First Responders have access to Narcan in NJ

[JackEMT 77]

Are there other areas where EMT/FR have approval to use Narcan? An increasing number of LEO have access to it, but it seems EMS is lagging behind.

http://philadelphia.cbslocal.com/2014/03/21/christie-approves-emts-giving-overdose-treatment/

[somebuffyguy 190]

Not coming from an EMS background I have very little knowledge of Narcan. Anyone care to explain to reasoning behind not letting EMT's or other first responders carry it? What are the side effects of it, or the dangers of it being used when its not an overdose?

[JackEMT 77]

I am not a physician, but there seems to be little down-side if used properly:

"There are no ill effects of naloxone, Lavelle said. If it is given to someone who is not overdosing, it would have no effect, he said. Naloxone provides an almost instant reversal for someone who has taken too much of a strong anti-pain medication or heroin, officials said."

http://www.app.com/article/20140228/NJNEWS14/302280074/Heroin-NJ

[SRS131EMTFF 471]

Are there other areas where EMT/FR have approval to use Narcan? An increasing number of LEO have access to it, but it seems EMS is lagging behind.

http://philadelphia.cbslocal.com/2014/03/21/christie-approves-emts-giving-overdose-treatment/

Most eastern states where heroin is popular have allowed BLS narcan.

[EMT111 149]

NYS allows EMTs to use it, but your agency must be approved by the state and the region to use narcan

[Ga-Lin 86]

There are no ill effects, that I know of, if given to someone who is not experencing an opiate overdose. The only bad effects would be giving Narcan to an opiate OD (morphine, heroin, methadone, codine and the recently popular synthetics vicaden, hyrdocodone) to quickly, which may cause sudden and violent withdrawal, in addition, if you administer enough to actually wake them up you will also have to deal with an upset junkie for "ruining" their high. Sometimes this can get out of hand. The other problem with waking them up is they always want to RMA which means forcing them to go or leaving them. This usually means you WILL be back for them (if they are lucky OR they get to go to that big shooting gallery in the sky) ALS usually gives just enough to get people to start breathing again on their own. I'm not sure of the uptake or dosage of the IN narcan. Opiate OD's are actually pretty easy to care for, you just have to breath for them. The last few years I've been telling students that if they are working in an tiered system and they have a complicated route back to the ambulance (flights of stairs mostly) to call for als backup (if they aren't on their way already), and stay put, cause it's not possible to bag someone going down the stairs and you always think you can get a "little" farther between breaths.

[Bnechis 3,961]

As others have mentioned, if you give the recommended dose, you run the risk of waking the patient up and they can get very violent (A number of inexperienced medics have been assaulted. I had a very large & very angry individual grab our drug box and fling it down the stair well of a 4 story walk up, nothing was salvageable).

Possible side effects include: change in mood, increased sweating, nausea, nervousness, restlessness, trembling, vomiting, allergic reactions such as rash or swelling, dizziness, fainting, fast or irregular pulse, flushing, headache, heart rhythm changes, seizures, sudden chest pain, and pulmonary edema. But you also run the risk of projectile vomiting. Never knew a patient laying on the stretcher could hit the ambulance ceiling like he was a fountain.

If you do wake the patient, they will want to RMA, the problem is the half-life of narcan is shorter than the half life of opiates. So the narcan wears off before the opiate and if they have enough on board they will go back into respiratory depression/arrest after the RMA.

[everybodygoes 331]

Nassau County PD was giving a class and handing out FREE nasal Narcan applicators. No prior training required. If you are seriously worried about someone being agitated because you brought them back to the living you should quit your job now.

[Bnechis 3,961]

If you are seriously worried about someone being agitated because you brought them back to the living you should quit your job now.

Having been assaulted and witnessing other responders being assaulted (after 1 individual was "agitated" he attacked ER staff member causing serious head trauma, then he pulled a knife on security. it took 6 responders to restrain him including 1 ESU officer, who almost lost his gun during the fight). Since that was about 25 years ago and I'm still in it, I am not worried as I KNOW how to titrate (adjust) the dose to bring back respirations, but keep them mellow enough that no one is put in danger. My concern is this is not being taught to all these minimally trained responders.

And a BVM will keep them alive. I would rather see that in every PD car before narcan. Since it could help many people, while narcan only helps a small % of that.

[STAT213 332]

Those violent reactions usually occur when the drug is given too fast via the IV route. I haven't seen it happen when given IN.

Like ALL drugs, narcan must be given carefully, with good judgement and when indicated.

I think we're forgetting an important fact though. The issue is respiratory depression. This is easily managed by any BLS trained provider. You don't need a magic drug to fix it. You need a BVM.

[Officer Ed 59]

Here in Arizona, our fire dept. paramedics have had Narcan for decades. We're glad that they do. I've seen junkies snap right out of their highs when a dose has been administered. I've also seen junkies who ODed fight to avoid a shot of Narcan....preferring to die over losing their high. We've had to restrain/subdue a number of them. But that's OUR job.

Narcan has saved a lot of lives and I see no reason why paramedics everywhere should not be able to administer it.

[Bnechis 3,961]

Here in Arizona, our fire dept. paramedics have had Narcan for decades. We're glad that they do. I've seen junkies snap right out of their highs when a dose has been administered. I've also seen junkies who ODed fight to avoid a shot of Narcan....preferring to die over losing their high. We've had to restrain/subdue a number of them. But that's OUR job.

Narcan has saved a lot of lives and I see no reason why paramedics everywhere should not be able to administer it.

Thanks Officer Ed.

I believe paramedics everywhere can administer it. We have here for more than 33 years (& I think longer). The issue is should EMT's with minimal training & police officers with no medical training be able to give it?

[Officer Ed 59]

Thanks Officer Ed.

I believe paramedics everywhere can administer it. We have here for more than 33 years (& I think longer). The issue is should EMT's with minimal training & police officers with no medical training be able to give it?

We police officers do not have the medical training to administer medications. We are only trained in advanced first aid. In a pinch, we can keep some people alive until the paramedics arrive. That's how we like it.

[velcroMedic1987 330]

Here in Arizona, our fire dept. paramedics have had Narcan for decades. We're glad that they do. I've seen junkies snap right out of their highs when a dose has been administered. I've also seen junkies who ODed fight to avoid a shot of Narcan....preferring to die over losing their high. We've had to restrain/subdue a number of them. But that's OUR job.

Narcan has saved a lot of lives and I see no reason why paramedics everywhere should not be able to administer it.

If the junkie is fighting with you he(she) probably isn't a candidate for narcan anyway. The whole point is to counter CNS depression brought about by opiate overdose and I never met one of those who had much fight in 'em. Most of them are too out of it to even BREATHE!!!

[velcroMedic1987 330]

Nassau County PD was giving a class and handing out FREE nasal Narcan applicators. No prior training required. If you are seriously worried about someone being agitated because you brought them back to the living you should quit your job now.

You should be alert for a patient becoming agitated or combative. That's part of the job.

To suggest that good situational awareness and conflict avoidance is wrong doesn't make any sense at all.

[Ga-Lin 86]

Nassau County PD was giving a class and handing out FREE nasal Narcan applicators. No prior training required. If you are seriously worried about someone being agitated because you brought them back to the living you should quit your job now.

By your post you obviously haven't "been there" which is OK. I always welcome, and I am sure bnechis agrees with me, the opportunity to educate those not as knowledge or those who have had a more sheltered career. The concern that most of us, who have more experience, are just saying to use caution when administering this med. If awoken to quickly not only can they become violent(doesn't always happen) but can also cause severe and in some instances life threating problems(again, doesn't always happen). I for one, not being familiar with the IN form of narcan, am unsure of the uptake (this means how fast it takes effect) of this form or if it can be titrated (given in increments, which I doubt)until the desired effect (they begin breathing on their own again)is reached. Just for the record, I've never, and again I'm sure bnechis hasn't either, held back any care or treatment for fear of a negitive response from my patients, I've done my own share of wrestling with those I'm tring to save in the gutters because they don't appreciate my efforts. Bringing them back to the living as you say is debatable, that the lives they live is called living.

My other concern is that this is being touted as the "wonder drug" to bring back the dead, figuratively speaking, and given out, like candy, to just about anyone who asks for it, regardless of training, indeed, often without any training. While, generally, I think it a good idea to have in trained hands, FD, PD, EMS, I have my reservation about it in the hands of the general public. My first concern is that other treatment, breathing for them, will be delayed for to long a time, waiting for the drug to do its thing which, by the way, can also happen in the trained hands mentioned above without proper training. This might not even happen (breathing) because it is caused by a different problem and therefor not affected by narcan. Second concern is that the calling of authorities (911) will either be delayed or deffered altogether. I mean, why call, we have the medication, all they (911) are going to do is force poor johnny the junkie to take an unnecessary trip to the hospital. (poor Johnny, all alone in that cold ER, because his other friends are to high to walk in and keep him company, surronded by uncaring people whose sole purpose is to ruin his good time high, for which he paid good, honestly stolen money!). I think we in the emergency services sector need to start speaking with elected officials to pull back on this issue and move a little more cautiously.

Edited March 24, 2014 by Ga-Lin

[SRS131EMTFF 471]

if it can be titrated (given in increments, which I doubt)until the desired effect

In VT, at the EMT level, Narcan is administered 2mg IN for adults (1mg in each nostril) and 1 mg IN for pediatrics (0.5 mg in each nostril). The IN Narcan drug kit comes with 1 IN applicator with 2mg of Narcan in the sole vial. The IN dose of Narcan can be titrated for pediatrics by simply not administering 1mg in each nostril and instead only administering 0.5mg per nostril.

While it is not "official" protocol, most ED docs have no problem with you giving a pediatric dose of Narcan to adult pts provided the adult pt is breathing adequately without additional ventilation after a pediatric dose of Narcan is administered. In that way can it be titrated to avoid combative patients or unwanted situations.

[Ladder44 73]

Throw in my 2 cents, another major side effect is if a LEO/FD first responder were to administer the narcan IN, and this guy was speed ballin (cocaine/heroin mix) the narcan will clear the depressent (heroin) and this guy with not only wake up but the stimulant (cocaine) will take over with tremendous agitation or even worst, cardiac arrest. Having those locked narcotics (ativan, versed, valium) from the ALS unit can help prevent this guy from further injury to himself and the crew or even arrest, So is it good for our first responders? Sure, but like every drug theres a time and a place IMO.

[Ga-Lin 86]

In VT, at the EMT level, Narcan is administered 2mg IN for adults (1mg in each nostril) and 1 mg IN for pediatrics (0.5 mg in each nostril). The IN Narcan drug kit comes with 1 IN applicator with 2mg of Narcan in the sole vial. The IN dose of Narcan can be titrated for pediatrics by simply not administering 1mg in each nostril and instead only administering 0.5mg per nostril.

While it is not "official" protocol, most ED docs have no problem with you giving a pediatric dose of Narcan to adult pts provided the adult pt is breathing adequately without additional ventilation after a pediatric dose of Narcan is administered. In that way can it be titrated to avoid combative patients or unwanted situations.

Well that answers some of my questions and concerns, thanks

[x1243 141]

NYS allows EMTs to use it, but your agency must be approved by the state and the region to use narcan

I submitted and recieved the approval through the Hudson Valley EMS Council for my department to use intransal Naloxone.

Used it once so far and it worked like a charm.......

20 yof unconcious CPR inprogress (not sure why CPR, she was moving air fine). 1mg each nostril within 3 minutes she walked to the ambulance.

We all know the epidemic with the heroin spreading like wildfire. Everyone says "just let them die", I explain 1 thats not our job and, 2 it is much easier to push a bristojet for 10 seconds then to do CPR for 30 minuntes....

I think you will see more skills come to the BLS side of EMS within the next couple of years.

Everyone stay safe.

Edited March 25, 2014 by x1243

[everybodygoes 331]

If you are working understaffed and choose to take a different approach from your life experiences as to how to titrate your patients ability to breath on their own go for it, in the end it will not be able to be proven in a court of law that you were more concerned with what 'could' happen from a person being combative IF they even will be. But like you just said, you can use this opportunity to educate yourself as well.

If the advantages of using a drug is so far outweighed by its negatives that they give it to John Q public why do you think it would create a safety issue? My cop friends all take the H users of the PCP guys any day, try and fight one of them, its like trying to get a dog in a bathtub.

By your post you obviously haven't "been there" which is OK. I always welcome, and I am sure bnechis agrees with me, the opportunity to educate those not as knowledge or those who have had a more sheltered career. The concern that most of us, who have more experience, are just saying to use caution when administering this med. If awoken to quickly not only can they become violent(doesn't always happen) but can also cause severe and in some instances life threating problems(again, doesn't always happen). I for one, not being familiar with the IN form of narcan, am unsure of the uptake (this means how fast it takes effect) of this form or if it can be titrated (given in increments, which I doubt)until the desired effect (they begin breathing on their own again)is reached. Just for the record, I've never, and again I'm sure bnechis hasn't either, held back any care or treatment for fear of a negitive response from my patients, I've done my own share of wrestling with those I'm tring to save in the gutters because they don't appreciate my efforts. Bringing them back to the living as you say is debatable, that the lives they live is called living.
My other concern is that this is being touted as the "wonder drug" to bring back the dead, figuratively speaking, and given out, like candy, to just about anyone who asks for it, regardless of training, indeed, often without any training. While, generally, I think it a good idea to have in trained hands, FD, PD, EMS, I have my reservation about it in the hands of the general public. My first concern is that other treatment, breathing for them, will be delayed for to long a time, waiting for the drug to do its thing which, by the way, can also happen in the trained hands mentioned above without proper training. This might not even happen (breathing) because it is caused by a different problem and therefor not affected by narcan. Second concern is that the calling of authorities (911) will either be delayed or deffered altogether. I mean, why call, we have the medication, all they (911) are going to do is force poor johnny the junkie to take an unnecessary trip to the hospital. (poor Johnny, all alone in that cold ER, because his other friends are to high to walk in and keep him company, surronded by uncaring people whose sole purpose is to ruin his good time high, for which he paid good, honestly stolen money!). I think we in the emergency services sector need to start speaking with elected officials to pull back on this issue and move a little more cautiously.

Edited March 25, 2014 by everybodygoes