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Narcan, or Not.

Discussion in 'ALS Discussion' started by Phillyrube, Sep 20, 2018.

  1. Tigger

    Tigger Dodges Pucks Community Leader

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    Other ways to alleviate said stress might be to just provide education?

    I am totally for law enforcement carrying narcan to be clear. I think they can make a huge difference just given their likely response time to overdoses.
     
  2. KingCountyMedic

    KingCountyMedic Forum Lieutenant

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    We provide both, not all LEO's are fortunate enough to have a EMS Medical Director and EMS Agency that takes an active role in their training and education. Those folks probably feel a lot better having it "just in case"

    I'd love to see more education for not only LEO but for all EMS providers....:)
     
  3. Remi

    Remi Forum Deputy Chief Premium Member

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    Dude, really?

    First, just because a cop thinks they were exposed and used narcan doesn't mean they were actually exposed, so narcan deployment is not evidence of anything. Second, nothing that anyone said in this thread indicated that they would withhold narcan that was clinically indicated and "kill a cop". Lastly, the fact that you "teach narcan to LEO" doesn't make you an authority on the subject, and certainly does not make you more objective.

    So seriously, the histrionics are not necessary.
     
    Never2Old and DesertMedic66 like this.
  4. ParamagicFF

    ParamagicFF Forum Crew Member

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    I wonder if the reason the guy panicked was because he woke up to 8 people holding him down? I would say I average between 1-2 narcan administrations per 24 hour shift at work. Our protocol for ALS or BLS is to give 2mg IM/IN for the unconscious heroin user regardless of respiratory effort. Regardless of personal feelings about the protocol or our local healthcare system strategies for these patients, it is how we handle these calls.

    That being said, I have NEVER had a single patient wake up combative. I have literally seen hundreds of patients go from unresponsive to standing and talking, and not once have they been combative. They may be uncooperative, not wanting to talk to me or admit to drug use, but they are never combative. I've seen them get sick and vomit, have diarrhea, and shiver. There is also the characteristic long yawn. But I've never seen someone angry or violent.

    Then again, we never try to restrain them physically. We support their respirations and oxygenation, and as they become rousable we give speak to them about the circumstances like we would a postictal patient. 90% of these patients end up refusing care either by listening to the informed consent speech, or by simply walking away and stating they don't want to deal with me anymore. The remaining 10% that accept transport are usually those that want to go get food.
     
  5. ZombieEMT

    ZombieEMT Chief Medical Zombie Premium Member

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    When Narcan first became available to BLS and PD, it was the standard 2mg kit that we had to assemble for IN administration. Generally we gave it, and I never had issues. Recently the 4mg doses became available that require no assembly. What happens is police get on location and they just keep pushing. Patients that might have gotten 4mg are now getting 8mg. Sometimes we are seeing police even giving up to 16mg, then our patients become agitation and vomit. :(
     
  6. NPO

    NPO Forum Deputy Chief

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    That's an education problem, not a supply problem.
     
  7. Joshua Henson

    Joshua Henson Forum Ride Along

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    I don’t think Police should have this.
     
  8. CCCSD

    CCCSD Forum Crew Member

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    Histrionics? No. Just real. If you weren’t there, and haven’t read the reports, then you needn’t make such a comment. I don’t know where you get your misinformation, I get weekly updates on exposures as part of my job.

    It’s simply AMAZING that some paramedics are so well trained that they can diagnose from across the country, and their chemical analysis skills are so incredible that I don’t understand why we bother with narcotics dogs.

    So...based on how you think, if a patient told you they were bleeding, but you didn’t see anything, you would just blow them off, because you don’t feel that they know what’s happening to themselves, but you always know better, right?

    Your fellows said they would withhold Natcan unless they felt it was needed, in this and other cases, just read the thread on Narcan use for PEA etc.

    I’m an quite versed in my role as a POST certified instructor, having written not only the EMS research paper, EMS Policy, and certification course, but I’ve spent hundreds of hours on research, application, and use.

    Good Day.
     
  9. CCCSD

    CCCSD Forum Crew Member

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    Why? Because they are cops?
     
  10. Remi

    Remi Forum Deputy Chief Premium Member

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    his·tri·on·ic
    /ˌhistrēˈänik/
    noun
    plural noun: histrionics
    1. exaggerated dramatic behavior designed to attract attention.
      synonyms: dramatics, theatrics, tantrums; More
    Apparently I need to remind you:


    If I wasn't where? Seriously, what are you even talking about? The comment that made you fly off the handle was that administration of narcan is not itself evidence of exposure. Which is 100% true. That's basic reasoning. No one has suggested that naloxone is never needed in these cases.

    I know paramedics who love to give narcotics, and use them way more than others in their system. Is that itself evidence that their patients have more pain? Of course not.

    Would I blow them off? No, of course not. I'd do an assessment. But if you are asking my whether I'd apply a tourniquet and pressure dressing to an extremity that shows no evidence whatsoever of hemorrhage, the answer is I would not. Would you?

    Well yeah….that's exactly how medicine works. Interventions are provided as indicated….I don't give anyone anything that isn't indicated, just because they think they need it.

    I don't instantly shock someone with a history of SVT just because they tell me their heart is racing….I put them on the monitor, do an assessment, and make a diagnosis. I don't slam 2mg of dilaudid into someone who walks up to me and tells me they need dilaudid because are in pain….I do an assessment and figure out the best drug and dose. I don't slam antibiotics into someone just because they tell me they haven't been feeling well. And lastly, no, I don't pump someone full of naloxone who is talking to me and not showing any signs of opioid intoxication, just because they tell me they were exposed.

    The narcan use in PEA has nothing to do with this. Yes, I will give narcan to someone in PEA if I think opioids may be part of why they arrested. There's also the novel use of high doses of naloxone as a sympathetic agonist. Not sure how that's relevant here, but you brought it up.

    Very impressive. But I would expect someone with your academic credentials to have more respect for the type of published work that Tigger posted the link to, and not to get so emotional when people express alternative views based on reason.

    If you want to educate us on the shortcomings of our understanding, please do. Pro tip: teaching and changing minds is much easier when you don't insult your audience and when you rely more on reason and published evidence than emotion.
     
    DesertMedic66 and VentMonkey like this.
  11. DrParasite

    DrParasite The fire extinguisher is not just for show

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    So your reports are all validated by lab results, and reviewed by toxicologist (you know, experts in this type of stuff), before they get disseminated? OR were they simply officer A was exposed to an opiate, was given narcan, and he is still with us and back on the job? BTW, just because your "exposed" to an opiate, doesn't mean narcan is indicated.

    But why don't you read the published and validated report from a known toxicologist? It was published in Emergency Medicine News,and explains what actually happens. Oh, and that's coming from an actual expert, and regarded as a "brilliant clinical toxicologist." I am pretty sure the authors of your weekly reports can't say the same.
    Because a dog can sniff a narcotic, while most paramedics can't? and just because a bloodhound catches a whiff of heroin, doesn't mean we need to give every cop preventative narcan, just in case.
    Ummm, if my patient is telling me they did heroin, than that chances are pretty good that they don't need narcan.

    Why do we give narcan again? What are the indications? Can you refresh my hose dragging brain?
     
    Last edited: Jan 3, 2019
    DesertMedic66 and Remi like this.
  12. Tigger

    Tigger Dodges Pucks Community Leader

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    Could you post the paper and policy? What course?
     

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