The Chinatown and Japantown portions of the Chinatown–International District in Seattle, as seen from the Columbia Center  • Wikimedia Commons

The Seattle Fire Department (SFD) is expanding its Health One program to include a new pilot overdose response unit as part of Mayor Harrell’s Downtown Activation Plan — an executive order announced in April. The expanded overdose response unit will focus its efforts throughout Seattle’s downtown, including the Chinatown International District (CID), where overdose rates are the highest in the county, according to the King County Medical Examiner’s Office.

At the end of the expanded unit’s three-month trial period, which started in July, the new initiative will be considered for a more permanent role in the Health One program, depending on if there is significant evidence of its effectiveness.

The move comes in response to the county’s increasing number of fatalities from drug or alcohol poisoning. A total of 681 fatal overdoses have occurred in 2023 alone, nearly surpassing last year’s total figure of 709.

Health One is “designed to respond to individuals immediately in their moment of need and help them navigate the situation — whether they need medical care, mental health care, shelter or other social services,” reads SFD’s website.

Health One units consist of SFD firefighters and case managers from the Seattle Human Services Department (HSD). These units are dispatched in specialized vehicles equipped with EMS equipment and other outreach items such as food and hygiene supplies.

Although these units are prepared with emergency medical equipment and training, they are not intended to replace traditional EMS units. Instead, their primary role is to provide rapid and mobile non-emergency health services to individuals in need, such as treating minor medical concerns, while also referring them to other resources that can assist them.

“We sit within the fire department with a very broad purview of helping the fire department manage frequent 911 callers,” said Jon Ehrenfeld, the Mobile Integrated Health Program Manager at SFD. “People with chronic illness, people with behavioral health or substance use disorders, people aging in place reported to the state as vulnerable adults, and other folks who generally don’t fit into the traditional EMS model.”

The new overdose response unit will provide the same services as other Health One units, but with a focus on overdose clients exclusively. Its goal, as stated in the Downtown Activation Plan, is to “quickly engage overdose survivors to increase acceptance of services or referrals for support.”

The expanded unit is not the “treatment or the final service destination,” Ehrenfeld said. “We’re more of a bridge or connector.”

Like traditional ambulance services, the unit will respond to overdoses in a first responder capacity through the 911 emergency system, accompanied by sirens and flashing lights. The difference, however, is that once a client is stabilized, a trained case manager can refer them to resources to assist them, such as in-patient detox centers, shelters, and respite care services.

Quynh Pham, Executive Director of Friends of Little Sài Gòn, said that many first responders are disconnected from the patient after the initial point of contact. “How do [patients] stay connected after the one incident that happens?” she asked.

Seattle Fire Department Ladder Truck 6 parked outside the former Naval Reserve Building, South Lake Union, Seattle, Washington during a memorial for Fire Department Battalion Chief David H. Jacobs, Jr • Joe Mabel, Wikimedia Commons

To solve this issue, the overdose response unit will have a follow-up component as well.

“We’re going out and visiting folks who have had an overdose recently, say the last day, two or three, and similarly trying to connect them to resources and figure out what their needs are,” said Ehrenfeld.

The new unit will consist of existing SFD personnel, as there has been no increase in City funding to support the initiative despite its inclusion in Mayor Harrell’s Downtown Activation Plan. It will include one full-time firefighter and one full-time case manager, selected from Health One’s current pool of 25 firefighters and 6 case managers.

One of Health One’s major limitations is its availability. All of its units, including the overdose response unit, currently operate on weekdays in 10-hour shifts starting at 7, 8, or 9 a.m. This scheduling is not expected to change during the trial period.

Ehrenfeld explained how most overdoses that SFD responds to occur between 2 – 10 p.m. This means that there is a 3 to 5-hour period where Health One units are not available during the time when overdoses are most prevalent.

This gap in availability is concerning for groups like the CID Community Watch, who conduct their patrols in the neighborhood to provide supplies to those in need — homeless residents, in particular — while also connecting them to social and health services. The watch conducts its patrols during times when Health One units are not on duty.

“I’ve actually never seen [any Health One units] in the CID,” said Tanya Woo, organizer of the CID Community Watch and a candidate for Seattle City Council, District 2.

This gap results in the exclusive deployment of traditional 911 units to the area, like those from the Seattle Police Department or EMTs, when the watch requests assistance during their patrols. According to Woo, this presents a problem since these dispatches do not operate with the same social and non-emergency health service focus that Health One does.

“Sometimes we don’t need a police officer, but it seems like a police officer is always deployed first,” said Woo. “So sometimes we just don’t call.”

The new overdose response unit on its own might not create much change in the current situation due to its limited scale. That said, when conducted jointly with other services, the additional unit may mark the beginning of a possibly larger and more impactful public safety alternative. Pham suggested the expansion of the Seattle Office of Emergency Management Community Safety Ambassadors (CSA) program in the CID.

“[The ambassadors] can create a more visible presence and welcome neighbors and visitors that come into the neighborhood. They could potentially hand out event flyers or have training to help with mental health crises,” she said.

“Much of what we do is social work, right? It’s slow, and it takes time and often the effects of it are well downstream beyond our ability to directly measure,” added Ehrenfeld.

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