Narcan, or Not.

StCEMT

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Our LEO folks are really big on EMS calls, they all have Defib units, trauma kits, Narcan. I've had cops beat us to dozens of CPR calls over the years and they have started CPR, shocked, and achieved ROSC prior to our arrival. Just south of us in Pierce County the Tacoma Fire Department is handing out Narcan on calls to family members when they show up on OD's. I believe they got a grant to do it.
That's awesome for them. Had one arrest I think PD make an impact on by beating us there. I've had them put a TQ or two on for me as well.
 

Never2Old

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EMS Crew: BVM, IV, titrate Narcan IV to effect, restore respiration, transport.
PD: 4mg Nasal Narcan, rinse and repeat till all the responding PD has used their Narcan and the spare in the trunk, or the patient drowns.

I am an advocate of removing Narcan from PD, and instead giving them a BVM and an AED. Couldn't tell you how many many times the PD is pushing Narcan when they should be pushing the chest.
 

KingCountyMedic

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EMS Crew: BVM, IV, titrate Narcan IV to effect, restore respiration, transport.
PD: 4mg Nasal Narcan, rinse and repeat till all the responding PD has used their Narcan and the spare in the trunk, or the patient drowns.

I am an advocate of removing Narcan from PD, and instead giving them a BVM and an AED. Couldn't tell you how many many times the PD is pushing Narcan when they should be pushing the chest.
It's all about training and having an involved Medical Director. Our cops save lives on a daily basis in King County, Washington. The Police Commander that oversees their EMS Training is a 20+ year EMT and a Senior EMT Instructor. Our Paramedics assist in "training the trainers" and they take pride in the work they do. Our LEO aren't allowed to administer their Narcan until they've checked for a pulse, start CPR if needed and apply their AED and given rescue breaths (at least 2)

Most LEO agencies are carrying Narcan because they are afraid of officers being exposed to Fentanyl and they want to be able to help their fellow officers, not a bad thing....:)
 

DrParasite

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Most LEO agencies are carrying Narcan because they are afraid of officers being exposed to Fentanyl and they want to be able to help their fellow officers, not a bad thing....:)
That's actually a really bad reason; how often are they actually exposed to Fentanyl? Better question: how many times in the past 12 months have they administered narcan to a fellow officer due to an exposure?

Now compare that to have given it to a member of the public.....

Don't get me wrong, I 100% agree that officers should and will do whatever they can to help their fellow brother in blue... but the amount of officers who die from a fent exposure, or even suffer negative irreversible effects before EMS can arrive, is tiny, at least compared to other things that kill and injures officers.

It's waaaay easier to give narcan than use a BVM. PD are not the only ones who are guilty of this. And as a FF, I look forward to the day when I can push Narcan and wake the dead. But if they aren't breathing, the solution isn't more narcan, it's manual ventilations, preferably with a BVM. too many first responders forget to do this part...

remember we are titrating till they are breathing, not until they are awake (but I still want to wake the dead with narcan).
 

KingCountyMedic

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That's actually a really bad reason; how often are they actually exposed to Fentanyl? Better question: how many times in the past 12 months have they administered narcan to a fellow officer due to an exposure?

Now compare that to have given it to a member of the public.....

Don't get me wrong, I 100% agree that officers should and will do whatever they can to help their fellow brother in blue... but the amount of officers who die from a fent exposure, or even suffer negative irreversible effects before EMS can arrive, is tiny, at least compared to other things that kill and injures officers.

It's waaaay easier to give narcan than use a BVM. PD are not the only ones who are guilty of this. And as a FF, I look forward to the day when I can push Narcan and wake the dead. But if they aren't breathing, the solution isn't more narcan, it's manual ventilations, preferably with a BVM. too many first responders forget to do this part...

remember we are titrating till they are breathing, not until they are awake (but I still want to wake the dead with narcan).
Here in Washington State in the past 12 months there's probably been fewer than 6 LEO's getting Narcan either from a fellow officer or self admin and probably in most cases didn't actually need to deploy it to begin with. There have been dozens and dozens of instances where first arriving LEO has successfully performed rescue breathing and given Narcan to appropriate patients and had good outcomes. The program is working well for us but we maintain a high level of control and training. For a cop, Narcan in your kit is one more tool you can use to save a life. Every cop in King County has a kit that contains Narcan, 2 CAT tourniquets, quick clot, HyFin Chest seal, trauma dressings, rescue mask, and AED. The are required to do quarterly training on everything same as our EMT's and many of the officers are required to be an EMT depending on where they work and their assignment.
 

DrParasite

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Here in Washington State in the past 12 months there's probably been fewer than 6 LEO's getting Narcan either from a fellow officer or self admin and probably in most cases didn't actually need to deploy it to begin with.
I bolded the important part. That part also validates my statatement in in response to your claim that "Most LEO agencies are carrying Narcan because they are afraid of officers being exposed to Fentanyl and they want to be able to help their fellow officers" is a bad idea, because they aren't using it for it's intended purposes, or when it's actually needed.

As for the rest (giving it to OD victims to get them breathing again, and not waking them up), I'm totally in favor of it. If narcan is used to restore respirations, than that's a good thing. especially if they are using a rescue mask to ensure they are breathing, and not just staring at the patient until they wake up (not saying Washington cops do this, but I have seen other LEO officers and firefighters do this)
many of the officers are required to be an EMT depending on where they work and their assignment.
Yeah, i work with a bunch of firefighters who are required to be EMTs as a condition of their job.... I question their levels of competency, their knowledge of A&P, and I wouldn't trust most to treat me unless I was near death. Unless you have spent time on an ambulance (preferably full time with a lot of patient contacts), I am going to be skeptical when you say "I'm an EMT and I know what I'm doing."
 

Tigger

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Most LEO agencies are carrying Narcan because they are afraid of officers being exposed to Fentanyl and they want to be able to help their fellow officers, not a bad thing....:)
I hope that is not true, as I am sure you aware that all the fentanyl "exposure" stories are complete BS.
 

johnrsemt

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Good I am glad it is working for you; thrilled the police are that active on EMS calls.

At my PT job the police are usually doing CPR when EMS and Fire arrive; I don't know if they have AED's or not, never noticed. Then again I have never been 1st truck in on an arrest: so everything is usually set up when I get there
 

Rommel

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Interesting that your PDs have this kind of access and skill. Has merit in high frequency areas I suppose.

Last time I was beaten by cops to a "cardiac arrest" the officer was doing sensational compressions, only the psych pt was playing dead and doing a great job at it. I still let him believe he saved her life ;o)

Out statewide protocol directs 100mcg IV/IM per dose at 2min or greater intervals until the desired response + airway management to a max of 2mg, so a little more conservative than some protocols. Its better than the old school 2mg straight up followed by the wrestling match.
 

CCCSD

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I hope that is not true, as I am sure you aware that all the fentanyl "exposure" stories are complete BS.
Nope. There ARE multiple verified exposures. I suggest you do a search. The latest is Alameda County SO, Narcotics Task Force. Feel free to contact the DEA, as they are the lead agency in the collection and verification of these reports.
 

CCCSD

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A single paper, in direct contrast to documented fact, does not mean they were not exposed.

Your responses show EXACTLY why I teach Narcan to LE. You have already made up your mind that you know more than anyone else, and that all cops are liars.

I’m glad to know that my guys will be ok and have a fighting chance if they are exposed, instead of having some medic withhold treatment. Besides, better to spray than not.

So when you do kill a cop because you felt Narcan wasn’t needed, make sure you fess up to the family and all my Brothers and Sisters out there.
 

DrParasite

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A single paper, in direct contrast to documented fact, does not mean they were not exposed.
you're right. After all, the documented facts should over ride the position of the American College of Medical Toxicology (ACMT) and American Academy of Clinical Toxicology (AACT). I mean, it's not like TOXICOLOGISTS would know anything about exposures.....:rolleyes:
So when you do kill a cop because you felt Narcan wasn’t needed, make sure you fess up to the family and all my Brothers and Sisters out there.
I have heard no reports of narcan being withheld from law enforcement by EMS, resulting .... and several cases of it being administered to conscious officers following an exposure.
Nope. There ARE multiple verified exposures. I suggest you do a search. The latest is Alameda County SO, Narcotics Task Force. Feel free to contact the DEA, as they are the lead agency in the collection and verification of these reports.
I'll call you bluff: you got an contact at the DEA I can direct this request to? an email or phone number would be great, sent via PM.

Oh, and I don't doubt that they were exposed; heck, you can walk into a heroin den and be exposed. the question is, were they exposed to the level where they were knocked unconscious and experienced decreased respirations, necessitating the narcan administration? or did they give each other narcan just because they felt icky, because they weren't wearing the recommended PPE?

BTW, here is the CDC statement on fentanyl: https://www.cdc.gov/niosh/topics/fentanyl/risk.html and https://www.cdc.gov/niosh/topics/fentanyl/healthcareprevention.html

And I know the CDC aren't cops, but they have some smart people working there Fentanyl Exposure Risks for Law Enforcement and Emergency Response Workers

And the DEA recommendation: https://www.dea.gov/press-releases/2016/06/10/dea-warning-police-and-public-fentanyl-exposure-kills
 

StCEMT

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We aren't going to kill anyone by withholding Narcan. I do it all the time and guess what? They live. Exposure does not mean they are going to be apneic and unresponsive.

Does it hurt to give? I suppose not. However, there is a time to give Narcan, and an exposure is not one of them.

You say this as if anyone of us, Tigger especially, wouldn't ensure that an officer that legitimately was exposed got the best and (emphasis here-->)most appropriate care we could offer, which is ****ing ridiculous.
 

VentMonkey

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Wait, so exposure now = overdose requiring Narcan administration? What have multiple LE agencies done for decades with the countless amounts of designer opioid epidemics prior to giving every cop Narcan kits?

I don't think training first responders to administer Narcan to be "life-saving"; educating them, yes. But those two words alone carry the heaviest of connotations pointing towards opposite directions.
 

Phillyrube

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I had a couple calls where school nurses hit kids with autoinjectors of epi because the kid saw someone with a PBJ sammich and ran screaming to the nurses office. Don't need prophylactic narcan.
 

KingCountyMedic

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I think it's great having LEO carry and give Narcan. Our LEO agencies are very well trained in providing medical aid. We are at a time right now, thanks in part to the media, that they have to carry it. It's being giving out to family members of addicts, it's given out at needle exchange programs etc. It's unfortunate but the fact is you carry it or you are asking for lawsuits. There have been many cases of officers using it on themselves or fellow officers when there was no exposure. I don't really have a problem with that at all. There has also been cases where it was needed and it helped. Our LEO in King County are using it on an almost weekly basis and doing a lot of good. I also have many friends that are cops and they face a ton of threats on a daily basis that most EMS folks can't even begin to comprehend. If my buddies feel a little bit safer because they have a nasal shooter of Narcan in their pocket and that helps alleviate a little bit of the stress of going out there and dealing with bad guys then I say GOOD DEAL.
 

StCEMT

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I don't mind that they have it, I just think it's use needs to be properly taught and comprehended. Just like tourniquets. One of the more severe shootings I ran this summer had a TQ in place by PD and appropriately so. It made a difference, because it was a 3 person shooting spread out over about 1/4mile and we were the second unit in having to figure out a location. I am all for them having the right tools in stuff like this, because I've seen the benefit. I just want them to know either A. How to progress up treatments before jumping to the new addition or B. Knowing what people you SHOULD skip everything and go to a TQ or Narcan. I don't think it should just be added to their kit with a 5 minute summary, pat on the back, and a go get em.
 

Tigger

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A single paper, in direct contrast to documented fact, does not mean they were not exposed.

Your responses show EXACTLY why I teach Narcan to LE. You have already made up your mind that you know more than anyone else, and that all cops are liars.

I’m glad to know that my guys will be ok and have a fighting chance if they are exposed, instead of having some medic withhold treatment. Besides, better to spray than not.

So when you do kill a cop because you felt Narcan wasn’t needed, make sure you fess up to the family and all my Brothers and Sisters out there.
Oh my. So much to unpack here.

So the thing with the "single paper" is that it's the summation of available research as put forth by legitimate subject matter experts, of which none of us are. So yes, that is the one I posted. You're right though, the number of papers that exist on a particular subject is how one decides if a point is valid or not.

Not sure where you got the impression that I would withhold treatment to the theoretical officer that's hypoxic and hypercapnic. If the patient is presents as such secondary to likely opioid exposure, I suppose I might give some Narcan. I might also just RSI them given the fact we have no idea what the "white powder" in question is. But yea, kill a cop through gross negligence? Not sure where you got that impression from.
 
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