"Multiple Naloxone Administrations Among Emergency Medical Service Providers is Increasing"

[EpiEMS]

For your reading pleasure.

Here's a highlight to ask yourself about (QA/QI folks): "

There was large variation in MNA by level of EMS service. BLS and BLS Emergency levels of service only provided MNA 11.9% and 8.4% of the time, respectively. The Advanced ALS Level 2 had the highest percentage of MNA (23.1%). EMS also administered oxygen in 46% of the events and, in those events, MNA was more common (19.5%).

Obviously, this could be due to incomplete data, but it certainly makes me wonder: Are EMS providers skipping steps (e.g.in protocols)?

 

[StCEMT]

I don't know, but my OD's typically go like this. FD has OPA+BVM. Pt is breathing about 9/min and in a land of dreams. Pull out the OPA because it's dumb. From there, they all start off the same. Anyone that I'm comfortable with gets NPA+EtCO2/O2+18ga. If I don't like what I see I add BVM+0.5mg Narcan-->0.5mg-->1mg.

Many times they are waking up around my arrival time without Narcan. They live and I don't have to swap my drug box.

 

[hometownmedic5]

In my town, PD/FD are now carrying the 4mg one step nasal spray. At one time, and I'm getting conflicting reports as to whether this is still true or not, the PD got 8hrs of comp time everytime they gave it. It was routine(and to a slightly lesser degree still is) to show up on scene to an overdose and find multiple cruisers on scene and multiple doses administered with a very conscious, very alert, and very angry patient.

All of that to say I almost never give narcan anymore. If they are/would charge me with those "multiple administrations", then sure; but personally I almost never give it.

 

[EpiEMS]

multiple cruisers on scene and multiple doses administered with a very conscious, very alert, and very angry patient.

This is the solution creating a problem of its own, I (not ironically) love this example.

 

[RocketMedic]

I wish I got Como tome for giving meds!

 

[Bullets]

In my town, PD/FD are now carrying the 4mg one step nasal spray. At one time, and I'm getting conflicting reports as to whether this is still true or not, the PD got 8hrs of comp time everytime they gave it. It was routine(and to a slightly lesser degree still is) to show up on scene to an overdose and find multiple cruisers on scene and multiple doses administered with a very conscious, very alert, and very angry patient.

All of that to say I almost never give narcan anymore. If they are/would charge me with those "multiple administrations", then sure; but personally I almost never give it.

Basically the same. Our cops love giving narcan to anyone who takes opiates. Usually one or two doses before we get there, even though the initial update is that the patient is breathing

Cops get real angry when we RMA them. I keep telling them to stop giving narcan but they just love that stuff. Gets them in the papers and all kinds of famous hero stuff

 

[StCEMT]

Before I moved, STLFD (the fire trucks) got IN Narcan that came in 4mg doses. You bet your *** those folks were awake when I got there. FD doesn't have Narcan here, but they are fond of OPA's for OD's unless I get there first to gently remind them I don't want puke in my truck.

 

[E tank]

...whether this is still true or not, the PD got 8hrs of comp time everytime they gave it. .

Lots of J-walkers get narcan where you are then, yeah?

 

[Carlos Danger]

At one time, and I'm getting conflicting reports as to whether this is still true or not, the PD got 8hrs of comp time everytime they gave it.

WTF?

 

[hometownmedic5]

The police unions around here are screwy.

I know a guy who was at one time the president of the union in the town I grew up. A local merchant donated an AED for every cruiser. The union held up putting them in service stating it was a change in job description requiring a renegotiation of compensation. They eventually got their raise because someone went to the town and said if the papers get ahold of a story where someone died because the AEDs were collecting dust in a locker, it's going to get ugly.

When PD narcan became a thing, the same thing happened. It's probably cheaper to only compensate officers when they actually do it v. paying every officer every hour for nothing.

Mind you, I don't agree with this. I'm just reporting the story.

 

[E tank]

When PD narcan became a thing, the same thing happened. It's probably cheaper to only compensate officers when they actually do it v. paying every officer every hour for nothing.

Mind you, I don't agree with this. I'm just reporting the story.

Going out on a limb here...I'm going to guess the EMS folks aren't compensated a bonus for restraining a violent patient.

 

[hometownmedic5]

I certainly am not, however you could argue that doing so is within the job description of an EMT while administering meds is not within the description of a cop.

I get what they're saying, even if I don't agree.

 

[trekmedics]

At some point, (and it's probably at a point called "carfentanil") a service is either going to run out of available units to respond to every overdose, or they're going to run out of narcan.

Anyone know where they are dispatching any of these laypersons that are being trained to carry and administer narcan?

 

[hometownmedic5]

I just gave narcan for the first time in my readily accessible memory. FOS for an overdose, 2mg nasal with judicious bagging, dumped a line and gave home two more and voila, were in business. If the second due ambulance had taken that call, the police/fire would have loaded him up with at least 12....