Help with Paramedic Resarearch for a short film Project

[Edgo]

Hello, I am a independent filmmaker living in New York. I am doing a short film project and needed help with some research. I was hoping to talk to an experienced paramedic who can guide me through a protocol when someone has overdosed on drugs.

- I have a scene where a paramedic comes into an apartment and finds a young girl overdosed on heroin.

I just need to know what a paramedic does in these type of scenarios. Do they inject some kind of medicine into the victim? Do they wait for more assistance? What type of medicine do they use to help the victim? How many paramedics travel to the scene and etc,.?

ANY HELP WOULD BE GREAT!

I am planning to do the short film in 3 weeks. I just want to make sure I make the scene realistic and accurate.

Thanks. Hopefully someone can help!

 

[NomadicMedic]

Narcan (naloxone) is the drug.
It either given as a atomized mist in the nose, injected into an IV or IM (like a vaccine)

2 paramedics on a call. They might have to assit the ventilation of the patient with a BVM (bag valve mask) as the drug takes effect.

It's pretty quick, within 5 minutes the patient is awake and breathing.

 

[Summit]

They will assess the patient during the course of this... shake and yell at them to see if they respond, open the girls airway, give breaths with a BVM if she isn't breathing (the other medic might hook it up to Oxygen), possible stick an OPA in her mouth (or NPA in her nose) to hold her airway open. One paramedic is probably going to handle that.

If they know or suspect that heroin is the cause, then other medic will focus on giving the narcan as Demedic mentioned

It's pretty quick, within 5 minutes the patient is awake and breathing.

This... in that period, they'll attach her to a pulse ox and take her blood pressure and heart rate while they continue to assist her breathing with the BVM.

Once the narcan starts working, you have options for dramatic license. If they give just a little bit of narcan (usually bit by bit until you get the desired effect), she'll start breathing but still be out of it or at least pretty groggy, coughing if that NPA/OPA is in (medic will remove it, because she'll maintain her own airway). If they give a lot of narcan (old school/poor form/inexperience), she'll be wide awake super angry (took away her high! she didn't realize she was dying), perhaps violently so, ripping out her IV, swearing, may run away, and it is highly likely she'll vomit (maybe projectile vomit). If she took heroin because she was in physical pain, she is now back in pain. You can see why the first method is the preferred way.

The narcan will also likely wear off before the heroin does, so if you want to make her go down again... you can. The paramedics are going to want to take her to the hospital for this reason among others.

 

[Edgo]

Narcan (naloxone) is the drug.
It either given as a atomized mist in the nose, injected into an IV or IM (like a vaccine)

2 paramedics on a call. They might have to assit the ventilation of the patient with a BVM (bag valve mask) as the drug takes effect.

It's pretty quick, within 5 minutes the patient is awake and breathing.

Thanks for the info ... and if you do inject the vaccine ... where do you inject?...in the arm?

 

[Edgo]

so is the narcan (naloxone) a fluid drug that is injected...correct? Sorry for my ignorance on this subject. I just wan to make sure i understand the terms and medicine.

 

[Edgo]

They will assess the patient during the course of this... shake and yell at them to see if they respond, open the girls airway, give breaths with a BVM if she isn't breathing (the other medic might hook it up to Oxygen), possible stick an OPA in her mouth (or NPA in her nose) to hold her airway open. One paramedic is probably going to handle that.

If they know or suspect that heroin is the cause, then other medic will focus on giving the narcan as Demedic mentioned



This... in that period, they'll attach her to a pulse ox and take her blood pressure and heart rate while they continue to assist her breathing with the BVM.

Once the narcan starts working, you have options for dramatic license. If they give just a little bit of narcan (usually bit by bit until you get the desired effect), she'll start breathing but still be out of it or at least pretty groggy, coughing if that NPA/OPA is in (medic will remove it, because she'll maintain her own airway). If they give a lot of narcan (old school/poor form/inexperience), she'll be wide awake super angry (took away her high! she didn't realize she was dying), perhaps violently so, ripping out her IV, swearing, may run away, and it is highly likely she'll vomit (maybe projectile vomit). If she took heroin because she was in physical pain, she is now back in pain. You can see why the first method is the preferred way.

The narcan will also likely wear off before the heroin does, so if you want to make her go down again... you can. The paramedics are going to want to take her to the hospital for this reason among others.

When in action ... how does one speak to a colleague when asking for the "narcan" or checking blood pressure? I just want to make sure I get the lingo correct. Also Narcan (naloxone) is a fluid that is injected correct? Thanks for the info.

 

[Edgo]

They will assess the patient during the course of this... shake and yell at them to see if they respond, open the girls airway, give breaths with a BVM if she isn't breathing (the other medic might hook it up to Oxygen), possible stick an OPA in her mouth (or NPA in her nose) to hold her airway open. One paramedic is probably going to handle that.

If they know or suspect that heroin is the cause, then other medic will focus on giving the narcan as Demedic mentioned



This... in that period, they'll attach her to a pulse ox and take her blood pressure and heart rate while they continue to assist her breathing with the BVM.

Once the narcan starts working, you have options for dramatic license. If they give just a little bit of narcan (usually bit by bit until you get the desired effect), she'll start breathing but still be out of it or at least pretty groggy, coughing if that NPA/OPA is in (medic will remove it, because she'll maintain her own airway). If they give a lot of narcan (old school/poor form/inexperience), she'll be wide awake super angry (took away her high! she didn't realize she was dying), perhaps violently so, ripping out her IV, swearing, may run away, and it is highly likely she'll vomit (maybe projectile vomit). If she took heroin because she was in physical pain, she is now back in pain. You can see why the first method is the preferred way.

The narcan will also likely wear off before the heroin does, so if you want to make her go down again... you can. The paramedics are going to want to take her to the hospital for this reason among others.

Sorry for my ignorance on this subject. I just wan to make sure i understand the terms and medicine. Is the narcon injected into arm?

 

[Summit]

Lingo for the second medic assessing the patient while the first uses the BVM (squeeze bag once every 5-6 seconds)
takes pulse "bradycardic" (her heart is beating slow because she OD'd)
takes blood pressure "BP 70 over 36" (her blood pressure is slow, symptom of OD)
attaches pulse ox "Her o2 sat is low, keep bagging" (her blood contains insufficient oxygen because she ain't breathing so please keep squeezing the BVM to breath for her)
phsyical/visual assessment to see if something is wrong "I see track marks" (answers why are they thinking its an OD... or whatever clue your script calls for... hollywood cliche is the needle still in the vein. but maybe she freebased)
"looks like an O D" (ok the treatment team has a possible diagnosis so they can choose their course of action)

Yes typically narcan injected into an IV the medic placed in the arm (probably crux of the arm) because the medics are going to use that IV for other things as well (like giving IV fluid or other drugs).

If you want the wide awake flying back to life angry drug addict result, the medic will say "I'm going to slam 4mg of narcan."

Then this happens:

If you want the bit by bit slow wake up, "I'm going to try ZERO POINT TWO mg of narcan." waits 2-3 minutes "ok 0.4 mg" "hey she is breathing"
(The medical professionals will forgive you if you turn those 2-3 minutes into a few suspense raising seconds)

If you want to sound jargony, pronounce mg as "Migs" instead of saying "miligrams"

 

[Edgo]

Lingo for the second medic assessing the patient while the first uses the BVM (squeeze bag once every 5-6 seconds)
takes pulse "bradycardic" (her heart is beating slow because she OD'd)
takes blood pressure "BP 70 over 36" (her blood pressure is slow, symptom of OD)
attaches pulse ox "Her o2 sat is low, keep bagging" (her blood contains insufficient oxygen because she ain't breathing so please keep squeezing the BVM to breath for her)
phsyical/visual assessment to see if something is wrong "I see track marks" (answers why are they thinking its an OD... or whatever clue your script calls for... hollywood cliche is the needle still in the vein. but maybe she freebased)
"looks like an O D" (ok the treatment team has a possible diagnosis so they can choose their course of action)

Yes typically narcan injected into an IV the medic placed in the arm (probably crux of the arm) because the medics are going to use that IV for other things as well (like giving IV fluid or other drugs).

If you want the wide awake flying back to life angry drug addict result, the medic will say "I'm going to slam 4mg of narcan."

Then this happens:

If you want the bit by bit slow wake up, "I'm going to try ZERO POINT TWO mg of narcan." waits 2-3 minutes "ok 0.4 mg" "hey she is breathing"
(The medical professionals will forgive you if you turn those 2-3 minutes into a few suspense raising seconds)

If you want to sound jargony, pronounce mg as "Migs" instead of saying "miligrams"

THANK YOU SO MUCH! This is a good start to my research. I will look at the video as well. If I have anymore questions, I will reply to the post to reach out to you. And also I will do my best to make the scene intense and suspenseful. Those few seconds will be epic. Thank you again!

 

[NomadicMedic]

They will assess the patient during the course of this... shake and yell at them to see if they respond, open the girls airway, give breaths with a BVM if she isn't breathing (the other medic might hook it up to Oxygen), possible stick an OPA in her mouth (or NPA in her nose) to hold her airway open. One paramedic is probably going to handle that.

If they know or suspect that heroin is the cause, then other medic will focus on giving the narcan as Demedic mentioned



This... in that period, they'll attach her to a pulse ox and take her blood pressure and heart rate while they continue to assist her breathing with the BVM.

Once the narcan starts working, you have options for dramatic license. If they give just a little bit of narcan (usually bit by bit until you get the desired effect), she'll start breathing but still be out of it or at least pretty groggy, coughing if that NPA/OPA is in (medic will remove it, because she'll maintain her own airway). If they give a lot of narcan (old school/poor form/inexperience), she'll be wide awake super angry (took away her high! she didn't realize she was dying), perhaps violently so, ripping out her IV, swearing, may run away, and it is highly likely she'll vomit (maybe projectile vomit). If she took heroin because she was in physical pain, she is now back in pain. You can see why the first method is the preferred way.

The narcan will also likely wear off before the heroin does, so if you want to make her go down again... you can. The paramedics are going to want to take her to the hospital for this reason among others.

Way more detailed than me! Well done. You should get a credit in the film!

 

[olaf1988]

Just to illustrate what other have said, check this out- it's a little outdated, but the assessment and treatment is pretty accurate... Jump to 7:12 and watch from there. This is an example of a system that sends out a fire engine on medical calls as well so there's more hands on scene. A lot of places there would just be the two medics. Hope this helps!

 

[Edgo]

Just to illustrate what other have said, check this out- it's a little outdated, but the assessment and treatment is pretty accurate... Jump to 7:12 and watch from there. This is an example of a system that sends out a fire engine on medical calls as well so there's more hands on scene. A lot of places there would just be the two medics. Hope this helps!

Thank you. I appreciate the help. I will watch.

 

[Edgo]

Way more detailed than me! Well done. You should get a credit in the film!

Good idea! I will credit the site.

 

[Handsome Robb]

Just to illustrate what other have said, check this out- it's a little outdated, but the assessment and treatment is pretty accurate... Jump to 7:12 and watch from there. This is an example of a system that sends out a fire engine on medical calls as well so there's more hands on scene. A lot of places there would just be the two medics. Hope this helps!

Hey I used to work there.




Sent from my iPhone using Tapatalk

 

[Edgo]

These are my last batch of questions (Hopefully)... I realized there is a difference between EMT and a Paramedic. So my question is ... are the EMT people able to inject narcan in a victim or is that more of a responsibility of the Paramedic? or How would a EMT person handle a overdose victim. If I can be explain how the two are different when it comes to approaching an overdose victim that will be great. What can or what an EMT cannot do will help.

 

[Jim37F]

Depends on the local area, some allow Narcan to be administered BLS (EMTs), some restriction that to ALS (Paramedics) only.

 

[Flying]

In areas that support police officers, EMTs, or even addicts themselves having access to Narcan (there has been a push to make this drug more widely available), we have the option of providing intranasal narcan (via the nose). There are plenty of videos that show the application of this.

EMTs and paramedics generally must approach calls the same way: assess, treat, prepare for transport. The education of an EMT is generally far more limited than a paramedic's, and this reveals itself in a number of ways, including how we go between the first two steps, but for this particular call, the approach may be similar.

Arrive > Greet and introduce yourselves > Find patient > Take vital signs and assess immediate life threats > correct those issues if you can > Greet Paramedics Steve and Lou, whom you've met at another call during this long night and present your findings in a brief report > Prepare for transport.

EMTs generally don't have access to "invasive" procedures, so no needles, no intubations. Many places don't have EMTs with Narcan. For this call, you can reasonably expect an EMT to be ventilating the patient with a bag-valve mask because the patient's breathing is depressed (slow) or nonexistent.

The order of events may change depending on the condition of the patient, where you are, and who has the Narcan.

 

[Flying]

An assessment almost always starts with: Are they conscious? Is the airway open? Are they breathing adequately? Is there a pulse? Is there anything else I'm missing (such as obvious bleeding)?

Here is a sheet that is used in EMT training to determine basic competencies, see Primary Survey
https://www.nremt.org/nremt/downloads/E202 Medical Assessment.pdf
Moreso than paramedics, EMTs are trained to follow a flowchart on top of having basic clinical knowledge.

So in this call, an EMT would stop at the third question (No breathing, hey John can you get start bagging while I check the pupils?) and start trying to ventilate the patient or have their partner do so, while considering reversible causes (made apparent by being dispatched for an overdose, pinpoint pupils, depressed breathing, and the popcorn bowl full of empty Fentanyl foils). Enter Narcan.

 

[StCEMT]

As an EMT for me it'd basically be a quick assessment of his airway, breathing, and circulation. If I suspect an OD, which info has generally been good for me to suspect it when dispatched, I am gonna check his eyes asap too for pinpoint pupils. If his respirations are slow, I am just going to bag him until the Narcan gets in his system. Just please, please, please, do NOT bag him at a rate of 30+ times per minute. Some EMT's can give Narcan intranasally, so that would be a plausible option.

Even when I work under a medic scope, I will typically start off with some intranasal Narcan, at least with the overdoses I have had lately. Then I will move on to an IV with a follow up as needed. The first parts of an overdose are ran the same whether an EMT or a medic, because we are still looking to manage the same things right off the bat. Main difference comes with the IV Narcan once you get a little further in and some people need a lot.