Intranasal Narcan for BLS

Jon

Jon

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Anyone giving Intranasal Narcan at the BLS level yet?

What do you think so far?

What is your protocol, and is there anything you'd change?
 
Jon said:
Anyone giving Intranasal Narcan at the BLS level yet?

What do you think so far?

What is your protocol, and is there anything you'd change?
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I have heard talk of this for like a year now but haven't heard of it actually in place anywhere.

People told me there are supposedly auto-injectors out there now that they give to known abusers to have like an epi-pen.

My only worry would be that many don't even realize that it only takes 0.2mg of nalaxone to bring back many patients. "Overdosing" Narcan could result in dangerous withdrawal symptoms. But at the same time I guess if ALS is not available, or extended and the person has obvious respiratory failure than the risk of aspiration and a pissed off patient are better than the risk of respiratory arrest.

Not to knock anyone, but I know a lot of EMTs, intermediates and some medics that don't understand the potential some supposedly "harmless" drugs have and they just like the keep pumping the patient full. Slamming 2mg of Narcan down someones nose is a massive amount...

A set of 0.2 or 0.4mg auto injectors would be pretty nifty though. Standing orders of 0.2mg for respiratory depression/failure/arrest secondary to suspected opiate OD with a repeat of 0.2 would be pretty cool.
 
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As with anything,

if adequete training, a functional system, and proper oversight are involved, I don't see it being a particularly bad idea.

But good or bad and what needs addressed will be determined by actual practice.
 
It could work well, but like NY pointed out it could turn bad as well. BVM + OPA or NPA works just fine...I could see standing orders for an arrest with opiod OD suspected but then you get into the argument of allowing basics to gain IV access because IM isn't going to cut it in that situation, not sure about IN but I don't see it working too well.
 
Boston EMS basics have been administering IN Narcan for sometime now. I am not sure what they're protocols are. I also know of a few police departments (Lynn and Quincy MA) that are also carrying prefilled IN Narcan setups. In Boston it's been very useful given the shortage of ALS trucks and proximity of hospitals.

Colorado EMT basics who have taken a state approved IV access class can also administer Narcan through both IN and IV routes. My IV instructor noted that the difference in onset between IN and IV are nearly identical, though he admitted that this was based only personal experience. Our protocol states to start with 0.4mg and then titrate to effect, up to 2mg.

Given that Narcan is packaged in prefilled syringes and prefilled IN setups, so I don't really see much of an issue with it when it comes to the providers making medication errors. So long as providers are receiving adequate education and aren't out trying to ruin people's highs by slamming the doses in, I think it's a fairly good idea. If the Narcan trial fails initially, then it's time to bring in ALS, or as NVRob said, NPA and bag them.
 
My former medical director was 100% in favor of this.

unfortunately, the state isn't as progressive as he was.
 
I guess it could be useful is areas of high opioid abuse.

Having said that, we us IM Narcan and I have not used ti once in over 2 years running emergency calls.
 
Id like to see it used in full arrests, but a pt w/ respiratory depression can be managed with a BVM & airway. The biggest thing is that there would need to be additional training.
 
I'm in the final stages of implementing a program to bring it to a BLS service... MA protocols make it fairly easy to implement beginning 3/1/12, so my service is taking it on with enthusiasm from our Med. Director and Hospital representative because of our service design. If anyone has specific questions, i'm happy to answer them...
 
Los Angeles county would never allow this.
 
Backwoods said:
Id like to see it used in full arrests, but a pt w/ respiratory depression can be managed with a BVM & airway. The biggest thing is that there would need to be additional training.
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Wouldn't it be better to remove the respiratory depression all together if possible. The BVM is a simple tool that many struggle to use effectively, if you can reverse respiratory depression, wouldn't you want to? Ineffective bagging could be doing the patient some serious harm.

I don't think pushing Narcan in every cardiac arrest is going to have useful effect, and as others here have mentioned it is not a harmless drug especially if the patient may need RSI in the near future.
 
ALL drugs have the potential for severe reactions. There are no such thing as safe drugs. I see no advantage in what is discussed. Oxygen will help & be more beneficial than naloxone.

In 6 years I have had need to use it twice. Not as a primary treatment, but as an adjunct to oxygen therapy. Both of these were for prescription accidental overdoses.

I don't know why you would consider lowering the standard for drug administration.

Wouldn't it make more sense to up skill & increase education levels & abolish BLS as a skill level & make an EMT-I a minimum skill level to provide optimum treatment to all people, all the time?
 
To those who say "just bag," I would say it depends on where you work. Where I do BLS shifts we are about 45minutes from the hospital, which is a long way to bag. Also I feel like you have a much higher chance of the patient vomiting from prolonged bagging, forcing air into the stomach, than if you use a little Narcan.

To the idea of making everyone an EMT-I, it sounds great. But I have 2 issues.

1. I know a lot of EMT-Bs who I wouldn't trust with an IV and I don't think have the smarts to give drugs.

2. Is it fair if most people are paying for EMT classes out of their own pocket to make them pay for an EMT-I class, which will be longer and more expensive? You could argue that they would make more but I don't think our healthcare system is going to give all EMTs a raise right now.
 
zmedic said:
To those who say "just bag," I would say it depends on where you work. Where I do BLS shifts we are about 45minutes from the hospital, which is a long way to bag. Also I feel like you have a much higher chance of the patient vomiting from prolonged bagging, forcing air into the stomach, than if you use a little Narcan.

To the idea of making everyone an EMT-I, it sounds great. But I have 2 issues.

1. I know a lot of EMT-Bs who I wouldn't trust with an IV and I don't think have the smarts to give drugs.

2. Is it fair if most people are paying for EMT classes out of their own pocket to make them pay for an EMT-I class, which will be longer and more expensive? You could argue that they would make more but I don't think our healthcare system is going to give all EMTs a raise right now.
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So 2 things.

1. If you don't trust them starting an iv let alone with medications how is naloxone at the BLS level even feasible?

2. You gotta pay to play. We all complain about not being respected as a profession yet many refuse to further their own education in their chosen field.
 
Why would you give narcan in arrest? What are you trying to accomplish?
 
NVRob said:
So 2 things.

1. If you don't trust them starting an iv let alone with medications how is naloxone at the BLS level even feasible?

2. You gotta pay to play. We all complain about not being respected as a profession yet many refuse to further their own education in their chosen field.
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There are places here giving it to MFR trained cops. If the junkie comes down stairs and says "he ODed," it seems to me that having the first person on scene reverse the respiratory depression instead of struggling to bag them one handed would be preferable.
 
Rev.IKON said:
i am surprised LA county even lets you look at a patient without fire being there.:rofl:
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In LA county, EMT's can look at a patient when it comes to dialysis, possibly even allowing use of a pillow:D
 
Hockey said:
If it was an opioid overdose...maybe? I've pushed it before during an arrest...a few times.
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Why?

What were you trying to accomplish? These are asphyxial arrests caused by a prolonged period of blunted respiratory drive. How is narcan going to fix this?
 
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