In the opioid crisis, here's what it takes to save a life | Jan Rader

翻译人员: Xu Xingruo 校对人员: Lipeng Chen

For the past 24 years, I have been a firefighter

我在西弗吉尼亚州享廷顿

in Huntington, West Virginia.

做了24年的消防员。

As firefighters, my team and I are tasked with saving lives

作为消防队员，我和我的团队担负着

and property

从诸如

from such disasters as car wrecks, house fires

车祸或者房屋着火这样的灾难，

and also life-threatening medical emergencies.

以及危及生命的医药事故中 拯救生命和财产的责任。

I am a woman leading a department in a male-dominated profession.

在这个男性主导的行业里，我， 一个女性，领导着一个部门。

And 10 years ago,

十年前，

I decided to increase my medical knowledge and I received a nursing degree.

我决定拓展自己的医疗知识 并考取了护理学位，

That was because it became clear

那是因为我开始清楚地认识到，

that the next big threat facing not only my city,

威胁着我所在的城市

but other cities around the country,

和这个国家的其它城市的，

was not the one-and-done disaster,

不再是那种能一次性解决的灾难，

where you can ride in like the cavalry, as a firefighter,

比方说你作为一个消防队员， 像骑兵一样冲进去，

put out the fire and leave, feeling like you have made a difference

将火灭掉然后转身离开， 感觉自己做出了巨大贡献，

and everything is OK.

一切都将回归正常。

The next big disaster in my city was and is the long, debilitating

我们城市面临的 下一个灾难是持久的、

and lethal disaster known as opioid addiction.

高消耗的，而且破坏性极大， 即阿片类药物成瘾。

We now call this a health epidemic,

我们现在称之为“健康危机”。

and we have replaced the name "addiction" with "substance use disorder."

我们也用“药物使用障碍”来代替“成瘾”。

To give you some perspective

我可以向你们展示

of how significant this epidemic has become,

这场危机已经变得多么的严重。

in 2017, in my county of 95,000 people,

2017年，在我们这个人口9.5万的郡，

we saw 1,831 overdoses

已有1831例的服药过量的案件，

[and] 183 deaths from overdose.

183人死于药物服用过量。

This is the job of my firefighters, as well as other agencies,

我的消防员们和其它机构的工作

to respond to that.

正是要着手处理这些情况。

(Coughs)

（咳嗽声）

Excuse me.

不好意思。

So, watching this epidemic unfold for several years,

所以，在几年里目睹了 这类危机的发生后，

I developed some insight.

我有了一些自己的见解。

For this disaster, we need to redefine our job as a first responder.

在这类危机中，我们需要 重新定义自己作为第一反应人的工作。

We need to be more than just the cavalry.

我们需要做的不仅仅 是像骑兵一样冲锋，

We need to do more than just save a life.

我们需要做的不仅仅 是救出一个生命，

We need to find ways to rebuild that life.

我们还需要找到重塑 那个生命的方法。

And it's going to take a lot of people to do that.

而这将需要多人的努力。

And that is exactly what we are trying to do

这也正是我们在 西弗吉尼亚州的亨廷顿

in Huntington, West Virginia.

尝试着去做的一件事。

Now, let me give you some insight as to what we do.

现在我来说说， 我们是如何处理这些问题的。

First, this is what happens when somebody overdoses.

首先，是过量服用 药物后会发生什么。

Imagine you are somebody who is suffering from the brain disorder of addiction.

想象一下你正饱受上瘾 导致的大脑紊乱之苦，

You are fragile.

你很脆弱，

You're embarrassed, you're ashamed.

你很窘迫，你感到惭愧，

And you overdose.

而且你服药过量。

Maybe a friend or a family member calls 911.

也许一个朋友或家人拔打了911，

And then all of a sudden,

然后突然间，

you are awakened by five or six total strangers in uniform.

你被五六个穿着工作服的陌生人唤醒。

And they're rubbing your sternum,

他们按摩着你的胸骨，

and they're saying, "Wake up, wake up!

并且在喊：“醒醒，快醒醒！

You overdosed, you could've died."

你服药过量了，你差点就死了。”

Now, would you not be defensive and angry?

你难道不会摆出防御姿态 并且感到愤怒吗？

Because I know I would be.

因为我知道我肯定会，

And on top of that,

然后紧接着，

those strangers gave you a dose of naloxone,

这些陌生人会给你来一剂纳洛酮，

which has sent you into withdrawals,

将你带入药物戒断综合征，

or what is better known as "dope sickness."

也就是”戒断不适“。

Dope sickness makes you feel absolutely horrible.

戒断不适会让你感觉非常痛苦，

Some say it's like the flu, times ten.

有人说它的难受程度是流感的十倍，

Nausea, vomiting, diarrhea, body aches.

恶心、呕吐、腹泻、全身酸痛。

So not only did we, as strangers, wake you up,

所以我们这些陌生人不仅把你叫醒，

but we also made you feel really sick.

还让你感到非常的不适。

So in turn, you, the patient, are not going to be very kind to us.

反过来，作为病人的你 也就不会对我们友好。

And you're going to refuse further medical treatment.

你会拒绝接受进一步的治疗，

OK, well, then that's going to frustrate the heck out of us,

然后你对我们的厌恶 会让我们感到沮丧，

and we're going to be mad,

我们会变得抓狂。

because you're ungrateful that we just saved your life.

因为我们救了你的命，你却不领情。

This is not a good dynamic here.

这基本上就是恶性循环。

What we are dealing with is a brain disorder

我们面对的是改变你思维的

that changes your thinking.

大脑紊乱，

It convinces you that you don't have a problem.

它使你相信自己状态良好。

So, this might have been not only the first time you've overdosed,

这可能不是你第一次服药过量，

it might have been the third, fourth or fifth time

有可能这是我们第三、第四

that we, personally, have revived you.

或者第五次唤醒你。

This is not a good situation.

形势不是很好。

Second,

其次，

first responders do not receive much education

第一反应人对于“药物使用障碍”

on what substance use disorder is.

没有多少的认知，

Neither does the medical community.

甚至在医学界也是如此。

We're not trained how to deal with those suffering from substance use disorder.

我们没有接受过如何处理 药物使用障碍的训练。

I am trained to put out many different types of fires.

我接受过扑灭许多 不同类型火灾的训练，

I am trained to save a life in the moment.

我接受过在现场救人的训练，

But I am not trained to deal with the intricate interaction

但我从没有被训练过 如何去处理第一反应人与

between first responders, the health care community,

医疗卫生领域、社会服务 以及对于长远的

social services

拯救一个生命有帮助的

and the wider community that is necessary to save a life long-term.

更广泛的群体之间错综复杂的关系。

Thirdly,

第三点，

and this hits home.

这也是最切中要害的一点。

As a first responder, I consider myself the cavalry.

作为一个第一响应人， 我将自己看作骑兵。

We're knights in shining armor.

我们是盔甲骑士，

We want to swoop in, do our job and leave feeling satisfied

我们想要冲进事发现场，投入工作，

that we've made a difference in somebody's life.

然后因拯救了别人 而心满意足地离开。

But that just doesn't happen

但是当我们面对

when we're dealing with somebody with substance use disorder.

药物使用障碍的病人时却并不能如愿。

We leave feeling frustrated and useless.

我们往往在离开时 感到沮丧和无能为力。

We deal with the same people over and over again,

我们一次又一次的面对同一个病人，

with no positive outcome.

而得不到任何积极的成果。

And you know what?

你知道吗？

At some point, I realized that it is up to us as first responders

在某一刻，我突然意识到 这一切都需要我们

and as a community

作为第一反应人，以及

to solve this problem,

一个团体来解决这个问题，

to find better ways to deal with those that are suffering.

去找到一个更好的方法 来解除他们所受之苦。

So what I did is I started observing more on overdoses.

因此我开始把注意力 更多地放在服药过量上，

I started talking and listening to my patients.

我开始倾听，并跟我的病人交谈，

I wanted to know what led them to where they are.

我想知道是什么导致 他们走到目前的地步。

What exactly are they experiencing?

他们正在经历什么？

What makes their situation worse?

怎样会令他们的情况更糟糕？

What makes their situation better?

怎样会让他们的情况好转？

I began experimenting with my words

我开始斟酌使用不同的字眼，

and paying attention to my own actions

并且留意自己的行为，

and how it affected those of my patients.

来观察它们对我的病人的影响。

The education that I have received

我在亨延顿实地学到

and continue to receive on a street level in Huntington

并且还将继续学习的知识，

has been both eye-opening and life-changing for me.

令我大开眼界，并改变了我的生活。

So, in Huntington, West Virginia, we have come together as a community,

在西弗吉利亚州亨延顿， 我们形成了一个团体，

and we are changing the way that we treat

我们改变了对待

those that suffer from this horrible disease.

饱受这一可怕疾病 困扰的患者的方式。

We have started many programs, and it's making a difference.

我们启动了很多项目， 它们正在发挥作用。

I'll tell you about just a few of those.

让我来讲讲其中的几个。

Last year, we started a Quick Response Team,

去年，我们组建了 一个快速反应小组，

QRT for short.

简称QRT。

The team consists of a paramedic,

这个小组的成员 包括一个护理人员、

a police officer,

一个警察、

somebody in the recovery community and somebody in the faith community.

一个来自康复团体的人员， 以及一个来自宗教团体的人员。

As a team, they go out and visit people who have overdosed

作为一个团队，他们一起 访问那些苏醒后，

within 72 hours of that resuscitation.

在72小时内又服药过量的病人。

They talk.

他们与病人交谈，

They listen.

他们倾听，

They build a rapport with that patient,

他们与病人建立良好的关系，

and they offer them treatment options.

并为他们提供不同的治疗方案。

Right now, about 30 percent or up to 30 percent

目前为止，快速反应小组 接触过的病人中

of those that the Quick Response Team have reached out to

大约有30%已经

have accepted some form of help.

寻求并接受了某些帮助。

And the wonderful thing about this

这件事的美妙之处在于，

is the first responders who are involved in this team,

这个小组中的第一反应人

they actually feel like they can make a difference.

能够真切地感受到 自己做出了贡献。

Positive change where there wasn't any.

这是未曾有过的积极改变。

This year --

今年——

(Applause)

（掌声）

This year, we opened a free-standing specialty clinic, called PROACT,

今年，我们成立了独立的 专科诊所，叫做PROACT，

for those suffering from substance use disorder.

旨在帮助那些为 药物使用障碍所折磨的人。

It's a one-stop shop, if you will.

你可以把它当作一种一站式服务。

A patient comes in,

患者进来，

they're immediately assessed by somebody who's an addiction specialist.

药瘾专家立马会对他们进行检查。

They work with them to provide treatment options

他们向患者提供

based on their own needs, individual needs.

基于患者自身需要的治疗方案。

This does several things for us.

这为我们带来了几项好处。

It gives first responders a place to either take or refer our patients

这使第一反应人能为 已脱离生命危险，

who are no longer in a life-threatening situation,

但又拒绝去医院的患者

that have refused to go to the hospital.

提供一个去处。

And it also clears up

这也能帮当地医院里

the overwhelmed emergency rooms in hospitals that we have.

早已超负荷运转的急诊室减轻压力。

The third thing that I want to tell you about

我想要告诉你们的第三件事

is very dear to me and very important to my team.

对于我和我的团队来说 是非常珍贵，也十分重要的。

We recently started a first responders self-care program.

我们最近开展了 第一反应人的自我调节项目。

More and more ...

第一反应人正越来越多地

first responders are experiencing compassion fatigue and PTSD.

患上“同情疲劳”和创伤后应激障碍。

It is not uncommon for the average firefighter in Huntington

对于亨廷顿的普通消防队员来说，

to deal with or see up to five young deaths per month.

在一个月内眼看着五个年轻生命 逝去，并不是一件稀罕事。

These are their friends, these are their classmates.

那些人是他们的朋友， 是他们的同窗。

So this much-needed program will not only recognize their hard work,

所以对这个项目的需求已经迫在眉睫， 这不仅仅是对他们辛苦工作的认可，

it's going to give them a voice.

还会为他们提供一个发声之地。

It's going to provide them with training

它将为消防员们提供

that will help deal with the stress that they are under.

缓解自身压力的训练；

And it will give them more mental-health options

同时也会为他们提供

that they desperately need.

自身急需的心理治疗方案。

We now have yoga classes in fire stations.

现在我们的消防站里有瑜伽课了。

(Laughter)

（笑声）

(Applause)

（掌声）

We've also provided on-duty massages, which is fabulous.

我们还在工作期间 提供非常棒的按摩。

(Laughter)

（笑声）

And we have some off-duty programs that we've started,

我们还有一些业余项目，

like cooking classes for first responders and their significant other

比如为第一反应人和 他们的爱人开设厨艺课，

and pottery classes.

还有陶艺课。

So a couple of months ago,

几个月前，

I walked out on the apparatus floor, where I had some firefighters.

我走进消防车车库， 那儿有几名消防员。

And half of them had had a massage,

一半的人已经做过了按摩，

and the other half were getting ready to have a massage.

另一半人正在准备去做按摩。

And I saw 10 firefighters who were bantering

我还看见另外10个消防员正以一种

in a very positive, relaxed manner.

积极的、放松的方式相互打趣。

And I hadn't seen that in years.

我好几年都没有看到这个景象了。

And that relaxed state is trickling down to the community, to the citizens.

这种放松的状态正逐渐 蔓延到社区和人们心中去。

So a couple of weeks ago, I had a neighbor overdose.

几个星期前，我的 一个邻居服药过量了。

Twenty-two years old.

他才22岁。

So of course, I hurried down to help my firefighters and my neighbor.

于是我急忙赶去帮助 消防员们和那位邻居。

And what I witnessed was my firefighters being supportive.

我看见消防员们正尽力提供帮助，

Talking in a non-judgmental way.

以一种不带批评色彩的口气说着话。

I watched as one of my firefighters

我看见其中一名消防员

showed the father and another family member

向患者父亲和另一名家属展示

how to provide rescue breaths, should this happen again.

如何在类似情况再次发生时 进行人工呼吸，

And left him with a bag valve mask.

并给了他们一个袋装呼吸面罩。

Positive change.

积极的改变。

Positive change.

正向的改变。

Did I happen to mention

我有没有碰巧提到过

the two things that firefighters dislike the most?

消防员最讨厌的两件事？

The way things are and change.

事物的本来状态，还有改变。

(Laughter)

（笑声）

You know, I recognize that there have been drug epidemics before.

要知道，以前毒品也流行过。

And I've seen what crack can do to a community.

我也知道可卡因会对 社区带来怎样的影响。

A lot of our critics think

很多批评家认为

that this new compassionate response that we're doing in Huntington

我们在亨廷顿做的这种 有人情味的新应急措施

is because of race.

是因为种族问题。

That because the overdoses are happening so much to the white community.

因为目前，吸毒行为在 白人社群里已经屡见不鲜。

And I understand that criticism,

我理解这种批评，

because we as a country messed up.

因为我们的国家得为 不负责任的行为埋单。

And we treated black people poorly during the crack epidemic.

我们曾在可卡因流行时 以很糟糕的方式对待黑人。

We can't forget that.

我们不能忘记这一点。

And we must do better.

我们必须做得更好。

But right now, what I know is people are dying.

但现在，我知道 有人正在死亡的边缘挣扎。

And we in Huntington deal with people suffering from substance use disorder

在亨廷顿，我们随时随地为每一个 受药物使用障碍之苦的人提供帮助，

of every color and every background, on the streets, every day.

不论种族，不论生活背景。

The job of a first responder: prevent unnecessary deaths.

第一反应人的职责在于： 防止不必要的死亡。

Period.

就是这样。

So ...

所以...

Obviously, I'm a stubborn firefighter and nurse.

显而易见，我是个 固执的消防员和护士，

And I refuse to believe that there isn't a way around every barrier.

我拒绝相信“走投无路”这种说法。

One of the barriers that we have

我们在处理阿片类药物危机 遇到的问题之一

dealing with the opioid epidemic is stigma.

是羞耻感。

So ...

所以...

We in Huntington, West Virginia, are showing the rest of the country

在西弗吉尼亚州的亨廷顿， 我们在向全国证明

that change can happen.

改变是可能的。

That there is hope dealing with this epidemic.

在治理毒品蔓延危机时， 希望是存在的。

Our current overdoses are down 40 percent.

现在，我们这儿过量服用 毒品的比率降低了40%。

(Applause)

（掌声）

Currently, our overdose deaths are down 50 percent.

现在，因过量服用药物而 致死的比率降低了50%。

(Applause)

（掌声）

This epidemic is far from over.

这场危机远未结束，

But each and every one of us has a part to play in this epidemic.

但是我们每个人都有义务 在其中尽一份力。

Just by listening and being kind to somebody,

仅是通过倾听和友善待人，

you have the ability to make a difference in their lives.

你就有能力改善别人的生活。

Thank you and God bless.

谢谢，愿上帝保佑你们。

（掌声）

(Applause)