Naloxone Admin By EMT's

HWhite98

HWhite98

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So recently my local protocols were updated to allow the administration of naloxone (Narcan) by EMT basics via nebulizer. My question to all of you is what is your opinion on this matter? Should EMTs be able to give patients Narcan? For my fellow basics out there, are you authorized to administer Narcan?

I live in VA btw.
 
In NJ, this varies agency to agency depending on the medical director. I lean towards EMTs having the option of IN narcan.

We suck at ventilation and it adds value to EMTs in rural systems.
 
If we can teach families and addicts how to give it, why can't EMTs give it? Sure, no medicine is without side effects but more are better than not breathing and dead.
 
ERDoc said:
If we can teach families and addicts how to give it, why can't EMTs give it? Sure, no medicine is without side effects but more are better than not breathing and dead.
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Addicts give Narcan to themselves after they are unconscious? Huh?

Family members makes more sense and I just Googled it. Looks like a good idea.
 
Just by the way, you are using an atomizer and not a nebulizer.

Had in MA where I started (the police had it way before us), and I have it here in Colorado both IN and IV. I think it has a place considering how poorly many EMS providers use a BVM. A solid education program is important to teach when and when it's not appropriate to give as well as what should be given dose wise (maybe not every patient needs a full two milligrams).
 
Good comments so far. I have heard that some PD's have officers carry and administer as well, although none around here do.
 
HWhite98 said:
So recently my local protocols were updated to allow the administration of naloxone (Narcan) by EMT basics via nebulizer. My question to all of you is what is your opinion on this matter? Should EMTs be able to give patients Narcan? For my fellow basics out there, are you authorized to administer Narcan?

I live in VA btw.
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I carry it when I'm working on the ambulance, have given it myself a few times, and have been on scenes where others have given it IN (via an atomizer, not a nebulizer. A nebulizer is a bit different just so you know :)). Overall, I'd say it's a good idea.

The problem, however, is training. Many people believe that opiate use automatically buys narcan. If the patient is talking to you or you have to tell them to "hold still," odds are they don't need it (and yes, I know of at least one case where it was given to a perfectly conscious patient). If trained correctly, EMTs SHOULD be able to carry it and use it. It's a medication that truly saves lives.

It just needs to be remembered that the point of narcan pre-hospitably shouldn't be to ruin a high or wake the person up. Instead, it should be to maintain an adequate respiratory drive. Aim for breathing, not consciousness.
 
Absolutely appropriate for BLS.

Just before leaving DE I was dispatched to an arrest. BLS arrived before me. (I was a single medic in a suburban). They advised via radio that it looked like an opiate OD and were giving Narcan and assisting ventilation. A few minutes later, "patient is conscious and breathing".

Whew. No code for me. (Which was good, it was close to quitting time!)

That's when it should be used.
 
The only problem I see with BLS naloxone is potential over-use. I can envision it very frequently being given in cases of reduced LOC that are unrelated to opioid use.

Find a way to get a handle on that, and it's all good.
 
HWhite98 said:
For my fellow basics out there, are you authorized to administer Narcan?
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In Southern California thats a big fat hell no! For the most part theres a medic on scene (fire or ambulance). In my county fire has at least 1 medic on the engine and 1 medic with 1 EMT on the ambulance. BLS won't respond to 911 calls unless were lvl 0 (no ALS rigs) and that almost never happens. Would it be nice to administer Narcan as a EMT? Hell yeah! Is it practical to administer Narcan as a EMT? Hell no.
 
medichopeful said:
It just needs to be remembered that the point of narcan pre-hospitably shouldn't be to ruin a high or wake the person up. Instead, it should be to maintain an adequate respiratory drive. Aim for breathing, not consciousness.
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Emphasized for the truth....the last thing you want is a patient waking up with a ruined high in the back of an ambulance. Nor is it a good idea to slam Narcan as your wheeling the patient thru the ER doors.
 
CALEMT said:
In Southern California thats a big fat hell no! For the most part theres a medic on scene (fire or ambulance). In my county fire has at least 1 medic on the engine and 1 medic with 1 EMT on the ambulance. BLS won't respond to 911 calls unless were lvl 0 (no ALS rigs) and that almost never happens. Would it be nice to administer Narcan as a EMT? Hell yeah! Is it practical to administer Narcan as a EMT? Hell no.
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Why is it not practical?
 
Tigger said:
Why is it not practical?
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You have a medic on every 911 call wether its fire or ambulance. The only way a EMT would give Narcan would be a still alarm, or they responded to a 911 call. I meant it wouldn't be practical in the sense of stocking it on the BLS ambulances.
 
Ah. Here it is commonplace for the EMTs to give the medications in their scope even with having a medic onboard every ambulance.
 
Tigger said:
Ah. Here it is commonplace for the EMTs to give the medications in their scope even with having a medic onboard every ambulance.
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It would make more sense for the rural counties in CA i.e. Tulare, Tuolumne, Mariposa that have BLS 911 rigs but for more larger counties like Riverside, San Bernardino, San Diego that have ALS 911 rigs its not practical.
 
CALEMT said:
It would make more sense for the rural counties in CA i.e. Tulare, Tuolumne, Mariposa that have BLS 911 rigs but for more larger counties like Riverside, San Bernardino, San Diego that have ALS 911 rigs its not practical.
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We don't really do BLS 911 ambulances out here (certainly not paid). I work for a pretty rural place with P/B ambulances where the EMTs have a legitimate scope of practice (for their education) and can take their own patients. While many post overdose patients need an ALS attend, not all of them do so those patients end up being my attend.
 
NM basics have been allowed to give Narcan IN/IM/SQ for a long time. It's not had any adverse effects that I'm aware of
 
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