about 30 percent
or up to 30 percent
or up to 30 percent
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of those that the Quick Response Team
have reached out to
have reached out to
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have accepted some form of help.
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And the wonderful thing about this
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is the first responders
who are involved in this team,
who are involved in this team,
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they actually feel
like they can make a difference.
like they can make a difference.
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Positive change where there wasn't any.
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This year --
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(Applause)
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This year, we opened a free-standing
specialty clinic, called PROACT,
specialty clinic, called PROACT,
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for those suffering
from substance use disorder.
from substance use disorder.
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It's a one-stop shop, if you will.
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A patient comes in,
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they're immediately assessed
by somebody who's an addiction specialist.
by somebody who's an addiction specialist.
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They work with them
to provide treatment options
to provide treatment options
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based on their own needs,
individual needs.
individual needs.
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This does several things for us.
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It gives first responders a place
to either take or refer our patients
to either take or refer our patients
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who are no longer
in a life-threatening situation,
in a life-threatening situation,
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that have refused to go to the hospital.
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And it also clears up
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the overwhelmed emergency rooms
in hospitals that we have.
in hospitals that we have.
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The third thing
that I want to tell you about
that I want to tell you about
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is very dear to me
and very important to my team.
and very important to my team.
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We recently started
a first responders self-care program.
a first responders self-care program.
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More and more ...
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first responders are experiencing
compassion fatigue and PTSD.
compassion fatigue and PTSD.
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It is not uncommon for the average
firefighter in Huntington
firefighter in Huntington
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to deal with or see
up to five young deaths per month.
up to five young deaths per month.
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These are their friends,
these are their classmates.
these are their classmates.
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So this much-needed program
will not only recognize their hard work,
will not only recognize their hard work,
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it's going to give them a voice.
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It's going to provide them with training
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that will help deal with the stress
that they are under.
that they are under.
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And it will give them
more mental-health options
more mental-health options
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that they desperately need.
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We now have yoga classes in fire stations.
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(Laughter)
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(Applause)
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We've also provided on-duty
massages, which is fabulous.
massages, which is fabulous.
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10:34
(Laughter)
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And we have some off-duty programs
that we've started,
that we've started,
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like cooking classes for first responders
and their significant other
and their significant other
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and pottery classes.
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So a couple of months ago,
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I walked out on the apparatus floor,
where I had some firefighters.
where I had some firefighters.
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And half of them had had a massage,
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and the other half were getting
ready to have a massage.
ready to have a massage.
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And I saw 10 firefighters
who were bantering
who were bantering
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in a very positive, relaxed manner.
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And I hadn't seen that in years.
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And that relaxed state is trickling down
to the community, to the citizens.
to the community, to the citizens.
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So a couple of weeks ago,
I had a neighbor overdose.
I had a neighbor overdose.
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Twenty-two years old.
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So of course, I hurried down
to help my firefighters and my neighbor.
to help my firefighters and my neighbor.
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And what I witnessed
was my firefighters being supportive.
was my firefighters being supportive.
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Talking in a non-judgmental way.
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I watched as one of my firefighters
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showed the father
and another family member
and another family member
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how to provide rescue breaths,
should this happen again.
should this happen again.
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And left him with a bag valve mask.
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Positive change.
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Positive change.
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Did I happen to mention
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the two things that firefighters
dislike the most?
dislike the most?
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The way things are and change.
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(Laughter)
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You know, I recognize that there have been
drug epidemics before.
drug epidemics before.
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And I've seen what crack
can do to a community.
can do to a community.
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A lot of our critics think
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that this new compassionate response
that we're doing in Huntington
that we're doing in Huntington
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is because of race.
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That because the overdoses are happening
so much to the white community.
so much to the white community.
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And I understand that criticism,
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because we as a country messed up.
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And we treated black people poorly
during the crack epidemic.
during the crack epidemic.
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We can't forget that.
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And we must do better.
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But right now, what I know
is people are dying.
is people are dying.
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And we in Huntington deal with people
suffering from substance use disorder
suffering from substance use disorder
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of every color and every background,
on the streets, every day.
on the streets, every day.
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The job of a first responder:
prevent unnecessary deaths.
prevent unnecessary deaths.
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Period.
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So ...
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Obviously, I'm a stubborn
firefighter and nurse.
firefighter and nurse.
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And I refuse to believe that there isn't
a way around every barrier.
a way around every barrier.
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One of the barriers that we have
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dealing with the opioid
epidemic is stigma.
epidemic is stigma.
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So ...
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We in Huntington, West Virginia,
are showing the rest of the country
are showing the rest of the country
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that change can happen.
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That there is hope
dealing with this epidemic.
dealing with this epidemic.
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Our current overdoses are down 40 percent.
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(Applause)
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Currently, our overdose deaths
are down 50 percent.
are down 50 percent.
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(Applause)
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This epidemic is far from over.
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But each and every one of us
has a part to play in this epidemic.
has a part to play in this epidemic.
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Just by listening
and being kind to somebody,
and being kind to somebody,
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you have the ability
to make a difference in their lives.
to make a difference in their lives.
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Thank you and God bless.
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(Applause)
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ABOUT THE SPEAKER
Jan Rader - Humanitarian warriorJan Rader is a firefighter and a nurse.
Why you should listen
Jan Rader joined the Huntington, West Virginia, Fire Department in August 1994. Rader is the first woman to reach the rank of chief for a career department in the State of West Virginia. She holds a Regents bachelor of arts degree from Marshall University and an associate's degree of science in nursing from Ohio University. She holds many fire service certifications and is also a fire and EMS instructor in the State of West Virginia.
Since November 2014, Rader has been serving as a member of the Mayor's Office of Drug Control Policy. The purpose of this task force is to address drug addiction in Huntington and the surrounding communities and create a holistic approach involving prevention, treatment and law enforcement. Rader recently came to national prominence after the release of the short documentary Heroin(e) by Netflix in September 2017. In April 2018, she was chosen as one of TIME Magazine's "100 Most Influential People in the World."
Jan Rader | Speaker | TED.com