CLARK COUNTY — A 2018 initiative by Clark County health officials to respond to cardiac arrest or drug overdose events is getting a boost from a national grant aimed at improving training and expanding services.
Clark County Health Officer Dr. Eric Yazel said the push to ramp up response and awareness of opioid overdoses comes at a time when it’s increasingly needed as the state and country are facing a rise in use.
As of the end of September 2020, there were 159 overdoses reported in Clark County, according to ER data from Clark Memorial Health. That’s compared to 128 in 2019 and 103 in 2018. While some people may have had multiple drugs in their systems, opiates were present in every case, Yazel said.
“We’re on pace to have our highest opiate overdose year in history,” he said.
The $213,000 grant from the National Institutes of Health has recently been announced to help researchers with Indiana University’s Prevention Insights and REAL Prevention, LLC to study, improve and extend the reach of the Pulse Point mobile app. The app alerts citizens crossed-trained in CPR and the administration of the opioid-reversal drug naloxone to respond to public situations where someone may be in need of aid.
The grant is expected to use information from current PulsePoint registrants to target the areas that could benefit from more or standardized training as well as to promote participation among citizens of Boone and Hancock counties. Those two counties — along with Clark — rank highest in the state as users of the Pulse Point mobile app.
Clark County began using the app less than two years ago and is now one of about 4,000 areas in North America to have implemented the mobile app, said Cris Henderson, evaluation specialist and research associate at Prevention Insights. The app was created to respond to cardiac arrests and works in conjunction with local 911 dispatch centers, but Clark County has taken it a step further by including people who may be experiencing drug overdose.
“The unique thing about what Clark County has done is they’ve recoded what it means to receive a call that says ‘unresponsive and not breathing,’” Henderson said. “So yes, it can mean that you’re potentially going to a scene where we have a cardiac arrest occurring or it can also mean that you’re arriving on scene where we could have a potential opioid-related overdose.”
Henderson said that in Clark County citizens have responded roughly 600 times to events where aid is needed, resulting in five people being saved from an opioid overdose.
“It’s been great,” said Yazel. “The rates of CPR and Narcan [naloxone] training have been way up since we had this platform and I think it engages people that might not normally be engaged.”
Training can be done through multiple avenues including the Clark County Health Department, LifeSpring Health Systems, Clark Memorial Health and first responder departments in the area.
Yazel said the engagement has been huge — while the goal was 500 participants for the first year, it’s grown to about 3,000.
“Honestly [that] kind of blew it out of the water,” Yazel said. “We’re doing great and we’d like to increase those numbers.”
He added that he hopes residents will continue to step up as they have by signing up with PulsePoint to help address the issue in Southern Indiana.
“I think it’s given a sense of community,” he said. “People see some of the hard stories from the opiate epidemic and it gives them something to say ‘this is something I can do to at least help.’”
Over the summer, IU researchers reached out to the about 3,000 Clark County residents registered for PulsePoint, to gain insight into how prepared they felt in responding to alerts and administering aid if needed. Evidence gleaned from that showed some felt they needed more training to feel comfortable.
“What we found was that people that have been cross-trained in naloxone and CPR reported a hesitancy,” Henderson said. “They reported feeling less confident to respond to PulsePoint notifications and administer aid.”
Researchers soon will be using that pool to seek 10 to 12 people for formative interviews, information that will be used by the team — including Henderson; Wasantha Jayawardene, assistant research scientist at the IU School of Public Health in Bloomington, and Yazel — to inform decisions on improvements to the initiative.
“It gives us baseline data from people who have been cross-trained and who are using PulsePoint in Clark County already, so it’s going to help us refine training and our recruitment process. It’s a win-win.”
Yazel said he understands why a non-medical citizen responder may have that caution, but hopes the increase can help dispel fear. He added that even if people aren’t comfortable administering aid directly, they can still sign up for the notifications and assist on scene.
“You can run and get an AED, you can call 911, you can flag down an ambulance when it gets there,” Yazel said. “There’s still a role no matter what.”
Carolyn King, member of Clark County CARES, a grassroots organization that helps educate and offer resources for addiction within the community, said she likes the idea of PulsePoint, especially out in the county, although she understands why a person may be reluctant to render aid. She hopes the focus on training can help with that confidence, as numbers show it may be a life-saving service needed more now than ever.
“That’s disconcerting because we had made a lot of progress since 2016 in bringing the numbers down,” King added. “So now they’re heading back up, there’s a good chance that somebody who signs up for pulse point may have to use their skills.”
Yazel said part of the reason for an increase is COVID-19, especially in the early spring, was because programs and services for people with addiction may have been halted or modified due to the state lockdown. There may also have been a loss of structure during that time period, complicated by added economic stress and amplified mental health issues.
He also said there appears to have been an increase in the supply of opioids on the street.
“That waxes and wanes but it seems to be up right now,” Yazel said. “I think all of that kind of created a perfect storm to see this increase.”
He said health officials and community agencies need to double down to respond to the situation, finding creative ways to reach the people experiencing addiction or struggling in their recovery. One such action will be the health department offering free drive-through naloxone training this week.
“In this new environment where you can’t just hold a class for everybody, you have to look for unique touch points,” he said.