Melbourne MICA
Forum Captain
- 392
- 13
- 18
Gently does it
Our experience here in Melbourne has been to see dangerous confrontations with Heroin OD's virtually disappear. Depending where you work, Heroin Od's are a daily occurence - went to one this week. At their peak when everyone involved in the Afgan war was trying to make money, we could easily do 3 or 4Heroin OD'S each and every shift - thats just one branch and one shift crew. It was everywhere. Far less so now but nonetheless all too regular.
Our guideline was changed years ago from MICA only IV Narcan with road crews watching on to everyone with IM Narcan and more importantly, emphasis on BVM ventilation and managing hypoxia first. Our doses are 1.6-2.0mg IM with MICA able to give a few more 400mcgm IV doses if needed. It rarely is.
And because we ventilate and give modest doses of Narcan slowly there is no imposed withdrawl syndrome and subsequent pallor, nausea, vomiting, tachy - feeling generally like crap and ready to take it out on someone.
Our O'ds wake up slowly and almost always refuse to go to hospital. Why? Because they are fully awake with no hypoxic hangover or withdrawl symptoms. They feel OK and most often are walking around the room apologising to others or just saying: "sh*t - did I really OD?"
We are happy to leave them be provided there is another half responsible person there to keep an eye on them. No recalls for ambulance, no hospital beds taken up, the user out of harms way but not being hassled by anyone.
Its been and remains a highly effective arrangement - and if you are local you start to realise the local users don't ever hassle you because you don't do it to them.
We know most will use again and occasionally there is a death, or hypoxic brain injury event. We always talk to them and to others around them, give some friendly advice and then get out of their faces.
My perception on this from 15 yrs working in the same area is we have earned their respect. Few Melbourne heroin users give ambos crap because of it.
(Now the amphets, GHB and alcohol is another story)
I've said it before but I think the changes to our Heroin OD guidleines are probably one of the best we ever did.
MM
Our experience here in Melbourne has been to see dangerous confrontations with Heroin OD's virtually disappear. Depending where you work, Heroin Od's are a daily occurence - went to one this week. At their peak when everyone involved in the Afgan war was trying to make money, we could easily do 3 or 4Heroin OD'S each and every shift - thats just one branch and one shift crew. It was everywhere. Far less so now but nonetheless all too regular.
Our guideline was changed years ago from MICA only IV Narcan with road crews watching on to everyone with IM Narcan and more importantly, emphasis on BVM ventilation and managing hypoxia first. Our doses are 1.6-2.0mg IM with MICA able to give a few more 400mcgm IV doses if needed. It rarely is.
And because we ventilate and give modest doses of Narcan slowly there is no imposed withdrawl syndrome and subsequent pallor, nausea, vomiting, tachy - feeling generally like crap and ready to take it out on someone.
Our O'ds wake up slowly and almost always refuse to go to hospital. Why? Because they are fully awake with no hypoxic hangover or withdrawl symptoms. They feel OK and most often are walking around the room apologising to others or just saying: "sh*t - did I really OD?"
We are happy to leave them be provided there is another half responsible person there to keep an eye on them. No recalls for ambulance, no hospital beds taken up, the user out of harms way but not being hassled by anyone.
Its been and remains a highly effective arrangement - and if you are local you start to realise the local users don't ever hassle you because you don't do it to them.
We know most will use again and occasionally there is a death, or hypoxic brain injury event. We always talk to them and to others around them, give some friendly advice and then get out of their faces.
My perception on this from 15 yrs working in the same area is we have earned their respect. Few Melbourne heroin users give ambos crap because of it.
(Now the amphets, GHB and alcohol is another story)
I've said it before but I think the changes to our Heroin OD guidleines are probably one of the best we ever did.
MM
