Lisa Feltz works a shift taking 911 calls at the Public Safety Center in Springfield. (Photo by Jym Wilson)

This story is the first in a Daily Citizen series on the opioid crisis in Springfield and Greene County.

Her lips and fingertips were blue by the time he got to the house on North Grant. The officer knew what to expect just by looking at her. You could always tell by the color, the shallow breathing and, sometimes, the chest spasms.

It’s Sunday, April 24. While Springfield slept, its first responders are already working their first opioid overdose of the day. Over the next 24 hours, there would be four more — four that they knew of. With so many people carrying Narcan around in their backpacks or stuffed in nightstands just in case, there’s no telling how many friends revived friends that day with a stiff squirt up the nose. Those are rarely reported.

April 24 in Springfield was a Springfield Cardinals vs. Drillers game at Hammons Field; a pancake breakfast at the GLO Center, a canceled SGF Kickball tournament due to a rainy forecast.  

For 911 dispatchers, emergency rooms, ambulance, police and fire crews, it was another 24 hours sweeping up after Springfield’s growing opioid obsession.

This is a story of that day.

The scene

The day began as the numbers continued to climb across the nation and Missouri. Here in Springfield, five additional locals were dying every month from opioid-related overdoses compared to the year prior — from 33.5 in 2021 to 38.5 per month this spring.

“This is not a new phenomenon,” says Springfield Fire Chief David Pennington, “but it’s a new phenomenon at this volume. If we stay on this trend for 2022, it’s a 49 percent increase from 2019.”

The whole class of opioids is out there: heroin, fentanyl, methadone, morphine, oxycodone, OxyContin and other prescription and nonprescription pain relievers. But it’s the highly potent fentanyl that’s behind most of the city’s overdose incidents, police say.

Combine meth with fentanyl, and you’ve got the leading cause of opioid deaths across Greene County, says the county medical examiner. Meth alone and fentanyl alone are neck and neck for the number two spot in cause of death.

The calls come from every part of town — “We go to nice houses, too,” one firefighter says. But Pennington’s heat map of opioid incidents year over year shows a red hot concentration in the city’s northeast and center-city neighborhoods. A firefighter reflects: It’s the homeless… low-income hotels… a lot of rentals.

12:57 a.m.

That’s where, early on April 24, Officer Isaiah Houseknecht arrives to find an ambulance crew already on the scene, administering naloxone, “Narcan,” to a 36-year-old woman. In 30-60 seconds, the pink returns to her fingertips and lips, and she comes to. Definitely opioids. Narcan has no effect otherwise, he says.

The 911 caller, a male friend in the home, tells Houseknecht the woman had taken fentanyl… or maybe heroin… he wasn’t sure. He’d been in another part of the house when he heard someone yell for help, got to the room and found her not breathing, he says. There may have been another woman with her, the man adds; he gives a first name, but that’s all he’s saying.

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David Manning, recovery chaplain for Freedom City Church at the Northside Recovery Community Center, with packages of Narcan. (Photo by Jym Wilson)

“In this instance, he might have been sitting on the couch right next to her and watched her use it,” Houseknecht said. “He might have been the person that gave it to her, but we don’t know that… Most times, it’s all we can do to get a name and a birthdate from somebody.” Sometimes the paramedics can get more details from nervous parties.

“It’s already a stressful situation because they think their friend is dying. They’re really not sure what to do. They call 911. They’re expecting an ambulance and the police show up. Most of the time people are really hesitant to talk to us, if they talk to us at all.” He always has to tell them, “Nobody here’s going to get in trouble… You guys are protected. We can’t get anyone in trouble for this.”

Missouri took that measure in 2017 with the Good Samaritan Law in an effort to reduce overdose fatalities. It gives people who witness or experience a drug or alcohol overdose immunity from prosecution. Witnesses to an overdose are known to panic and leave a friend to die, or load them in a pickup and drop them off at the door of a hospital emergency room. Today they’re more apt to call 911, says Anthony Barber, who worked two such calls that day as equipment operator on Fire Engine #3.

Equipment operator Anthony Barber, left, and Captain Eric Roepke, members of Springfield Fire Department’s Engine 3. Barber and Roepke were part of a team of first responders who answered 911 calls on April 24, 2022. (Photo by Jym Wilson)

By 1:30 a.m., the woman is up and alert. The Narcan reverses the overdose, but paramedics warn that Narcan is an intervention, not a solution. If enough opioids are in her system, she could slip into an overdose state again.  “We do end up going back to the same place, picking up the patient after they’ve refused care… or they take more,” says CoxHealth EMS Director Mark Alexander. “I mean, it’s sad. These people are not in control. They don’t have control over this.” 

The paramedics suggest a trip to the hospital to be safe, but the woman doesn’t want to go and signs a “refusal of treatment” form. They don’t see her again that day.

Under different circumstances, the overdose wouldn’t have generated a panicked 911 call, no police report, if the witness had a Narcan kit. The two-dose box kits are easy to get. It’s at area pharmacies for about $144 — about $50 with a GoodRX coupon — no prescription necessary.

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Narcan packaging at the Northside Recovery Community Center. (Photo by Jym Wilson)

The Springfield-Greene County Health Department, through the Missouri Overdose Rescue & Education Project (MORE) provides free Narcan kits and training to 95 regional sheriff, police, fire and county health departments, Springfield city park rangers, animal control, Ozarks Technical Community College, the O’Reilly Hope Center (formerly One Door) and municipal court bailiffs.

Another program, the Drug Overdose Trust and Safety (DOTS) Project provides Narcan for treatment and counseling centers like the Northside Recovery Community Center. The drop-in center offers free Narcan, plus employment services, recovery housing and other peer-support services. The hope is that drug users who rely on those centers for free Narcan may trust and later return for help getting off the drugs, says Jody Austin, health department social worker.

About 50 people stop by each week for any number of services, says recovered addict David Manning. He’s the recovery chaplain for Freedom City Church, a wing of the recovery center, and housing manager for Straight Street Recovery Housing. Manning also gives monthly Narcan training and opioid reduction and overdose awareness classes to Springfield businesses and recovery housing providers. He knows that life — his father turned him on to drugs at age 10 and he’s done time.

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David Manning, recovery chaplain for Freedom City Church at the Northside Recovery Community Center, with packages of Narcan. (Photo by Jym Wilson)

Some 20 people a week come just for Narcan, Manning says. “It could be somebody in active addiction, it could be a family member who has a loved one struggling with addiction, and want to keep it close in case something happens.”

He sees a north side devastated by heroin and fentanyl addiction. “We’ll be at our classes, people will pull up in our parking lot with a person overdosed in their car, and we’ll run out there and hit them with Narcan. More than once we’ve had to save a life with Narcan in our own parking lot.”

County health department leaders in a report this spring named substance abuse, including opioid addiction, as one of three health issues it will focus on over the next three years. Community Health Improvement Plans are expected to come from that this fall.

The MORE program also funds  “Leave Behind” Narcan kits, which ambulance crews can leave behind with family, friends or bystanders at the scene of a non-fatal overdose. Survivors are at such high risk of overdosing again, it’s one tool that could save a life.

“A lot is the close friends of folks, or the family members,” says CoxHealth’s Mark Alexander. “They’ll have it on hand just in case they find them in an overdose situation. If you stop breathing, time is ticking. You don’t have very long.”

Lisa Feltz, lead telecommunicator and fourteen-year employee, foreground, and Marleen Maupin, dispatcher for 17 years, work a shift taking 911 calls at the Public Safety Center in Springfield. (Photo by Jym Wilson)

8:28 a.m.

A “check well-being” call comes through 911. Unconscious female, not breathing. Officer Justin Garrett arrives at the East Cherry apartment. She’s lying on the floor, lips and fingers blue. A female witness is hysterical. She thinks her friend is going to die in the back bedroom of her own place.  This friend, with a history of heroin use, recently got out of jail on drug charges but didn’t like the halfway house. The woman was just letting an old friend stay there, “to get her away from more temptation…” Garrett says. She last saw the friend conscious just after 8. Ten minutes later she heard a loud thud from the bedroom and found her friend on the floor.

Fire Engine 3 crew is already on the scene. A male witness is performing CPR on the woman, and he stops so the firefighters, all licensed EMTs, can get her breathing again. It’s their primary task on these calls. The brain and organs are at risk if starved of oxygen too long. They find a strong, fast pulse and slow, shallow breathing — four times a minute. Engine 3 Capt. Eric Roepke wants it at 12-20. Firefighter Titus Elliot is already unpacking and assembling their standard equipment — a slender oxygen tank and a “bag valve mask.” The firefighters tilt the woman’s head back, place the mask on her face and send 100 percent oxygen into her lungs. Within seconds her skin goes from blue to pink just as an ambulance crew arrives with Narcan.  

Capt. Roepke watches a familiar scene play out:  “After about 30 to 45 seconds their eyes open. She popped up, sitting on the ground, and said, ‘What’s going on? What happened? What happened?’ She started looking around, was very confused, didn’t realize what had happened.”

You overdosed, firefighters got you breathing and Narcan reversed the overdose. You should go to the hospital because the Narcan could wear off. You could go unconscious again.

She doesn’t want the help. Officer Garrett notes in his report:  “She stated that she had not taken any drugs and had only eaten a sandwich before losing consciousness and stopping breathing.”

Equipment operator Anthony Barber, left, and Captain Eric Roepke, members of Springfield Fire Department’s Engine 3. (Photo by Jym Wilson)

  1:03 p.m.  

911: Possible overdose. Engine 3 firefighters arrive to find a 22-year-old male lying on the kitchen floor of a Springfield duplex, and begin restoring his breathing with the oxygen and mask. Paramedics arrive; start an IV with Narcan, and the man wakes up.

“This all kind of went pretty smoothly,” says Mercy paramedic Jacob Madche. But even after being told the risks, the man refuses further treatment at a hospital. “As soon as he woke up, he denied taking anything.”

Madche reminds the man he can get help, when he’s ready, at one of the treatment programs through the hospital or other facilities. Some eventually do, based on the number of men and women seeking help through any number of drug treatment and recovery resources. At the CoxHealth Center of Addictions, alone, some 444 patients are currently enrolled for treatment of opioid use disorder. Firefighters often give survivors a business card with a QR code that takes them to Springfield-Greene County’s list of local resources and support for substance abuse recovery. When all else fails, there’s the “safe use” talk — If you’re going to use, use with a friend who can call 911. 

Madche never knows who might be ready for the help. “Once I make them aware of those types of risks and benefits and they refuse, my hands are tied,” Madche says. “I can’t make him go.”

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A police report of overdoses from April 24, 2022. (Photo by Jym Wilson)

3:09 p.m.  

A woman calls 911 on her cell phone; the man with her just overdosed. She stays on the line so a call taker, true to her training, coaches the caller to perform CPR while the dispatcher relays details to Engine 1 and an ambulance crew.

But there’s a problem — the caller has no idea where she is and doesn’t know the address. She does remember seeing a U-Haul truck parked out front. Responders are going to need help, and time is ticking for the unconscious man. The 911 dispatcher goes to work and is able to locate the woman’s cell signal based off area cell phone towers, which narrows her location close enough.  Engine 1 crew en-route spots a U-Haul, and enters what appears to be a vacant, fire-damaged house that’s gutted and trashed.

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Exteriors of the house at 219 S. Broadway where first responders revived a man who had overdosed in the afternoon of April 24, 2022. (Photo by Jym Wilson)

The ambulance is right behind. Engine 1 Lt. Mark DeLozier tells the woman to stop CPR so his crew can find a pulse. Firefighter Frank Oswald uses the bag valve mask and oxygen to restore the man’s breathing until paramedics arrive with Narcan — first the nasal spray, then through an IV to push in the rest of the medicine.

The line of questioning is the same: Did you take something? Yes. Have you overdosed before? Yes, a couple months ago. He agrees to go to the hospital by ambulance.

Who knows whether he’ll be the one to seek treatment toward recovery. Fire Lt. DeLozier: “I consider it a success if we get them back breathing and talking again.”

4:27 p.m.

Dispatch from a 911 call sends crews with lights and sirens to a possible overdose at a downtown restaurant/pool hall. A 24-year-old man is on the ground and employees have just given him a dose of Narcan up the nose when two police officers,  along with Lt. Mark DeLozier’s Engine 1 staff and an ambulance crew descend on the stunned diners.

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Billiards of Springfield, pool hall and restaurant, located at 541 E. St Louis St. Scene of an employee opioid overdose on April 24, 2022. (Photo by Jym Wilson)

An officer who is first on the scene gives rescue breaths until he turns it over to Engine 1 Firefighter Frank Oswald, who snugs a mask over the man’s face and sends in 100 percent oxygen.

 “Not the dinner and a show they’re typically used to, I’m sure,” Officer Aaron McConnell says. He checks the man for weapons and a wallet for ID. The man survives the overdose but doesn’t come to until he’s loaded into the ambulance.

 Some of the witnesses know only his first name.  “They said he had just clocked in that day, and just collapsed.”

A plea for change

Ask the April 24 crews what it would take to put an end to running after one, three, or five opioid overdose calls in 24 hours, and they offer some thoughts:

  • Support the police working to arrest dealers and disrupt trade.
  • More support for drug courts.
  • Establish Watchdogs.
  • Hotlines.
  • Maintain support for treatment resources that will help those who want it.   
  • Create a culture of reassurance and acceptance of survivors.
  • Stop the pipeline of new users, starting with education in grade schools.

CoxHealth EMS Medical Director Matthew Brandt proposes an idea: Create a combination of “cultural abstinence” so that it’s not acceptable, it’s not cool, and it’s not available.

 “It’s easy to see the impact on family members when you go to these calls, whether it’s like they’re mad because (someone) relapsed, or ‘This is the third time…’ or they’re just concerned,” says Joel Champ, Springfield’s Engine 1 equipment operator. “The way I look at it — man, this guy might do it tomorrow, but … hopefully, this is his last time. You hope they seek those resources so it is their last time.”

And if he does it tomorrow, “We’ll be there tomorrow, too.”

The 4:27 p.m. plea for help won’t be the last emergency call of the day for Springfield first responders, but it will be the last reported opioid overdose.

Somewhere in the city’s apartments, hotels or parked cars in vacant lots, there’s likely a friend, a fiancé, or family member ready with a dose of Narcan, just in case.


Kathleen O'Dell

Kathleen O'Dell

Kathleen O’Dell is a veteran journalist who has covered health care, business, education and investigative pieces throughout her career. She’s a St. Louis native and a graduate of the University of Missouri School of Journalism. In addition to working for a Texas newspaper, she was on the first staff of USA Today in Washington, D.C., and spent most of her newspaper career at the Springfield News-Leader. More by Kathleen O’Dell