Captain Steve Larsen gripped the wheel of the bright red Bellingham Fire Department van, weaving between traffic with sirens blaring. Larsen, a paramedic for more than a decade, was responding in June to another overdose — one of many he had faced in the last few years.
Larsen pulled into a gas station off Northwest Avenue and immediately recognized the patient. The man was a former client he’d supported for several months as part of the Community Paramedic program, newly relocated to downtown as part of the city’s efforts to combat the area’s fentanyl crisis.
The patient was up and walking already, having received several doses of naloxone and a round of CPR from friends. His hands shook and a sheen of sweat clung to his face as he sat in the back of the van while Larsen checked his heart rate and blood oxygen level. Outside, several friends milled about, talking about how blue his face had been just minutes before.
Despite nearly dying from an overdose, he refused transport to the hospital and said he didn’t want to talk to anyone besides Larsen — someone he had gotten to know over the last few months, someone he trusted.
The man had just been released from a three-week stint at a detox facility where he’d been involuntarily admitted. He returned to the same environment, returned to using drugs and immediately overdosed.
After Larsen checked the client’s vitals, the man quickly left, hopping in a family member’s car and speeding away, avoiding further contact with professionals who could send him back into detox.
Larsen’s sadness, mixed with frustration, was evident. The weeks of support he’d provided weren’t enough to combat fentanyl’s grip.
“He has no intention to stop doing what he’s doing and he doesn’t have the capacity or the strength to do that on his own,” Larsen said.
A Cascadia Daily News journalist spent five shifts with Community Paramedic teams to document the impact of the downtown opioid response team, put in place by Bellingham Mayor Kim Lund in February to fight the ongoing drug crisis. CDN is not naming patients who did not agree to be identified.
The teams have a dual focus: supporting the needs of long-term clients and responding to overdoses to support overburdened EMS responders.
Between February and July of this year, the two community paramedic crews have responded to 29 suspected overdoses during shifts that run Monday through Friday, roughly 7 a.m. to 5 p.m. The number reflects times of the day when overdoses are less frequent. Nights and weekends can see spikes in overdoses, but as yet, the program has not expanded to cover those hours. The teams need to operate during business hours to support long-term clients.
Some days are busy — “There was one day where we responded to three in 30 minutes,” Larsen said soberly. Most days are quieter, focused on the clients’ needs and appointments.
Back on the road, Larsen pulled up to a medical clinic to pick up his partner Hadley Prentiss, who’s worked for more than two years as an intensive case manager with Ground-Level Response and Coordinated Engagement (GRACE) of Whatcom County Health and Community Services. In tow was another one of the duo’s clients, Jackie Wood, who’d just finished an appointment, supported by Prentiss.
“What were you up to?” Prentiss asked chirpily as she stepped in the van.
“Stories for later,” Larsen answered quickly.
Prentiss launched into a rundown of Wood’s appointment and what else Wood needed to get done, delaying the debriefing of the other client’s overdose to focus on the needs of the one in the van.
On the ride back to her residence, Wood’s boisterous laugh filled the van as she bantered with Larsen and Prentiss. She shared her opinions of Santa Claus and spicy food, amid conversations with Prentiss about what paperwork needed to be filled out for her care.
Less than an hour had passed and the energy inside the van had completely flipped.
“You got to have short-term memory,” Larsen said about their day-to-day duties, which can include clients’ extreme reactions of pain, joy and chaos. Each interaction requires a specific mindset and attitude, Prentiss said.
Together, Prentiss and Larsen manage as many as 20 clients at a time.
Larsen and Prentiss balance each other with varying skills and temperaments. Larsen provides medical support and physical aid while Prentiss guides clients through complex medical, housing or judicial systems. They provide emotional support as a team, focusing on building relationships and fostering trust to provide quality client care.
Taking on the opioid response
Six months since the program’s move downtown, Mayor Lund said she’s supportive of the teams’ efforts to combat fentanyl overdoses while continuing the work of the city’s long-term mission.
“They’re an essential component of meeting members of our community with high needs where they’re at,” Lund said. “It’s incredibly hard work.”
Lund said the relocation and designation of an opioid response crew followed the fire department’s recommendation, in wake of the March 2023 fatal fentanyl overdose of 15-year-old Emily Halasz. Her death heavily impacted the responders and encouraged conversations about how they could do more for those who suffer from substance use disorder.
The two crews — comprising Larsen and Prentiss, and paramedic Cody Carver with GRACE intensive case manager Nick Rogers — now work beneath the Commercial Street Parking Garage, four floors down from where Halasz first tried fentanyl.
The Community Paramedic program’s goal is to lighten the call load for other emergency medical services by serving as primary overdose responders — and also serving as liaisons, or familiar faces, to those who live on streets and use drugs.
As a whole, the Bellingham Fire Department, which includes Community Paramedic and standard EMS crews, reported being dispatched to 537 suspected overdoses in 2022 and 898 in 2023, according to the data dashboard.
As of Aug. 1, they’ve been dispatched to an additional 509 in 2024. Each call takes close to an hour of the department’s time, EMS Division Chief Scott Ryckman said.
“There’s this little window where they might be interested or able to consider getting into treatment,” said Shannon Boustead, a family medicine doctor who specializes in addiction medicine at Sea Mar. “Which is really why our first responders are so important in potential solutions that are going to be more effective for dealing with this because they’re seeing people in this really vulnerable spot.”
Crews act as bridge to long-term services
The first responders’ new role is a far cry from the roots of the program which began in 2014 with one medic in a minivan.
The decision came from realizing that many people called 911 for non-emergency reasons, but needed support and didn’t know who else to call.
“There’s still a perception that firefighters or somebody in blue is there to be a helper,” Lund said.
If someone calls 911, they expect to get support or an immediate fix to an issue, Carver said, whether emergent or non-emergent.
If a person calls repeatedly, the community paramedics can enroll the client. The team works with the client to create a plan to meet short-term needs to access long-term support, an effort that requires significantly more time than typical paramedic work.
“We act as more of a bridge until we find a reasonable long-term plan for their comfort and care,” said Carver, who’s been in the role since April.
That bridge can mean installing grab bars in a home to reduce falls or fixing a furnace in a home. It might be regular rides to the methadone clinic to fight substance use disorder or support in medical appointments to deal with illnesses.
“We’re not only practicing medicine; we’re practicing problem-solving,” Larsen said.
Clients are typically enrolled for four to six months, until they access more services or can support themselves in “activities of daily living” and stop calling 911 for non-emergency reasons. Since 2018, the program has enrolled 223 people and assisted countless more, Larsen said.
The first community paramedics dealt primarily with the aging and disabled, but quickly realized services were needed beyond just that group in Whatcom County.
“When the pilot program started, we thought it was going to be aging, disability [and] chronic medical patients out in the community,” said Captain Joe Frank, who served as a community paramedic for about five years. “But, it’s just been overshadowed by the amount of homelessness, mental health, substance use interactions.”
Over the years, the program has worked with different organizations, currently GRACE, to supply social workers to help meet increasingly complex needs.
In 2020, a second community paramedic rig was added, expanding the city’s caseload to about 40 clients. A third rig was added to cover the county, operating out of Whatcom County Fire District 7.
The Community Paramedic program is funded via the Medic One Fund, which comes from the countywide EMS Levy, said Melissa Morin, assistant communications director for the City of Bellingham. In 2023, the program cost $575,000.
The need is incessant, deeply personal
Instead of providing care for a few minutes or hours in emergency settings, the crews work with clients week after week through daily activities.
“It pulls a little bit more at my heartstrings,” Larsen said. “Now, I’m getting to know these people. I’ve built a relationship with these people. I know them by face, by name.”
“They genuinely care,” said former client Stephen Graves, who struggles with housing and uses a wheelchair.
With their support, the work becomes personal and more difficult if things go wrong and a system fails or a client falls out of the program or dies, Prentiss said.
“We are able to have a positive relationship with so many of our folks,” Prentiss said. “With that, if we take some heartache and grief, I’ll take that any day of the week. At least they knew we cared.”
The crews face limitations in their capacity to help, restricted by time, staff and resources. Larsen said they know dozens more in the community could benefit from the program.
When asked about potentially expanding, Lund said the work of the community paramedics is vital to the city’s goals of providing support to the citizens with the highest need. She said the city is considering increasing the program’s staffing with a separate opioid response team “as resources are available.” The City of Bellingham is expecting a budget deficit next year.
“No matter our capacity, our community needs the support,” Larsen said. “If we had double the amount of people, there’s work still there.”
Hailey Hoffman is a CDN visual journalist; reach her at haileyhoffman@cascadiadaily.com; 360-922-3090 ext. 103.
