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Riding With Philly AR-2
A specialized EMS unit wages war on opioid dependence in one of the nation’s hardest-hit battlegrounds.
A specialized EMS unit wages war on opioid dependence in one of the nation’s hardest-hit battlegrounds.
It’s early on a sunny June morning in Philadelphia’s Kensington section and the streets are already alive. The El train thunders overhead, residents stroll and mingle, the air is thick with city life and the drug trade is evident wherever you look. This is the heart of the Philadelphia Badlands—an amorphous section of the city’s industrial section that is notorious for its crime and pervasive narcotics use.
In 2020, 1,214 people died from drug overdose in Philadelphia, according to statistics released by the city in December 2021. This was the second highest number of overdose deaths on record, following 1,217 who died in 2017.
In the national crisis of opioid dependence, Philadelphia ranks near the top, and Kensington is one of the key battle fronts.
“The number of people lost to overdose in 2021 is shocking, and the pain suffered by their loved ones is incalculable. We mourn every one of those lost last year and over the past decade,” said Philadelphia Deputy Health Commissioner Frank Franklin in December 2021.
“I grew up right here in the area,” says Philadelphia Fire Dept. Lt. William Stahl, an Army veteran and former combat engineer team leader, and a paramedic with the Philadelphia Fire Department’s AR-2 unit, specifically commissioned to curb the epidemic of opioid overdoses and deaths. A nearby storefront mural memorializing lives lost to drug addiction features faces that Stahl knew and loved.
But while Stahl is dismayed to see what has happened to friends, neighbors and his childhood home, he’d rather take action to change it than relinquish defeat.
Humble Origins
Philadelphia Fire Department’s AR-2 task force is not your typical team of uniformed EMS providers responding to calls from an unknown location. They are visible. They walk the streets, shake hands, ask about relatives, crack jokes and offer hugs. Everyone knows their names. They grew up here, they know the habits and the hangouts, they breathe the streets and speak the language.
In 2018, Philadelphia Mayor Jim Kenney announced the Philadelphia Resilience Project to combat the opioid crisis. The program, of which AR-2 is a component, is funded through federal SAMHSA and CDC grants administered by the Philadelphia Department of Public Health.
AR-2 hit the streets in April 2019 and engaged 25 people in its first six weeks. It started small—high demand for services quickly prompted the team to add an RV for mobile office space and client comfort items.
Fire Department personnel team with the Philadelphia Department of Behavioral Health and Intellectual Disability Services (DBHIDS) to provide harm reduction programs and linkage to care for people with substance abuse disorders. The objective of AR-2 is to arrive on scene and administer Narcan and any other interventions to patients who have overdosed on opioids. After the patient achieves a normal mental status and has stable vitals, the unit can help facilitate direct placement into drug treatment facilities.
A paramedic and case manager patrol the neighborhood in a marked Fire Department SUV, keeping lines of communication open and offering resources to residents. If a 9-1-1 overdose call comes in, it’s handled via the traditional EMS system, and AR-2 steps in if the individual declines transport to a hospital. AR-2 staff can refer people to a variety of rehabilitation services, including residential treatment when space is available.
The program works because of community connections. Philadelphia’s Rock Ministries, which reaches at-risk inner-city youth through sports, arts, music, recreation, mentoring, Bible studies, addiction support and a food pantry, has a physical location on Kensington Avenue that grew into a defacto second base of operations for AR-2 because of the consistent back-and-forth of people seeking help. Now, it’s a close relationship that works together to send people to resources that will best work for them.
A Day on the Streets
Working AR-2 is not for everyone. One of the regular stops on patrol is what some locals call “Needle Park,” formally designated McPherson Square Park, a grassy urban oasis featuring a public library and playground that has become a haven for open-air drug activity that requires daily needle cleanups and police and EMS patrols to check on people in distress, or dead—including AR-2.
A 2022 article by The Philadelphia Citizen branded McPherson Square Park “the last lifeline of a hurting neighborhood.” Gunshots ring out daily—including the day of EMS World’s visit, prompting an urgent yet well-rehearsed exit from the vicinity.
Tabitha Boyle is a fire paramedic captain for Philadelphia FD. She’s not an imposing figure. She’s not one you’d expect to see patrolling the streets of Kensington in any kind of city uniform. But when the opportunity to serve this neighborhood—just a few miles from her home—presented itself, she jumped at it and hasn't looked back.
“The Fire Department asked how we could contribute,” says Boyle of the early days of the Resilience Project and the formation of AR-2. She approaches the inhabitants of Needle Park with an easy familiarity mixed with calm and purpose, checking pulses, asking questions, and assessing who might need help.
Boyle has community service in her blood—last September she served on a team with Philadelphia’s Medical Reserve Corps to provide medical evaluations and treatment to Afghan evacuees.
If a person recovering from an overdose call—or a person the team speaks with on daily patrols—agrees to desiring assistance, Philly AR-2 springs into action. The person is taken to a waiting RV for a warm handoff that consists of a thorough evaluation, treatment of medical concerns, and referral to whatever residential space is available.
The people the team welcomes are not junkies, addicts, derelicts or criminals—they are friends, neighbors, community figures, even family. They are welcomed, offered coffee and a change of clothes, and most significantly, spoken to with professionalism and respect.
One of the providers they might meet is Barry Stith, a jovial and cheerful EMT for the Philadelphia Fire Department who grew up in this area, loves helping his neighbors in need and thrives on the unpredictable and fast-paced nature of the job. “It’s a way for me to stay connected to the community,” says Stith, who’s a fierce advocate for Narcan leave-behind programs as well as public education and outreach efforts to stem the scourge of drug use that’s taking lives on his streets. “I feel like I’m making a difference out here.”
Expanding the Mission
The word about AR-2 is getting out. Earlier this year, PFD announced a $265,000 grant to AR-2 from the University of Baltimore’s Center for Drug Policy and Prevention.
Specifically, the grant will fund three PFD EMT positions for a year and provide two laptops to improve the treatment acceptance rate among overdose survivors.
Boyle co-authored an article in Prehospital Emergency Care with Philadelphia Fire Dept. Medical Director Crawford Mechem profiling AR-2 and the benefits to costs,
outcomes and 9-1-1 burden. “We want to share our successes with other departments and services,” she says.
It’s a time-worn descriptor of EMS that it’s not a job—it’s a mission. That’s more evident than anywhere on the streets of Philadelphia’s Badlands.
“This assignment is personal for me, because a close family member was once in addiction,” says AR-2 paramedic Tiesha Thomas. “She's been clean now for about 20 years—so I know people can change.”
Thomas, a nursing student, plans to dedicate her career to serving populations in need.
“AR-2 has been very successful and the community has welcomed us. They know who we are and what we do,” she says. “Sometimes we distribute naloxone and just talk to people, letting them know that we see them as human beings and that we do care.”
Jonathan Bassett, MA, NREMT, is editorial director for EMS World.
Comments
I generally enjoy the articles and information in the EMSWORLD magazine. However, the article (Riding with Philly AR-2) really raised some questions. I have been in pre-hospital medicine for over 40 years and have seen this drug problem the whole time. Although it has escalated dramatically in the last few years it is nothing new. I really question the use of limited funds to cater to a group of criminals. Call it what you want but that is what they are. What they are doing is illegal. The very people who want more done are the same ones who want them out of jail, don’t think we should stop the drugs at the border and go soft on the dealers and distributors. How many times do we go to the same person who as overdosed on an (illegal drug) before we say that’s enough? It seems all we have done with these special programs and codling is create more addicts and a bigger problem. Maybe we should be more concerned about the people who are victims of the addicts when they commit crimes to get their drug money. Maybe the money should be used to help them. How many times does someone have to wait for an ambulance because none are available, or are coming from across town because the one that should be there for them is taking an addict to the hospital for the 5th time? How many senior citizens struggle to afford their medication while we hand out Narcan for free? The system seems to be broke.