Narcan at the EMT level.

[Richard B the EMT]

No.  Because the cops are usually there first.  Or are usually in a better position to get there first....Because the cops are already out on the street, usually patrolling their sector, they're going to get there first.

My EMS agency had, and has,  "Staging" at various street corners as the rule, not the exception, hence, we're "already out on the street". A car is always easier to get through traffic than any design of ambulance, because it's smaller, also, if PD "gets there first", it's because there are more Police "Cruisers" then Ambulances.

[Lone Star]

Having been an EMT for 12 years before "moving up the 'food chain', so I can say this with some authority:

 

I'll start with the standard "120 hours of class room education" argument.  Having sat through the EMT-B course twice (with a significant interval in between classes), I can attest that the EMT-B program really hasn't changed much, and the young EMT's are still being taught irrelevant information, and it is not adequate enough to start administering pharmaceuticals (especially those with such serious ramifications when administered incorrectly).

 

Additionally, is the EMT-B really equipped and trained to deal with the effects of improper administration of Narcan?

 

The EMT-B is barely taught more than the superficial mechanics of the body systems, and not to think about the 'why' of treatments.  If it's bleeding, stop the bleeding (insert ICE mnemonic here), if it's not breathing, ventilate, if it's at an odd angle, splint it....high flow O₂ , and rapid transport (radio for ALS intercept if necessary).  Is this REALLY the educational level that is appropriate for the administration of Narcan?

 

I'm in no way busting the chops of the EMT-B, but I AM railing against the educational levels that they receive.  I'm also advocating for the patient, which I can see ending up in dire straits because of an inadequately trained, over zealous EMT-B 'slamming Narcan'...

[triemal04]

Additionally, is the EMT-B really equipped and trained to deal with the effects of improper administration of Narcan?

What effects are you talking about?  The ones that won't exist if this is done using more than 2 brain cells?  Just because an EMT can administer narcan does not mean they need to be giving a large dose; 0.4 or 0.8mg is all that is needed in probably 95% all all narcotic OD's, especially if paramedics are also responding.  I know there is talk of developing an auto-injector ala the epipen, but a much easier thing to do would be to give EMT's a 3cc syringe, 18g needle, alcohol wipe, and a 0.4mg vial of narcan.  Just like they give to junkies is some places.

Of course, this being EMS I do understand that 2 brain cells will not be used when implementing most programs like this and dem bad ass lifesava EMT's are gunna be savin dem sum lives with dat der 2mg narcan thingy!

[Lone Star]

What effects are you talking about?  The ones that won't exist if this is done using more than 2 brain cells?  Just because an EMT can administer narcan does not mean they need to be giving a large dose; 0.4 or 0.8mg is all that is needed in probably 95% all all narcotic OD's, especially if paramedics are also responding.  I know there is talk of developing an auto-injector ala the epipen, but a much easier thing to do would be to give EMT's a 3cc syringe, 18g needle, alcohol wipe, and a 0.4mg vial of narcan.  Just like they give to junkies is some places.

Of course, this being EMS I do understand that 2 brain cells will not be used when implementing most programs like this and dem bad ass lifesava EMT's are gunna be savin dem sum lives with dat der 2mg narcan thingy!

First off, improper administration of Naloxone can induce:

 

Abrupt reversal of opioid effects in persons who are physically dependent on opioids may precipitate an acute withdrawal syndrome which may include, but is not limited to, the following signs and symptoms: body aches, fever, sweating, runny nose, sneezing, piloerection, yawning, weakness, shivering or trembling, nervousness, restlessness or irritability, diarrhea, nausea or vomiting, abdominal cramps, increased blood pressure, tachycardia. In the neonate, opioid withdrawal may also include: convulsions; excessive crying; hyperactive reflexes.

The rest of your sarcastic (and highly unnecessary) post included a lot of 'talk' and 'ifs', so it's based on facts not entered into evidence.

 

EMS education in the United States still tends to accommodate the 'lowest common denominator', and with only 120 hours of classroom education and 24 hours of clinical experience, it's not a good idea to start pushing pharmaceuticals until an education system is implemented that accommodates higher educational requirements for entry level EMS (another topic that has been beaten  to death). 

[Just Plain Ruff]

But lone, not getting in on the argument, but what are your thoughts on police officers giving narcan who have ZERO medical background or education?  EMT's have at least a rudimentary medical education while often police officers have little to none other than "here hold this guaze on this bleeding spot, and hey catch this baby!"  

Why in your logic trail, should police officers be allowed to administer narcan but EMT's should not?

[uglyEMT]

Ruff just beat me too it.  In my response area the PD has Narcan in prefilled syringes for nasal administration.  So far since implementation it has been credited with over 500 saves.  Their training was a 1,ONE, hour course before shift.  In my area, anyway, it is as easy as an EpiPen.  We let children self administer EpiPens do we not?

Now if we are talking about moving beyond prefilled and going into actual draws then no I do not think EMT's should be doing it unless their training includes IV med administration.

Edited August 6, 2015 by uglyEMT

[ERDoc]

There are even places that are teaching friends and family to administer it.  Again, which is worse, the side effects listed above or being dead?  We can deal with the side effects but we still can't fix dead.  I agree that it needs to be pre-filled syringes and IN administration.

[spenac]

There are even places that are teaching friends and family to administer it.  Again, which is worse, the side effects listed above or being dead?  We can deal with the side effects but we still can't fix dead.  I agree that it needs to be pre-filled syringes and IN administration.

As so many druggies come awake violently, should the pre-filled syringes/IN be at a low dose to just improve respiration rather than a full dose?    Or just let the EMT's/Cops/family/etc just get their butts kicked?

[itku2er]

If it is just a BLS crew that administers the drug will they be capable of managing an acute withdrawl episode if it occurs. Will they be able to handle any of the multiple problems that could occur with any medication administration? Yes it might save more lives than it takes but in the big scheme of things it just takes one incident to end the career of a good ems provider. 

It is less pronounced in effects if it is given IM but still there is too much liability for allowing EMT's to give the drug. 

[Lone Star]

But lone, not getting in on the argument, but what are your thoughts on police officers giving narcan who have ZERO medical background or education?  EMT's have at least a rudimentary medical education while often police officers have little to none other than "here hold this guaze on this bleeding spot, and hey catch this baby!"  

Why in your logic trail, should police officers be allowed to administer narcan but EMT's should not?

I am an advocate of leaving the 'medical stuff' to the 'medical folks'.  Sure, Band-Aids on boo-boos is alright, but putting pharmaceuticals in the hands of the uneducated/improperly trained can never be a 'good thing'....

As so many druggies come awake violently, should the pre-filled syringes/IN be at a low dose to just improve respiration rather than a full dose?    Or just let the EMT's/Cops/family/etc just get their butts kicked?

Correct me if I'm wrong here, but doesn't the amount needed to improve respiration depend on the amount of the opiate in the system?  Is the LEO drug box going to be enough to properly mitigate the situation?  If LEO want to get into medical, they should go to school like the rest of us.