Should we use Narcan on all CPR calls?

VentMonkey

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So in NJ, BLS and PD protocol is 2mg IN. So guess what every single unconscious patient i go to gets from the cops before i arrive? 2mg IN Narcan. we have tried to teach them but it has been an uphill battle. Its probably 50% of my patients who come up agitated and combative.
What's your relationship like your local LEO's, and how well are your BLS providers taking to the protocol? Are they doing a better job than LE seems to be doing regarding judgement, and restraint with when to properly administer the Narcan?
 

DrParasite

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Just as an aside, how many people are regularly slamming huge amounts of Narcan and having their patients wake up flailing and fighting? Do people still really do this?
I've seen it happen once, on an accidental OD on prescribed pain meds.... unfortunately, the patient happened to be a former linebacker and current LEO, so it was not fun during the first 30 seconds, but once he realized what happened, he was fine and grateful that we were there to keep him breathing and alive.

I have heard anecdotal stories about paramedics giving 2 mg of narcan and then leaving the room for BLS to carry the patient out, or giving 2 mg of Narcan as they are walking into the ER and letting the hospital staff deal with the projectile vomiting that follows. \

The majority of ODs who get Narcan don't wake up fighting, despite what many senior paramedics tell their newbies; I've dealt with more combative drunks than opiod ODs.
What's your relationship like your local LEO's, and how well are your BLS providers taking to the protocol? Are they doing a better job than LE seems to be doing regarding judgement, and restraint with when to properly administer the Narcan?
Probably similar to mine: good guys, good at the LEO stuff, not so great at the medical side, but if they can save a life with narcan before EMS gets there, they will. They are also the types who go into house fires with a fire extinguisher and try to put the fire out before the fire department gets there.

I do think the lack of oversight and accountability from a medical authority when it comes to LEO administered Narcan is one of the huge causes of this.
 

EpiEMS

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So in NJ, BLS and PD protocol is 2mg IN.

My protocol is the same, no room to titrate to effect. I have to say, I'd rather BVM for the 2 minutes it takes me to get a medic on scene (in the rare case that I'm not with one).
 

NomadicMedic

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My protocol is the same, no room to titrate to effect. I have to say, I'd rather BVM for the 2 minutes it takes me to get a medic on scene (in the rare case that I'm not with one).

It would give you the opportunity to practice your BVM technique. Something most providers could use.
 

EpiEMS

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It would give you the opportunity to practice your BVM technique. Something most providers could use.

Yup, that's my preference. Same reason why it doesn't bother me (practically speaking) so so much to work a futile code.
 

usalsfyre

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2mg IN rarely needs to be titrated, I'm not 100% sure what the fear is? IV naloxone is far more unforgiving.

Perhaps I've just seen too much ham handed BVM use.
 

VentMonkey

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My experience with IN Narcan has actually worked quite well. 0.5 in each nostril seems sufficient enough to get their respiratory drive up enough where I can move them from whatever floor they're found on, to the gurney, and then to the back of the unit just enough to reassess their mental status, drop a lock, and determine if they need anymore titrated for the trip to the ED.

A BLS provider properly delivering breaths via BVM upon my arrival is simply an added bonus.
 

Bullets

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What's your relationship like your local LEO's, and how well are your BLS providers taking to the protocol? Are they doing a better job than LE seems to be doing regarding judgement, and restraint with when to properly administer the Narcan?
Generally pretty good. On a 100 man department we have probably 6ish current or former EMTs. But like @DrParasite said, their training has filled their heads with heroism and the media absolutely loves it. A headline a week "Local cops save man". We have been able to educate some, but its not uncommon to get radio updates of 1, 2, 3 narcans delivered prior to our arrival.

Our BLS providers have no problems, but we just rarely get to use it because the cops carry 2-3 doses per cop.
 

E tank

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How routine is the use of an oral or nasal airway with mask ventilation for folks? Always? Sometimes? Hardly? Do you teach it?
 

NysEms2117

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just as a reference Parole officers in the State of New york do not carry narcan in our cars. Police do, as well as state troopers.
 

VentMonkey

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Generally pretty good. On a 100 man department we have probably 6ish current or former EMTs. But like @DrParasite said, their training has filled their heads with heroism and the media absolutely loves it. A headline a week "Local cops save man". We have been able to educate some, but its not uncommon to get radio updates of 1, 2, 3 narcans delivered prior to our arrival.

Our BLS providers have no problems, but we just rarely get to use it because the cops carry 2-3 doses per cop.
Right, I worry this would be a similar effect if our local LEO's and/ or fire first responders were given this (even some overzealous EMT's, though they're theoretically easier to remediate in-house).

I'm not saying it shouldn't be an option, but as your example implies, the "hero mechanism" seems all too often to put blinders on these folks in spite of our best efforts, and intentions to properly educate them.
 

VentMonkey

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How routine is the use of an oral or nasal airway with mask ventilation for folks? Always? Sometimes? Hardly? Do you teach it?
When I first started out, our company only stocked nasal trumpets in the BLS first-in bags (no clue why). Well, I would always ask our supply techs for a stack and they were usually kind enough to wrap one in each size in a rubber band, and I would stuff it in my first-in bag (same with the bougies, but another medic kindly swiped that without hesitation). I must not have been the only one bugging because now they're in every jump bag, ALS and BLS.

To answer your question though, tank I use NPA's whenever applicable, and appropriate with semi-conscious, and/ or unconscious--->soon to be conscious types...like an OD.
 

NomadicMedic

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I use an oral and a nasal every time I mask ventilate someone.

And 0.5 in the snout always seems like enough to get them breathing again. I rarely use any more than that. It's not uncommon to hear the ED doc order 2mg IV for a breathing, sleeping OD as I'm walking out. "Better you than me pal..."
 
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DrParasite

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How routine is the use of an oral or nasal airway with mask ventilation for folks? Always? Sometimes? Hardly? Do you teach it?
I always teach students to use an adjunct whenever they are using a BVM. I typically start with an OPA, unless I think they are going to get better shortly (IE, an opiod OD or a witnessed arrest who arrests in front of me who i can shock immediately), then I might start with an NPA. Or if they have a gag reflex, it's NPA or two.

It makes such a difference. I've seen a patient go from poor compliance prior to OPA to much better with OPA..... I tell people all the time, it makes things much easier for all parties involved.
 

E tank

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It makes such a difference. I've seen a patient go from poor compliance prior to OPA to much better with OPA..... I tell people all the time, it makes things much easier for all parties involved.

Absolutely...been doing this kind of work for 30+ years and I use an OPA on everyone I mask ventilate. So much of what we do is made easier by getting out of our own way, and using an airway to mask ventilate is definitely a biggie.

C- mask ventilation can be brought up to a B- or B just by using one. Preach it Brothah!!!
 

StCEMT

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How routine is the use of an oral or nasal airway with mask ventilation for folks? Always? Sometimes? Hardly? Do you teach it?
The last time I worked my way up the ladder. Got there and an off duty doc was bagging with positioning-->I got an OPA--> Then I replaced the OPA with an igel a a little later. For me it's most of the time, it just depends on if we are going straight to an SGA or not.
 

EpiEMS

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How routine is the use of an oral or nasal airway with mask ventilation for folks? Always? Sometimes? Hardly? Do you teach it?

Tube in every hole - double NPA plus an OPA. That said, I am lucky to have ALS with me 90% of the time, so it's usually just me BVM'ing with an OPA until they are dropping an ETT. Which, frankly, seems to be a waste for most of my calls - they are typically arrests due to cardiac cause, so time spent ETT'ing is time off the chest...right?
 

StCEMT

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Tube in every hole - double NPA plus an OPA. That said, I am lucky to have ALS with me 90% of the time, so it's usually just me BVM'ing with an OPA until they are dropping an ETT. Which, frankly, seems to be a waste for most of my calls - they are typically arrests due to cardiac cause, so time spent ETT'ing is time off the chest...right?
Although the exception rather than the norm in my limited experience, my last arrest is why I don't believe in jumping straight to intubation. You're awake? Cool, lets just pull this out.
 
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