"Welcome back."
It was the first thing Sgt. Giovanni Trello heard when he woke up in the back of an ambulance headed to the hospital.
He felt groggy and confused. "What do you mean?" he asked the medic.
Trello, an Aliquippa police officer, overdosed on pure fentanyl, a potent synthetic opioid blamed for killing three-fourths of the 153 overdose victims in Beaver County over the last two years.
For Trello, it was just a matter of seconds before he passed out and was left completely helpless.
It happened last September on a relatively common call. Officers from the Aliquippa Police Department were dispatched to the parking lot of a Main Street church for a report of two people sitting in a car, going in and out of consciousness.
Officers know that call well. When they hear phrases over the radio like "seizure activity," ''loss of consciousness" and "slow to respond," they know it often means they're headed to an overdose. Sometimes, they even recognize the address from previous calls.
When they got to the parking lot, both people were alert and waiting for an ambulance. Inside the car, drug paraphernalia, including needles and a bunch of empty stamp bags in an open Ziploc bag, was in plain view - on the seats and in the center console. Trello didn't need a warrant to start collecting evidence.
It was a really hot September day, he said, and the car was still running with the air conditioning in the car on "full blast."
Trello reached in and grabbed the open Ziploc bag. He squeezed it slightly. Residue from the drugs got caught in the air conditioning and blew directly into his face, hitting him in his mouth, nose and eyes. He was hot and sweaty, and the residue stuck to his skin.
"I immediately knew I was in trouble."
'We just don't think about it'
First responders, police officers and firefighters face a growing and deadly risk every time they respond to an overdose call.
They answered more than 1,100 such calls in Beaver County for the 21 months ending Sept. 30, according to an analysis of 911 calls by the Beaver County Emergency Services Center.
The nearly constant demand for help and the exposure to deadly drugs has changed how the first responders do their jobs.
"You just don't know what you have," Aliquippa Police Chief Don Couch said.
Couch was hesitant to mandate his department carry naloxone - until Trello overdosed. After the incident, he realized how quickly things can go wrong when responders encounter drugs as toxic as fentanyl.
"I gotta rethink this," Couch said to himself.
Now, all city police cars are equipped with the drug, which reverses the effects of an opioid overdose.
Center Township Police Chief Barry Kramer, who also serves as head of the Beaver County Chiefs of Police Association, said officers across the county are in danger of coming into contact with hazardous drugs every day.
"I'm forcing my guys to go into a potentially contaminated biological scene," he said of responding to an overdose.
While no one in his department has had the same experience as Trello, one of his officers was pricked by a needle and required medical attention.
"We carry masks, rubber gloves and Narcan," he said.
But there's still an increased risk for exposure when officers respond to calls involving opioids.
Couch agreed and called police work a "risky business now." While officers have always put themselves at risk to serve the public, the opioid epidemic and the use of naloxone adds another layer to their jobs.
Officers are now not allowed to touch anything, he said. They wear rubber gloves and masks. Then they package suspected drugs and immediately send it to a lab for testing.
When Trello realized he was overdosing, he removed his gear and grabbed water from another responder. He splashed the water all over himself, trying to rinse the residue from his skin.
"That's pretty much the last thing I remember," he said. He lost consciousness.
The next thing he knew, he woke up in an ambulance. Trello spent the next few hours in the emergency room, his wife and colleagues at his side.
He doesn't remember much from that day. "It's a spot in my life that's just gone."
Trello wasn't panicked or angry, just groggy and confused. It wasn't the first police work-related injury he's had. His wife, he said, is used to meeting him at the hospital.
"I torture her, the poor girl."
Trello said the grogginess lasted for a few days.
Through an investigation, police learned the residue that hit Trello was pure fentanyl - "no heroin at all," he said.
He's pretty cavalier about the incident. Perhaps time has healed the wound, but Trello said he's just the type to roll with whatever comes his way.
Trello said officers are always cautious but often have to put themselves in high-risk situations.
"We're always careful, but things happen," he said.
Similar issues have been reported at other police departments, including officers in Allegheny County and East Liverpool, Ohio.
In August, 18 officers in Pittsburgh were hospitalized when they came into contact with fentanyl during a raid at a West End home. All were treated and later released.
In many ways, Trello said, he's more cautious now and he knows he never wants to be exposed again.
"We just don't think about it. It's just your job."
Those people in the car, he said, have issues that they need to deal with. He doesn't blame them for what happened, and he doesn't think twice about rendering aid now when called to an overdose.
"Yeah," he said. "Shit happens."
'It's just sad'
Firefighters and emergency medics are at risk, too, said Beaver Falls Fire Chief Mark Stowe.
"We always are on the lookout for the telltale signs, like powder - things that could cause us problems," he said.
As first responders, fire departments have to be careful to avoid needles and any potentially airborne drugs.
Stowe said responders often just cut open people's pockets to "avoid the risk" of coming into contact with paraphernalia.
Beyond the risks the drug epidemic has placed on police, Couch said every overdose death affects the entire community, police included.
"There's a lot of victims," he said. From families, to friends, teachers, even the responders called to an overdose - the impact is devastating.
"It's just sad," he said. Couch has seen families lose children and children lose parents to the epidemic. "It's tough."
While responders take their jobs seriously, Stowe said it's easy to become frustrated when the same person overdoses "over and over again." Drug users, he said, often overdose in public places because they know they will be found and revived. The trouble, he said, is when that endangers the public, as well.
Often, he said, responders recognize the victim as someone they have treated for an overdose multiple times before.
"We see these people. We just know eventually if that person doesn't get help, we're going to find them dead," he said.
"It's sad, sad. Really sad," he said.
'Law enforcement can't solve this problem'
According to Couch, Aliquippa, much like Beaver Falls, is working to implement a drug diversionary program that directs drug-related offenders to non-jail rehabilitation.
"It just makes sense," he said.
Stowe said the initiatives seem to be helping to give people more access to treatment.
"It is making a difference," he said.
While it's not a topic people typically like to discuss, Couch said he can tell the community at large is becoming more aware of the epidemic. Agencies, police departments, the court system are all working to solve the problem.
He praised what he sees as more sharing of information across agencies on efforts to curb the epidemic.
In early 2016, Beaver County District Attorney David Lozier implemented changes to the way police departments respond to overdoses. Now, they investigate each call as a crime scene, so their work does not stop after rendering aid to a victim or removing a body.
The change has resulted in many police departments filing charges against drug dealers who sell heroin or fentanyl that results in a death. Because police continue to investigate, in many cases they are able to determine who sold drugs to an overdose victim and arrest that person on the felony charge.
"Law enforcement can't solve this problem," Kramer said. "We can keep arresting people, and, I think in certain aspects, that's one way to contain it. But this isn't just a law enforcement problem."
He said every overdose call and overdose investigation pull officers away from other duties and regular patrol.
"That's our job," Kramer said. "We have to take care of people and save them, but as a taxpayer who's not a heroin addict, do you feel it's fair that your tax dollars are being diverted to that?"
While many police officers and firefighters didn't choose their jobs because they expected to be responding to overdose calls, Stowe said that's just the way things are now.
"If someone's dying, we got to go save them. That's the way I look at it. That's what we're here for," he said.
