Should Firefighters (or BLS) Be Able To Administer Narcan?

[x635 4,066]

Should Firefighters (or BLS) Be Able To Administer Narcan, the antidote to a heroin overdose? I think so.

LA CROSSE, Wis. – Firefighter Jim Hillcoat knows the signs: slow, shallow breathing, shrunken pupils, weak pulse. Occasionally, even a needle nearby. A drug overdose — and it’s becoming more common as heroin has infested this college town along the Mississippi.
But on a call with the fire department here, Hillcoat can’t give the antidote he’s sure will help: naloxone.

The drug, also known as Narcan, can quickly reverse the effects of an overdose, bringing a person from unconscious to complaining in a matter of minutes. Paramedics can, and increasingly have, used the drug. But timing is crucial, and paramedics are often not first to a scene. Officials here believe that by putting naloxone in the hands of firefighters — and perhaps police officers — they can save lives.

FULL ARTICLE: http://www.startribune.com/local/231513901.html

[SRS131EMTFF 471]

Just under went my protocol transition to allow Intranasal Narcan at the EMT level saturday. EMR will be allowed as well. New protocols go live 1/1/13.

Edited November 14, 2013 by SRS131EMTFF

[comical115 32]

Scenario: 45 year old female found on the street, called in by passer-bys. It's Friday evening, patient is responsive to pain with a GCS of 11 (2/4/5). Patient wakes up to sternal rub and quickly nods off. She is unable to provide any information as to her present condition or history.

Resp: 12.

HR: 66, Regular.

BP: 94/50.

SPO2: 97% room air.

BGL: 118 mg/dl.

Skin: Cool, pink, dry.

Eyes: Pinpoint, reactive.

Patient has x3 empty methadone bottles in her pocket.

Narcan or not? Keep in mind that ED's are using 1/10th of what we are in the field as the first line dosage now-a-days (that's 0.04 mg for those keeping score) and I've seen my share of crews bringing in patients who are either actively seizing due to narcan mediated withdrawal or some other acute stress response that ensures the patient's stay in the ICU...

No medication administration is without it's potential adverse reaction and unless you're equipped/trained to deal with it, you have no business administering the drug to begin with. *Especially* if the condition can be mitigated with a BVM and some O2...

Edited November 15, 2013 by comical115

[vtach39680 23]

This is in reference to the scenario listed above

If a patient has spontaneous respirations narcan should be administered in Neb as it is a safe proven titrated dose that is easy to manage. In cases of the patient with no spontaneous respiration a a "rescue" dose of narcan should be delivered intranasal and ambu-bag

As always good judgment should be used to decide if any medication should be given and what the effects any medications has both therapeutic and side effect

And that is why if anything neb the narcan instead of intranasal it's proven to work, it's a titrated dose and easy to manage.

But it is not protocol

Edited November 15, 2013 by vtach39680

[BM234 2]

Never heard of nebulized narcan and not sure my medical director would be happy with that, but don't doubt it works well.

Very simply, narcan is there to treat respiratory drive. If there is respiratory drive and the patient is unconscious, they're probably better off that way.

NYC has started BLS, PD, and substance abuse counselor IN narcan already with good results.

[comical115 32]

Never heard of nebulized narcan and not sure my medical director would be happy with that, but don't doubt it works well.

Very simply, narcan is there to treat respiratory drive. If there is respiratory drive and the patient is unconscious, they're probably better off that way.

NYC has started BLS, PD, and substance abuse counselor IN narcan already with good results.

According to who? I'm all for the expansion of scope of care but there are times where a patient needs to be monitored more intensively than what a CFR and EMT can provide. The fire service talks about the right tool for the right job, a potential OD of narcotics with respiratory compromise is an ALS job. Period.

[Jybehofd 85]

Yes it's an ALS call but if first on scene can start treatment till the medic gets there what's the problem. It's like the big hold up go the use of glucometers for the BLS ?? Why it's in the state it's another tool in the bag that doesn't cause arm and why not. EMTs are being held to a hirer standard now anyway???

[Stuart 1]

Massachusetts is running a pilot program making nasal Narcan available to the friends and family of 'opiate users'. See http://www.mass.gov/eohhs/docs/dph/substance-abuse/naloxone-info.pdf

Not every community is fortunate to have paramedics stationed in their town. If the State can give it to civilians, doesn't it make sense that medically trained first responders have access to this as well?

[v85 212]

Wasn't Boston or some place in Mass actually giving the IV version to users. I guess they figured the users already knew how to handle a hypodermic.

[thebreeze 194]

Never heard of nebulized narcan and not sure my medical director would be happy with that, but don't doubt it works well.

Very simply, narcan is there to treat respiratory drive. If there is respiratory drive and the patient is unconscious, they're probably better off that way.

NYC has started BLS, PD, and substance abuse counselor IN narcan already with good results.

This is purely a pilot program in one precinct with the NYPD. Personally I feel that they could worry about some more important things than helping out what will often just be junkies. They are barely equipped to do CPR and now you expect them to give Narcan? I don't think so, what happens if something goes south? They don't carry any equipment to perform any type of interventions. Many officers I have spoken to on the street have told me they have been told in not so many words that they are not to touch patients when they respond in to EMS runs. Maybe they should get everyone re-certified or refreshed in CPR or start giving them defibs before they start worrying about this. Mind you I am in no way bashing the overwhelming majority of officers out there who do perform CPR and do the right thing trying to save people, I am just pointing out that there have been incidents where a few officers have not (and been appropriately disciplined), they are not always kept current on CPR, and the city does not properly equip them for it.

[INIT915 1,119]

This is purely a pilot program in one precinct with the NYPD.

This pilot program is being tested in other areas outside of NYC as well.

[Bnechis 3,961]

How about we make sure that Firefighters 1st meet NFPA standards for firefighting before we add more training requirements?

NYS needs 1 standard for that, but we can not even do that.

How about making sure that we can get an ambulance on the road in a timely manor. While this is a nice sounding concept (particularly in areas with high drug usage) we have a limited amount of training hours available and their are many other priorities

[thebreeze 194]

This pilot program is being tested in other areas outside of NYC as well.

I understand and am aware that it is being tested elsewhere, I was simply responding to and elaborating on the other posters assertion that the NYPD is using it.

[Sean11FD 3]

No

[mmwolf65 1]

I work just outside of Boston. We (FD) have been using Nasal Narcan for 4 years at the BLS level for Opioid overdoses. Works wonders.

[Ladder44 73]

When these lovley citiznes of society are speed ballin and you hit em with narcan, the cocain hits their system and now we have a worst issue, the stimulant over takes and we have the possibility of a stroke, heart attack, seizure, withdrawls ect. PD and bls FD dont have the drugs to re sedate and protect the patient.

[Morningjoe 162]

Seriously though, lets allow EMT's to drop combi-tubes or king airways before we start talking about pushing meds to wake junkies.

[vtach39680 23]

Never heard of nebulized narcan and not sure my medical director would be happy with that, but don't doubt it works well.

Very simply, narcan is there to treat respiratory drive. If there is respiratory drive and the patient

is unconscious, they're probably better off that way.

NYC has started BLS, PD, and substance abuse counselor IN narcan already with good results.

Very good article on the subject

http://m.jems.com/article/patient-care/nebulized-naloxone-safe-effective-treatm

[velcroMedic1987 330]

How about we make sure that Firefighters 1st meet NFPA standards for firefighting before we add more training requirements?

NYS needs 1 standard for that, but we can not even do that.

How about making sure that we can get an ambulance on the road in a timely manor. While this is a nice sounding concept (particularly in areas with high drug usage) we have a limited amount of training hours available and their are many other priorities

I don't disagree with any of your comments but you're talking about 2 different things.

The thread is about BLSFR administering Narcan to elevate patient care and improve outcomes. With regard to this question, we should be asking - not about system deficiencies but rather - about risk/benefit and cost/benefit.

Risk/Benefit - if a patient is found hypoventilating or apneic, will the BLSFR administered Narcan improve their outcome? What is the potential downside to this treatment? Can BLSFR administer this medication without complications or side effect?

Cost/Benefit - what is the cost to train personnel and equip them to provide this treatment?

Is there any empirical data to support such a program or is that why we're looking at these pilot programs popping up? During my career I've been part of a variety of studies. Some continued after the study period because they found that it was worthwhile and others just disappeared.

As for your points about first responders needing to get their houses in order, you're right. But we shouldn't prevent this because we have other issues. If we did that we'd be nowhere.

[WAS967 97]

Nebulized narcan works. Why don't we do it? Who the hell knows.

Resps of 12 and Sat 97% on R/A? Leave em alone. I'd rather take an obtunded person into the ER and let them manage the problem in a controlled environment than risk crew safety by waking up an opiate junky and have them start swinging in an small enclosed box.