Northern Westchester Heroin Overdoses

[NWFDMedic 58]

My major concerns with giving first responders Narcan would be airway protection and other drugs on board. We all know the vomiting that is almost sure to occur after Narcan, even if pushed at 0.4 mg intervals. Also, I had a reported heroin overdose a few weeks ago that actually had quite a few other things on board. The heroin was causing some respiratory depression but actually masking the effects of the other recreational pharmaceuticals. Once I fixed the heroin part, I had to manage the patient pretty aggressively due to the other stuff on board. With the tools available to a BLS provider, I think bagging that patient would have been the most effective means of patient care whereas if they had used IN Narcan, they would have had a world of other issues.

[911FIRE 0]

Instead of taking a reactive approach to the drug overdoses in N westchester by giving pd/fd narcan, whay not take a proactive approach and have law enforcement really crack down on the growing drug use that is happening in these locations? I understand that some of the areas where this has happened have rather small pd's i.e. croton falls somers etc. that is where the county pd needs to come in and support the pd's in combating the problem.

[Jybehofd 85]

how about instead of giving out Narcan they cops start cracking down on this s*** and arresting the hell out of people for it. its been going on too long up here in northern westchester for way too long. i remember back in my high school days when it was getting bad and kids were doing it in schools in between classes at a VERY well to do high school too. it needs to be put under control before it gets worse then it is... and the rate its been going its going to be bad.

[ny10570 745]

Do you really think the problem is on PD?? Cracking down on the users doesn't have any affect on this crap. All it does is tie up cops, courts and jails while someone else is out there getting high. Look at how completely ineffective the Rockefellar era drug laws were at detering drug use.

[Jybehofd 85]

narcan sure isn't going to fix it. that is like a finger holding back a dam when hurricane is coming something should be done

[ny10570 745]

What narcan does is keep the junkies alive. Hopefully long enough to eventually hit bottom and seek recovery.

If you can figure out how to stop people from using you can push $15 Billion a year back into the government's coffers and thats just on the federal level. What is certain is punishing users does nothing to curtail use and adds expenses.

[Guest alsfirefighter]

A couple of thoughts on a few comments I've read.

I repeat this below...I have no issue with BLS or PD having narcan. But....in the end they already have the most important skill available to them...AIRWAY MANAGEMENT. Bag the patient! They need oxygen until narcan can be given...or the opiate wears off. Get them moving if ALS isn't on scene or not available. If you bag them...they generally will do ok as that is why their heart rate increases is due to hypoxia from the respiratory depression the opiate causes!

1. There is no collation that any of the Heroin on the street is "bad." The majority of OD's I've done have been due to those who haven't used in a while and use too much. Or some just used to much overall. Plus every batch of heroin in literal ways..."is bad."

2. Narcan is in most Firefighters hands as many of us are dual role Fire/ALS. There is no collation that either skills suffer in high volume departments with excellent training programs. That argument never holds water on any side. If it did none of us would have skills or trades outside the fire service...I mean we would have to suck at one right?

3. France and other european countries a few years ago were piloting narcan autoinjectors. I have no issue with having IN narcan out there or the autoinjectors..which may be the better answer as the absorption rate is probably a bit slower and will allow the patient to increase in mental status a bit slower and improve respiratory effort.

Again.. here is the biggest thing that some have missed in their points on BLS or anyone else...IF YOU ARE RESPONDING TO AN OD AS FD...YOU SHOULD HAVE MEDICAL TRAINING ALREADY ANYHOW. PD maybe not..however BLS already has the most critical skill that is needed for an opiate overdose...AIRWAY MANAGEMENT. Bag the frigging patient..and get them moving if ALS isn't there or available. Either ALS will get there...or you will get them to the ED...and/or some of the drug will work its way out of their system.

[Guest alsfirefighter]

One more thing...anyone who brings up "cracking" down on the drugs..really doesn't understand the scope of the problem nor the drug trade, networks. You really thing LE isn't actively investigating and doing their part? In my municipality they have a very proactive and successful drug unit that consistently makes arrests and investigates suppliers...so then what? I mean with the meth trade in the west...is LE sitting on their hands?

[911FIRE 0]

Its not to say that LE is "sitting on their hands" or "not doing their job" that is not what I said. My suggestion was that instead of dealing with the problem after it happens, dealing with it before it happens may be more beneficial. Thats great that your municipality is able to conduct drug investigations on such a scale. But what about departments like Somers PD who have limited powers and arent on 24hrs/ day. I understand that they are supplemented by Troopers, but the Troopers have several other municipalities in northern westchester to deal with...just trying to look at this from a different angle

[JJB531 652]

Its not to say that LE is "sitting on their hands" or "not doing their job" that is not what I said. My suggestion was that instead of dealing with the problem after it happens, dealing with it before it happens may be more beneficial. Thats great that your municipality is able to conduct drug investigations on such a scale. But what about departments like Somers PD who have limited powers and arent on 24hrs/ day. I understand that they are supplemented by Troopers, but the Troopers have several other municipalities in northern westchester to deal with...just trying to look at this from a different angle

Dealing with it before it happens is not as easy as it sounds. You don't have individuals standing on the street corners dealing narcotics in the more affluent parts of Westchester. A lot of the narcotics purchased by users in more affluent parts of Westchester are purchased in some of the more impoverished parts of the county or NYC. So unless LE can intercept these individuals in their vehicles while they are transporting their narcotics to their residence, once they're inside their home, there's not much LE can do. LE has to follow the CPL in regards to stopping and searching persons and their vehicles, which brings up the obstacles of the law and reasonable suspicion, probable cause, etc. I think overall LE does a great job of intercepting larger amounts of narcotics on the county's roadways, but for every good grab 10 more individuals are slipping through the cracks. In NYC drug dealers and collared and released the same day with no bail, so the problem of enforcing drug laws goes well beyond LE. Judges are held to practically zero accountability and continually release these individuals back onto the streets to continue their "jobs" as a street pharmacist.

[911FIRE 0]

Dealing with it before it happens is not as easy as it sounds. You don't have individuals standing on the street corners dealing narcotics in the more affluent parts of Westchester. A lot of the narcotics purchased by users in more affluent parts of Westchester are purchased in some of the more impoverished parts of the county or NYC. So unless LE can intercept these individuals in their vehicles while they are transporting their narcotics to their residence, once they're inside their home, there's not much LE can do. LE has to follow the CPL in regards to stopping and searching persons and their vehicles, which brings up the obstacles of the law and reasonable suspicion, probable cause, etc. I think overall LE does a great job of intercepting larger amounts of narcotics on the county's roadways, but for every good grab 10 more individuals are slipping through the cracks. In NYC drug dealers and collared and released the same day with no bail, so the problem of enforcing drug laws goes well beyond LE. Judges are held to practically zero accountability and continually release these individuals back onto the streets to continue their "jobs" as a street pharmacist.

That makes sense, thanks for the explanation

[DWC295 70]

I found this article on Boston.com about the push in MA to get Narcan in the hands of police and fire who aren't on EMS units. I wonder if this will gain any traction.

My link

**Moderator Note** This posting was merged with a pre-existing thread already discussing this topic.

Edited October 25, 2011 by xfirefighter484x
Merged

[xfirefighter484x 234]

See below link for a related discussion!

http://www.emtbravo.net/index.php/topic/41253-northern-westchester-heroin-overdoses

I've been reading about all the overdoses in Northern Westchester on LoHud.com. All seem to be a bad batch of Heroin going around, which happens every fews years.

Which leads me to the question- should first responders (PD,EMS,Fire) be equipped with Narcan that can be delivered via the nasal route? Heck, some cities give it out to junkies to prevent heroin overdoses they may come upon. Although it doesn't rule out an IV injection, it could help buy some time, especially when ALS is coming from a distance.

Boston did a comprehensive study on this:

http://www.bphc.org/programs/aptrss/ourservices/preventionandharmreduction/Forms%20%20Documents/Boston%20OD%20prevention%20pilot%20report%20to%20BOD.16April2007.pdf