This is why you only give enough narcan to get them to breathe.

[9D4]

Sherm showed it's ugly face here the other day. I'm not excited for it to become popular. They're also worried about Krokodil showing up here soon.

Never had a violent wake up, never had someone puke either. IV and 0.2 increments make it happen smoothly and safely. I can bag someone all day long with my vent (basically a demand valve with TV/RR settings) and a BVM mask, some suction and a BLS adjunct.

From my limited knowledge isn't sherm a PCP dipped cig? Hasn't that always been in the market, not really mainstream though, right? I may just be too young to ever remember it a lot, though.
Apparently lucky us in Az got one of the first cases of Krok in the states. Not only that, but there's been several more now. One of the girls at the hospital that treated him actually got permission to record them cutting an incision on his leg. Wasn't easy to watch at all...
Kinda makes me wonder about the demographics of the users, though; Az, Illinois and Oklahoma are apparently the most common states so far. Not a lot of continuity between those three.

 

[Christopher]

Ok, sounds like the MDs in that area are willing to accept that risk.:huh: Because no MDs around FL that I am aware of, are willing to do that at all. :unsure:

To say nobody dies from naloxone treat and release is actually not far from the truth.

At least it isn't far from the studied truth.

RESULTS:
There were 117 ME cases of opiate overdose deaths and 317 prehospital patients who received naloxone and refused further treatment. When compared by age, time, date, sex, location, and ethnicity, there was no case in which a patient was treated by paramedics with naloxone within 12 hours of being found dead of an opiate overdose.
CONCLUSIONS:
Giving naloxone to heroin overdoses in the field and then allowing the patients to sign out AMA resulted in no death in the one-year period studied. This study did not evaluate for return visits by paramedics nor whether patients were later taken to hospitals by private vehicles.
(PubMed)

Vilke looked at it again in 2003

RESULTS:
There were 998 out-of-hospital patients who received naloxone and refused further treatment and 601 ME cases of opioid overdose deaths. When compared by age, time, date, sex, location, and ethnicity, there were no cases in which a patient was treated by paramedics with naloxone within 12 hours of being found dead of an opioid overdose.
CONCLUSIONS:
Giving naloxone to patients with heroin overdoses in the field and then allowing them to sign out AMA resulted in no identifiable deaths within this study population.
(Pubmed)(Full Text PDF)

If you don't like Vilke...

RESULTS:
The list identified 592 patients treated with naloxone and not transported to the emergency department. Five-hundred fifty-two patients received naloxone and refused transport or were not transported. The remaining 40 patients all presented to EMS in cardiac arrest, naloxone was administered during the course of resuscitation, and subsequent efforts were terminated in the field. None of the patients receiving naloxone with a subsequent patient-initiated refusal were examined at the MEO within the two-day end point. The 30-day assessment revealed that nine individuals were treated with naloxone and subsequently died, but the shortest time interval between date of service and date of death was four days.
CONCLUSION:
The primary outcome was that no patients who were treated with naloxone for opioid overdose and then refused care were examined by the MEO within a 48-hour time frame.
(PubMed)(Abstract and Figures PDF)

However, they may not choose to stop abusing and have some risk of death from continued abuse:

RESULTS:
The authors recorded 4762 episodes of opioid overdose, covering 1967 unique identified patients. A total of 78 patients (8.4%, 95% CI 7.0 to 10.4) died within 48 h in the period 1999-2003, and 85% (66/78) of these had cardiac arrest and died. The authors found age >50 years and overdose during the weekend significantly associated with 48-h mortality. Gender, former episodes of opioid overdose, time of the day, month or year were not significantly associated with increased mortality.
CONCLUSIONS:
The author found a 48-hours mortality of 8.4%. Advanced age and opioid overdose in the weekends were significant risk factors. Release on scene after treatment was associated with a very small risk.(PubMed)

Treat and release is safe. Seriously.

 

[exodus]

Ok, sounds like the MDs in that area are willing to accept that risk.:huh: Because no MDs around FL that I am aware of, are willing to do that at all. :unsure:

You going to force an AOx4 patient to go?

 

[AeroClinician]

You going to force an AOx4 patient to go?

I know of one MD that has it written into the protocols, to deem them as "medically incapacitated" post narcan, and transport with restraints, even if they become A/Ox4. The short half life of narcan is cited as the reason.

With that said, it becomes the MDs problem if they are taken against their will, and then come back to sue.

 

[exodus]

I know of one MD that has it written into the protocols, to deem them as "medically incapacitated" post narcan, and transport with restraints, even if they become A/Ox4. The short half life of narcan is cited as the reason.

With that said, it becomes the MDs problem if they are taken against their will, and then come back to sue.

It's your problem when you're arrested for assault and battery + kidnapping with forced restraint isn't it?

If someone tells you to commit a crime, you will do it blindly?

 

[AeroClinician]

It's your problem when you're arrested for assault and battery + kidnapping with forced restraint isn't it?

If someone tells you to commit a crime, you will do it blindly?

He refers to this statute:

http://www.flsenate.gov/laws/statutes/2011/401.445

 

[Paramedic0311]

Narcan

I have had two patients become violent. Always try and titrate to reps.

 

[exodus]

He refers to this statute:

http://www.flsenate.gov/laws/statutes/2011/401.445

(a) The patient at the time of examination or treatment is intoxicated, under the influence of drugs, or otherwise incapable of providing informed consent as provided in s. 766.103;
(b) The patient at the time of examination or treatment is experiencing an emergency medical condition; and
(c) The patient would reasonably, under all the surrounding circumstances, undergo such examination, treatment, or procedure if he or she were advised by the emergency medical technician, paramedic, physician, advanced registered nurse practitioner, or physician assistant in accordance with s. 766.103(3).

C: If they are AOx4, then section C is invalid. Also, B.. Once they're awake, there is no longer an emergency medical condition. I would fire off an email to your district attorney and ask for their thoughts.

 

[jlw]

This is not surprising in this area, opioid overdoses are quiet common and frequently treated by CFD. These situations are treated nearly like a non-emergency situation due to their cause and frequency.

 

[rwik123]

This is not surprising in this area, opioid overdoses are quiet common and frequently treated by CFD. These situations are treated nearly like a non-emergency situation due to their cause and frequency.

Huh? Just because you may frown upon junkies and it happens way to much doesn't make it any less acute.

 

[Carlos Danger]

Huh? Just because you may frown upon junkies and it happens way to much doesn't make it any less acute.

Where in his post did he say anything that leads you to believe he "frowns upon" junkies?

Like most disease processes, opioid abuse tends to be a very chronic problem, not at all an acute one.

An opioid OD is acute, but once it is fixed, there is nothing more that EMS or the ED is going to do for the patient.

Therefore, after the narcan is given and the patient is woken up, the situation is not treated as an acute problem.

Make sense?

 

[jlw]

Huh? Just because you may frown upon junkies and it happens way to much doesn't make it any less acute.

I agree, but I don't work for CFD, but I do work in this city.

 

[rwik123]

I agree, but I don't work for CFD, but I do work in this city.

Sorry didn't mean it to seem like I was critiquing your personal view...more the system as a whole.

 

[Smash]

Simple heroin overdoses have been a catch and release call for well over a decade in Melbourne, Australia. It is safe, effective and sensible.

Treating heroin overdose like in the video posted is none of those things.