Pubdate: Wed, 25 Jul 2012
Source: Oneida Daily Dispatch (NY)
Copyright: 2012 Oneida Daily Dispatch - a Journal Register Property
Author: Caitlin Traynor and Jolene Cleaver


Many times local ambulance crews are the first at an emergency scene
trying to provide medical care someone high on bath salts.

"It's total chaos," said EMT Bill Vineall.

Vineall, who is owner of Vineall Ambulance and the mayor of Sherrill,
said crew members sometimes find themselves wrestling with individuals
to treat them, or breaking up fights between users and others on the

Lately, Vineall said, emergencies involving bath salts are seen as
"regular calls, not big surprises anymore."

Several week ago, Vineall's crews were dispatched to six bath-salt
related calls in one day. "We are seeing this quite often now," he

The frequent calls strain the system, particularly repeated calls for
the same individual.

"Because the ingredients are changing so rapidly, we really don't even
know how to treat it," he said. "There is no miracle cure."

First responders can only try to determine what reactions the user is
having and alleviate the symptoms.

Six months ago, Vineall would not have even known what to look for.
There still are no field test kits for the drug, but he and his staff
are now able to identify it on sight. "The biggest thing is the
violence," he said.

Symptoms range from violent outbreaks, to hallucinations, paranoia and
drastic spikes in body temperature, sometimes causing users to strip
naked. Vineall has seen cases where individuals think spiders are
coming out of their skin or they chew and claw at their limbs.

"Unfortunately, they are so aggressive that the majority of the time
is spent keeping them under control," Vineall said. The increased
adrenaline combined with hallucinations and anxiety give them "super

Vineall said it's not uncommon for individuals who weigh 140 to 150
pounds to require eight to 10 adults to restrain them. He's even seen
people run into traffic. As much as people read about the wild side of
bath salt usage, Vineall said there are also individuals who become
lethargic and depressed.

Similarly the Oneida Fire Department has seen a surge in bath-salt
calls, averaging about one a day. The members of the 23- man
department are professional firefighters, but are all also certified
EMTs, varying in expertise levels from basic EMTs, critical care,
intermediate to paramedics.

The department's practice has been to send no fewer than three of its
five firefighters on duty to respond to calls dealing with bath salts.
The incidents have varied from persons simply not feeling well to
extreme cases where they attempt to harm themselves or others.

Because users are so frequently unstable, Deputy Chief Rob Cowles said
firefighters don't attempt to interact with them until police are present.

First responders almost always have to treat people without being sure
what drug they ingested. Cowles said users rarely admit to taking the
synthetic drug. Occasionally, it creates such a drastic change in
their system that the reaction scares them enough to divulge that

An essential part of treating people who have ingested bath salts is
to keep them calm, reassure them and avoid startling or upsetting them
or increasing their paranoia level.

The user must be approached in a way that they don't perceive EMTs to
be a threat, but there to help, Cowles said. By establishing a rapport
with the patient, they are more able to ascertain what's wrong.
Firefighters often have to convince users they aren't cops, Cowles
said. Users often act differently around police and may become more
erratic, firefighter Dennis Relyea said.

Classic signs and symptoms for the relatively new drug haven't been
established yet, Cowles said. The OFD has witnessed a range, from
general illness, to rapid heart rates, incoherence and complete

Crews bring the same basic equipment with them when responding to bath
salt incidents as they do to any other medical emergency: a heart
monitor, an airway bag with oxygen, IVs, medication and equipment used
to treat drug overdoses.

"Our job is to treat them like anyone else who doesn't feel good or
was injured," Cowles said.

On June 29, three firefighters dealt with one of the most extreme
cases the department has seen. Responding to a report at the Oneida
Towers on Farrier Avenue that someone wasn't "acting right,"
firefighters Relyea, Scott Burbidge and Deputy Chief Kevin Salerno
could hear a man yelling hysterically inside one of the apartments.
Police were tied up with other emergency calls and couldn't
immediately provide assistance. The three entered cautiously and found
the man pacing rapidly around the apartment and yelling.

"The guy was just tweaking out," Relyea said.

A friend of the man told firefighters he had smoked bath salts about
15 minutes before he called 911. Relyea said the man wasn't hostile
and instead seemed more afraid for his life, thinking he was dying. As
firefighters convinced him he would be OK, they tried administering an
IV but his muscles were tensing and relaxing so rapidly it was
impossible, Relyea said. They gave him oxygen through a mask, which he
ripped off as he became more agitated.

Relyea said the man went over to the window; and the crew thought he
was simply trying to get some air. Instead the man yanked out an air
conditioning unit and tossed it aside as if it were nothing. He backed
away from the window and then ran toward it, attempting to jump. He
was able to get his head, shoulders and upper torso out of the window
before firefighters pulled him back in. Bringing him to the floor,
firefighters, ambulance crews and newlyarrived police struggled to
restrain him. Estimating the man weighed about 150 pounds, Relyea said
the five people trying to control him had a difficult time.

"He manhandled us pretty good," he said.

The man was later transported to the hospital after crews pushed a
narcotic sedative through an IV to control him.

Another recent case called firefighters to South Willow Avenue where a
man high on bath salts was driving a car, swerving in and out of a
line of trees trying to do figure eights, and eventually smashing into
a tree.

The bath salt problem is widespread throughout the city. It crosses
into all economical and social groups, Fire Chief Gregg Myers said.
The department has treated users as young as 16 and as old as 52.

Calling bath salts a "labor intensive" "blight on the community,"
Myers said it's common for nearly a dozen people from different
agencies to respond to a call. These types of emergencies also take up
more time.

"It's creating a huge burden on services," he said, adding that it's
likely costing the department overtime.

Having already responded to more than 1,100 calls for service already
this year, the demand for services is up over last year and with the
recent bath salt trend, Myers expects to break the 2,000 mark.

With a goal of being in service and available 100 percent of the time,
Cowles said the frequency of bath salt-related emergencies is
problematic. Those calls tend to be more time-consuming because the
patient is often unwilling to cooperate and ties up resources. He
estimated calls dealing with bath salts typically take up twice as
much time as a normal emergency call.

Before bath salt usage exploded, Cowles said calls for unintended
reactions to synthetic marijuana were just as prevalent as the newest
fad with three or four calls a day. Users of that drug weren't as
unpredictable or as psychotic as those who use bath salts though,
Relyea said. They often reported feeling unwell and had a rapid heart
rate, but "most of the time they would just lay on the ground in a
ball and puke on themselves and cry."

The public needs to be educated on the effects the drug can have and
that may act as a deterrent, Cowles hopes.

"We've fought the war on drugs for decades and we haven't won yet,"
Cowles said.

"It's this particular type of call that is a burden and a strain on
society," Myers said. "I haven't seen anything that's risen to the top
so quickly."

Bath salts are so new, they're not included in EMT

"It's a whole new ball game for us," said Vincent Faraone, regional
EMS clinical coordinator for Midstate Emergency Medical Services
Council, a regional entity charged with oversight and training for EMS
services in Oneida, Herkimer and Madison counties.

He said the medical community is working together to provide support,
training and information.

Faraone said specific information regarding bath salts was not
included in many EMTs' training because it is so new. EMTs are trained
to handle drug overdoses, "but six months ago, most people didn't even
know what this was."

During continuing education training, Faraone said EMTs are advised to
be careful and keep themselves out of harm's way when dealing with
bath salt users.

"There's something different about this," Faraone said. When someone
is high on cocaine, they are antsy and uptight. If someone is
overdosing on opioids such as Vicodin, they are unconscious. However,
if someone is having a bad reaction to bath salts, they are violent
with incredible strength, hallucinating and irrational.

"None of us understands it," Faraone said. "The best bet is to get
them to a hospital in the safest way possible."

As much as this is unfamiliar territory for EMTs, it is also for 911
centers, often the first agencies alerted to emergencies involving the
use of bath salts. It is dispatchers' critical responsibility to
decipher what's going on and dispatch the appropriate responders. The
outbreak of bath salt usage has posed a particularly difficult
challenge for 911 dispatchers as hallucinations are a common symptom,
clouding the perception of an actual emergency from an imagined one.

In Madison County, the 911 Center has received six to eight calls a
week relating to bath salt usage. The majority of those calls are in
the northern part of the county, but several have been in southern
municipalities, too, said Emergency Communications Center Assistant
Director Mellissa Hannan. In most cases family members, friends or
neighbors are calling out of concern for an individual exhibiting
bizarre behavior.

Callers often report the person is running around aimlessly or taking
their clothes off, Hannan said. Only a few calls have been made
directly from the person high on bath salts. In those instances, it's
almost immediately apparent that bath salts are a factor; the person's
reports are highly paranoid, claiming someone is breaking into is or
her home or an inanimate object is posing a threat.

The Madison County 911 Center handles bath salts calls with existing
drug overdose procedures. Because of the unpredictability of users, as
often as possible, police are dispatched to the scene before EMTs and
rescue crews to provide some protection. Ensuring the safety of first
responders is a top priority, Hannan said. Even if the users aren't
violent when the 911s call are made, in cases where they just aren't
feeling well, they could become spastic at any time, putting EMTs and
firefighters at a huge risk, she said. They've even received calls
from individuals who haven't taken the synthetic drug in weeks but are
still experiencing side effects.

While bath salt-related calls haven't overwhelmed the call center,
there's an obvious increase in their frequency, Hannan said. In turn,
that increase puts a strain on local agencies available to respond to
the calls.

"I've never seen one thing spike so quickly with such force, with such
an impact on the person and such a concern for the behavior it
creates," Hannan said. She has worked at the 911 Center since 1999.
Even methamphetamine, which has been more prevalent in the area in
recent years, has not caused such a problem.
- ---
MAP posted-by: Matt