addiction

Episode 7: The Man in the Ambulance

Learn about Shane Hardwick and the Shalom Project, a community-based initiative helping EMTs and police officers get help to those who need it most.

Transcript

(00:00) Phil Lofton:
From the Regenstrief Institute, this is The Problem. The Problem is an anthological podcast dedicated to fighting the hydras of healthcare, those complicated big, hairy issues that impact healthcare on the societal level. Every season you’ll hear about a different big, massive problem and each episode within that season will feature a different discipline or industries take on that problem, how it’s being addressed, how it’s being talked about, and the trials and triumphs of those involved clinically and personally. This season is all about opioids. Over the next few episodes, the problem, we’ll talk about how we local communities, Indiana and the United States got into this crisis, how people suffering from addiction are treated and how the needle can be moved on addiction. This is a podcast for anyone who might be interested in how these problems have developed and are approached. You don’t need a PhD to be affected by them, so you shouldn’t need a PhD to learn more about them. Regenstrief institute is a global leader dedicated to improving health and healthcare through innovations and research and Biomedical Informatics, Health Services, and Aging. Welcome to The Problem.

(01:05) Phil Lofton: 
Hey guys, it’s me, Phil. Today’s episode is about the EMT perspective on the opioid crisis, and it’s largely going to be a conversation between myself and Shane Hardwick, an EMT with Indianapolis EMS and Shepherd Community Center. He’s in a unique position from most EMTs, and you’ll hear why in just a bit. But first things first: Welcome to The Problem.

(01:44) Shane Hardwick:
My name is Shane Hardwick. I’m a community paramedic with Indianapolis EMS.

(01:48) Phil Lofton: 
I met Shane a few weeks ago at the studio for our interview after my boss, John, was gracious enough to connect us. I got the impression at once that he was good with people — great with people, in fact — and he had a confidence that made me think he was exactly the sort of person I’d want taking care of me if I was hurt. It was clear that he loved his job.

(02:07) Shane Hardwick: 
I think being a paramedic is rewarding. No day is the same. I’m not stuck behind a desk. It’s a phenomenal job. You get to do and see some really incredible things.

(02:20) Phil Lofton:
How did you get involved with EMS?

(02:23) Shane Hardwick: 
Oh, well, going back a couple decades, ever since I was a kid I wanted to be a paramedic, and I can actually take it back to when I was leaving detention in fourth grade. I saw a crash happen right in front of me and, and, you know, just seeing the fire trucks and the police cars and the ambulances roll up. It went from chaos to calm just when the people started showing up. So that was something that was always kind of … I just always liked it. So at age 14 I enrolled in an EMT class and by age 16 I was the youngest certified EMT in the nation. Yeah. I had to go before the state commission, and they waived my age because you’re supposed to be 18 and kind of off to the races.

(03:18) Shane Hardwick: 
So I started hanging out in the Wishard ER on the weekends. What teenage kid doesn’t hang out in a level one trauma center on the weekends? But yeah, I’ve always done it. I’ve always loved it. I’ve actually officially been hired and employed for the last 25 years as an EMS professional.

(03:41) Phil Lofton: 
What does a day in the life look like for you?

(03:43) Shane Hardwick:   
Um, I think my day looks a little unique compared to most, EMT/paramedics and the fact that, my deployment is a little different. I’m not on an ambulance. I’m actually assigned to a police officer, so I work in a very, um, high violence, high over-utilization of 911, a lot of need neighborhood on the Indianapolis Near East side and I’m partnered with a police officer and we don’t just attack community paramedic-type stuff, of which the bread and butter is your repeat congestive heart failure patients, your repeat COPD-ers, diabetics, etc. We deal with that. But we also try to just kind of tackle quality of life in the neighborhoods. So we’re just as concerned with the diabetic that keeps calling an ambulance because they can’t get their insulin. We’re just as concerned about that as we are prostitution or illegal dumping and alleys. You know, we try to tackle the whole problem and it’s a… it’s a unique program. It’s actually Shepherd Community Center who spearheads that program. It’s at three years now, and it’s a very rewarding position.

(05:01) Phil Lofton:
I want to talk to you more about this. So it seems like you have a big heart for caring for the whole person. Talk to me more about how the program you’re involved with does that.

(05:13) Shane Hardwick:
So with our program, we use over-utilization of 911 as a symptom of an otherwise larger problem. So if you get the same person going to the hospital over and over and over again, obviously there’s something in the bigger picture that’s being missed. There is some need that’s not being addressed. And we’re kind of the last rung on the ladder, the last layer of the social safety net. So the same thing happens with the stories that you hear about the same person getting Narcan eight, nine, 10 times. And I think what’s different about us is not only do you have a paramedic and a police officer partnered in this area proactively identifying these people, but the back end resources that we have, we, we employ a Shepherd employee, a certified drug counselor, and we’re able to refer back to that counselor and kind of close the loop a little bit.

(06:16) Shane Hardwick: 
There’s more resources. And what we found are people that actually… they have that moment of clarity or “Today’s the day that I need to get clean.” What we don’t want to do is say, well, here’s a pamphlet, go call these people, we’ll have a bed for you in six weeks. So to have this clinical addictions counselor on the back end, he’s able to start working the phones and he’s able to start getting them into different hospitals, different treatment centers. But at the end of the day, we’re building a relationship with these folks, and we’re kind of showing them that someone does actually care about their wellbeing.

(06:59) Phil Lofton: 
What sort of an impact do you think that makes? Do you think that that’s a thing that people get all the time?

(07:04) Shane Hardwick: 
No, I don’t. I don’t think that’s something that people get all the time, and one of the things that I think we’ve become keenly aware of on the job that we have is that loneliness is part of that epidemic. It’s not just the addiction, but you know, what’s the root cause… and to have people that are otherwise strangers that are pouring into these folks’ lives, I think it does have a profound impact. And to know that there’s someone out there that truly cares about you and your wellbeing is, um, that’s a pretty darn empowering thing.

(07:40) Phil Lofton:
You’ve been involved with Shalom for three years now. How did that start? How did you become involved with it? Were you involved from the outset?

Shane Hardwick: 
No, actually it was the most amazing timing ever. I had my former career. I had been an administrator and had taken the last six months off and was a stay at home dad. I worked part time as a paramedic and kinda wanted to get back in because of the tuition reimbursement.

(08:12) Shane Hardwick: 
I kind of wanted to get back into full-time employment through IMS, and so I called called Dr. Miramonti and said, you know, you probably don’t have anything that resembles this but I need 9-5 Monday through Friday, and I’d really like to do outreach and um, “hat in hand,” you know. … And ironically enough, within a week of me darkening his doorstep, he had this meeting with Shepherd and the theory had been born of the Shalom Project and bringing a paramedic on board. So it was amazing timing. Um, and you know, Dr. Miramonti being the cool guy that he is was just like, “You know, I think I got something for you.” I left it at that. So I was kind of in limbo for about a week. And I met with the director of Shepherd, Jay Height, and it was a very eye opening interview with this gentleman where I used to work — the Near East side, years ago — and you know, you have a front row seat to what poverty does to families and the things that human beings are capable of, and after a while you become a little jaded, and you start questioning a lot of things.

(09:32) Shane Hardwick: 
And so I had promised myself pretty early on in my career that I wasn’t going back to this neighborhood. This came up and my curiosity was sparked. So I took the job, and I’m talking with Jay Height on the first day, and he’s painting a very bleak picture that the homicide rate is 200% greater than the average neighborhood, or the average zip code in Indianapolis. Overdoses are over 340% greater in the zip code, nonfatal shootings are 400% greater. The largest demographic we have is single mothers. Thirty-five percent of all houses are abandoned. And you know, I’m just getting peppered with these statistics, and I’ll never forget, he looks out the window and there were some kids playing outside. He just goes, “You see that young man out there?” And I said, “Yeah.” And he says, “His parents tried to sell him for drugs three years ago.” And you know… you hear that and… you’ve maybe heard stories like that before, but to actually see this young man out there playing, I mean, it just works on your heart. And not that one program or one person is going to, you know, knock the dust off the problem as much as it is people coming together in a collaborative effort. And I was hooked. I said this neighborhood needs some help. Somehow.

(10:58) Phil Lofton:
The part of Indianapolis where Shepherd Community is based did need some help. In 2014, the city looked at the neighborhood and found that it had 400% more shootings, 400% more mental health issues, and 300% more overdoses than the rest of the city. In response, Shepherd started the Shalom project, a project centered on three ideas: feeding the hungry, improving housing and Shane’s part, promoting health.

(11:25) Shane Hardwick:
And so it was off to the races after that first day in the car together with my officer partner. I very clearly remember we both agreed on it and said, look, we can’t overpromise and underproduce with this neighborhood. And so that was day one, hour one. We made a promise to each other not to do that. So I think we’ve kept to that. I think we’ve done a pretty solid job of gaining the trust of the residents in the neighborhood.

(11:56) Phil Lofton: 
Can you share with me maybe a story about a time where you felt like you were really, really making a difference with this program?

(12:07) Shane Hardwick: 
We brought our addictions counselor to the emergency room with this girl said enough, 30 years old, raging alcoholic shakes the whole, the whole shooting match and you know, we’re, we’re able to say, hey, you know, and the doctors are like, this is amazing. You did. You do what? I remember one guy that they called 911 and he just, he literally said enough’s enough. And we, we, we backed onto the run and we get there. And the ambulance crews like, well, okay. And he’d called the ambulance to say today’s the day that I want to get clean and we know that he goes to the emergency room, they’re going to sober him up and they’re going to give him a pamphlet and send him on his way. So we get there and we were able to bring our addictions addictions counselor to the scene. Numbers were exchanged the next day. Our addictions guy actually had made phone calls, work the phone that afternoon, was able to get him into rehab the next day, sober him up. He’s able to dig up funding for like a 30 or 60 days sober living.

(13:19) Shane Hardwick: 
So he’s in sober living for 60 days. He comes out, he’s like a totally different human being. Problem is he still lives in the same house, in the same neighborhood that has been a flop house. And so now you’ve got this guy who’s clinging on to sobriety and he’s terrified because people are just showing up at his house at 3:00, 4:00 in the morning.And he can’t seem to get out of that cycle of people just assuming that it’s okay. So we ended up having former addicts that wanted to volunteer their time, actually come to the house. They’d kicked in his door so they were able to put in a new door, a new deadbolt, new frame. And we ended up at the end of the day, Shepherd and their staff ended up helping this guy sell his home. We moved him into another apartment and to this day we’re still engaged with this guy and from start to finish from the day I met him to today, is a totally, totally different human being.

(14:22) Shane Hardwick:
But we were able to come alongside him and we were the only people that were positive influences in his life in years. So, I mean, it’s, it’s, it’s hard and it’s kind of like pick your favorite kid, you know, it’s hard to think of like the, the, the best story to, to, to put a bow on it and say, this is what we do. Addiction. Addiction seems to have no boundaries. It’s not, it’s not, um, socioeconomic. It’s not gender, it’s not race. It seems to be pretty equal opportunity. And so, um, you know, we have just as much. It’s just as impactful when it’s a 22 year old female as opposed to a 65 year old male. It just feels good to be able to kind of come alongside folks in and help them out and say there is a better life out there for you.

(15:25) Shane Hardwick:
I’ll tell you a story. This is kinda just the way our program works because we’re out in the neighborhood. We pulled up on a man that had been stabbed to death in an alley back in July, June or July. And we were the first people there and so we pull up and there’s a man doing CPR on this guy and, you know, hey, thanks, we got it from here. So we started working this guy and, and ultimately he passes away. Fast forward the next day and one of the fire crews in the area calls and says, Hey, we’ve got these people, we’d like you to come help out. They’re, they’re living in the parking lot of a grocery store. So we get over there. We’ve got four adults living in a Ford focus. Yeah. So we got four adults living in a Ford focus. Turns out the guy who lived in the driver seat quite literally was the same guy who was doing CPR on the gentleman the day before. So they had a flat tire. Um, they were trying to make ends meet. They were obviously, they were addicts. And so through some of the connections we made, we were able to make phone calls and say, Hey, this guy’s got a flat tire.

(16:44) Shane Hardwick: 
They’re trying to get wherever we know a tire shop in the neighborhood and you know, it literally was like, Hey, this guy, this guy was a good Samaritan yesterday and helped us out. Is there any way you can help him out? So we were able to get the tire to the tire shop. They replaced it free of charge just because they had done what they did the day before. And so while we’re talking to him, we had a very frank conversation and um, I was um, kind of collectively giving public safety and public of Indianapolis a pat on the back that last year. It seemed like we were giving out Narcan by the gallon and this year we’re just not really seeing it that much and what a great job we’ve done. And obviously someone has stemmed the tide. And um, it was a very sobering comment that the girl I was talking to, she goes, oh, make no mistake about it. It’s not what you’re doing. It’s the fact that the drugs in this town are not good anymore. And it was kind of frightening that basically the potency of the drug wasn’t fatal anymore. It wasn’t killing them. So it’s, it’s, I don’t know, it was, it was a very, it was a very sobering thing to hear from somebody who was like, make no mistake about it. It’s not what you guys are doing. We just can’t find any good drugs. So you hear that and that’s a little disheartening. And I think what you’re going to see is a pretty big uptick in methamphetamines.

(18:16) Phil Lofton:
Why do you say that?

(18:19) Shane Hardwick: 
Without sounding incredibly callous? I think that, and this is just my humble opinion, I think that the cartels realized that they were killing off their loyal customers and I think they switched to something that’s equally as addictive, but the people are still going to be around to throw more money at it.

(18:43) Phil Lofton: 
Can I ask you, this is another one that wasn’t really on our list, but I think it’s relevant given the conversational arc. How do you think we got here?

(18:53) Shane Hardwick:     
Oh man, that’s a good question. I don’t know. I know back in the seventies, from what I’ve heard, it came back from Southeast Asia. Yeah. This go around. I have no idea. I don’t know. There’s a million things you can pin it on, but I really, I’m not going to say it’s because we’re over prescribed. I’m not going to say that. I don’t know. I mean, is it, is it culture? Is it the en vogue thing to do that? I don’t know.

(19:29) Phil Lofton:
It seems like that a lot of the work that you do, it’s about fixing a brokenness in a community that is associated with the overuse of addicting substances. How do you think that we got to the point where that is what our communities are turning to?

(19:49) Shane Hardwick:
It’s a good question and I don’t know, is it hopelessness? Is it that, you know, is it the loneliness component to it? I don’t know. Is it chicken or the egg theory? We have our, our area, we see a lot of folks that were once housewives on the north side that kind of leave everything. We’ve got a couple of those, they leave everything and then they go where the drugs are at. So, you know, we have people that five, 10 years ago were living it up on the north side and living normal lives and now they’re, you know, they’re, they’re out walking the streets and we had a woman that actually flagged us down, showed us the mugshot photo and said she’s wanted, please find her because we know she’ll be safe in jail.

(20:57) Phil Lofton:
So what’s next? If we’re basically out of the worst of it, the absolutely threatening part of it. What’s next? What do we need on the EMT perspective?

(20:59) Shane Hardwick:
I don’t know, because, because I, I think what we see a lot of is you’re exchanging or you’re trading one addiction for the next. And I’ll give you a perfect example. Spice. Synthetic marijuana that in our neighborhood, they’re spraying oven cleaner and bug killer. And it enhances the effects of this synthetic marijuana. We encountered a gentleman one day who was schizophrenic, unmedicated, and he was self medicating with synthetic bug sprayed marijuana. And it was, it was frightening because I said, man, why do you smoke this stuff? And he said, well, because I hear voices all the time and they’re usually telling him pretty unpleasant things. But when he smokes spice, it changes the sound. It’s a more pleasant sound in his head when the voice is talking to him. So I don’t know, I think it’s, they’re usually just trading one addiction for the other. It goes, it goes deeper than just what drug it is, you know, how do we fix that, you know, how do we keep people from not hurting themselves? I don’t know the answer to that.

(22:16) Phil Lofton: 
You are so involved on the front line of this crisis. You are so involved on the rebuilding of communities. What is one or two things that you would want everyone to know about the communities that you’re involved in, about the work that you’re doing about what this crisis is like, that you don’t think that people know or if you think people know, you think maybe they forget.

(22:38) Shane Hardwick: 
Sometimes I’ll tell you what, the neighborhood that we work, there’s a lot of good people, there’s a lot of good people in this neighborhood and it’s very easy to rope and entire community into very few people that are committing x, y, and z crimes. We’re doing x, Y, and z things. Like I said, the number one demographic in our neighborhood are single mothers followed quickly behind senior citizens. Um, but yet we still have, you know, this, this lagging problem with, with crime and crime goes where it’s appropriate. And I can tell you that a fast majority of the people that, that we, that we interact with in the neighborhood are just good people and they’re not drug addicts and they’re not violent criminals.

(23:32) Shane Hardwick:
That’s the one thing that I would say if you’re, if you’re talking about the 10,000 foot view of the neighborhood, is that there’s a lot of good stuff going on in this neighborhood and there’s a lot of people that care. We recently partnered with, Partners In Housing. We recently partnered with a charity that came in and built some new homes in the neighborhood and they couldn’t figure out how to zone it properly because it had been since the 1960’s that anyone had built a residential home in this neighborhood. So, you know, you talk about stemming the tide and changing things in the neighborhood. We’re building new houses and we’re trying to educate children. Shepherd community center has a community center and also has an elementary school and they have kids now from this neighborhood that are in, IU, they’re in Purdue, Notre Dame, Harvard. It’s the empowerment. It’s having people coming into their lives and saying, you know what, you can do anything you want to do. Your life is not defined by just this block.

(24:40) Phil Lofton:
Before we wrap things up, Shane shared something with me.

(24:44) Shane Hardwick:
I’m the luckiest guy I could possibly be. I’ve got a job that I cannot wait to get, to get to work in the morning and do some of the stuff that we do. And it’s always fun to get out first thing in the morning before the school bus runs and see the kids on the sidewalk and, and, um, it kinda reminds you like what we’re here to do. And we delve in some pretty dark places sometimes, but at the end of the day, I think we’re kind of doing the greater good when it comes to just bringing something to the neighborhood that says, we care about you.

(25:22) Phil Lofton:
We know that our social factors can impact our health. We heard that last episode with Shaun. We know that health systems aren’t always designed to treat people’s total needs. We heard that with Andy Chambers and with Ashley Overley and we know from our talk with Carolina and Deb Litzelman that the best possible way to help people effectively is to give them care in a way that makes them feel safe and comfortable. I think about all of that is Shane and I wrap up and I think about the statistics that led Shepherd Community to start the Shalom project. Then I think about the man in the ambulance and I think that if we’ve got people like Shane looking out for our communities, we might be okay in the end.

(26:02) Phil Lofton: 
Music this episode was from Everlone and Broke for Free. Our theme and additional musical cues in this episode were written and performed, as always, by the Apophatic Five.

The Problem is produced at studio 132 in the Regenstrief Institute in Indianapolis, Indiana, where we connect and innovate to provide better care and better health. Learn more about our work and how you can get involved at Regenstrief.org, and see bonus content from this episode, including sources, pictures and more, at theproblem.regenstrief.org.

The Problem is written, hosted, edited and produced by me, Phil Lofton with additional editing by Andi Anibal, John Erickson, and Jen Walker. Web design and graphics are by Andi Anibal, and Social Media Marketing is done by Jen Walker.