Narcan, or Not.

Tigger

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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.
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.
 

KingCountyMedic

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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.
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....:)
 

Remi

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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.
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.
 

ParamagicFF

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Ok, watching Nightwatch on AETV. First call, overdose. Cool. Get him in the box, O2, pulseox. EtCO2., Fire department bagging guy. Start an IV, and "Narcan is in". Next second guy is up, with like 8 people trying to hold him down. Blood from the pulled out IV sprays everyone. Finally guy calms down after being restrained every which way.

Sound familiar? How do you handle it? Our protocols call for 2-4 mg narcan IV or IN. With the advent of CO2 monitoring, do we need to throw the entire dose on the patient? We've been giving the patient 1-2 mg narcan, and monitor. If the numbers are good, let them sleep. Now, we gotta train the cops not to be so quick with their INs. Had a couple get pissed cause the woke up the pateint, who is now combative, and I made them ride in with us (helps that I was also a PD supervisor).

What say you?

Carry on, boys.
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.
 

ZombieEMT

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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. :(
 

NPO

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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. :(
That's an education problem, not a supply problem.
 

CCCSD

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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.
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.
 

Remi

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Histrionics? No. Just real.
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:
You have already made up your mind that you know more than anyone else, and that all cops are liars.

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.


If you weren’t there, and haven’t read the reports, then you needn’t make such a comment.
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.

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?
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?

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.
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.

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.
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.
 

DrParasite

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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.
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.
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..
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.
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?
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?
 
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Tigger

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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.
Could you post the paper and policy? What course?
 

bbrg548

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Narcan drip. NPA/EtCO2/NRB or BVM if ventilations are too low. **** around for a few minutes while EtCO2 and O2 sat returns to a happy place then start an IV. 2mg Narcan in 250cc. Titrate to effect just like D10.
Could you show us your protocol for this? We're redoing our protocols and I'd like to submit something similar for consideration, and something to use as a reference would be very helpful.
 

StCEMT

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Could you show us your protocol for this? We're redoing our protocols and I'd like to submit something similar for consideration, and something to use as a reference would be very helpful.
We don't actually have one specifically for it. Did it in response to almost getting kicked in the face.
 

NPO

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EMS World published an article about paramedics giving Suboxone or Subutex with narcan. Apparently New Jersey has added this in their state protocols.

I'm interested to hear some opinions from the wise and experienced people here.
 

GMCmedic

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EMS World published an article about paramedics giving Suboxone or Subutex with narcan. Apparently New Jersey has added this in their state protocols.

I'm interested to hear some opinions from the wise and experienced people here.
I think its buprenorphine. Buprenorphine and narcan essentially make suboxone.
 

CCCSD

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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?
I’m not here to teach you what you should know. However, if you need a class, I’d be happy to set you up.
 

DrParasite

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I’m not here to teach you what you should know. However, if you need a class, I’d be happy to set you up.
translation: you don't know, you're teaching bad information not based on actual medicine but on panic and hysteria, and when someone someone calls you out on it, you aren't able to back up your BS claims with actual facts or science. but if I wanted, I could pay you to tell me all this incorrect information.

I think I'll pass on your offer; thanks though.
 

hpclayto

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We issue it to all of our people. I don’t have a problem with it. I agree that the risk of exposure through daily operations is extremely small. If you can ask for narcan you don’t need narcan. The majority of time we make scenes long before the fire department and are waiting 5-15 minutes for an ambulance. The negative effects of pushing too much too fast are minuscule as opposed to not giving it. It’s harmless, a lot easier to carry than a BVM and is a simple thing for patrol guys to give because the majority of cops are idiots when it comes to doing non cop things.
 

DrParasite

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The negative effects of pushing too much too fast are minuscule as opposed to not giving it. It’s harmless, a lot easier to carry than a BVM and is a simple thing for patrol guys to give because the majority of cops are idiots when it comes to doing non cop things.
and it's great, until you come across an unconscious and apneic patient who either ODed on drugs other than opiods, or who didn't OD at all..... then you can give all the narcan you want, but the patient is still going to die.
 

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