Narcan at the EMT level.

[triemal04]

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). 

Sarcastic?  Absolutely.  Sadly though, there was more truth in it than there should be.  Get to that in a minute.

For you, I'd suggest that you actually learn a bit about pharmacology and the in's and out's of narcotics, narcotic withdrawal, and narcotic antagonists instead of just parroting a textbook.  Because as I said, giving someone 0.4mg of narcan, or even 0.8mg if it's needed is not going do all those nasty, dirty things you mentioned.  And even the lowest common denominator can be taught how to dry up 1cc of liquid and inject it into the deltoid or thigh.

Now, given that the sarcastic part of my post was far to true, it is still very likely that many EMT's won't be given 0.4mg vials of narcan, but some type of autoinjector that has a much larger dose and WILL precipitate withdrawal.  Sad but true.  Just like to many EMT's will look at the addition of this as a supercool special thing that makes them uber highspeed low drag.

Really, it comes down to this:  is it going to be better to manage someone in withdrawals or someone who is dead?  Given the admitted piss poor training of EMT's, expecting them to effectively ventilate someone with a BVM and not inflate the stomach is asking to much for most.  

Personally, if EMT's are taught how to draw up and inject a small dose of narcan I don't have any major issue with this, though how needed it is will depend on each specific area.  If EMT's are only given large doses of narcan...a much more thorough look needs to be taken at a given area before implementing this.

[ERDoc]

So we have a drug that can save someone's life and is easy to administer.  Why would we not allow non-medical people to use it?  Tylenol is lethal but yet we let anyone buy it.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2661437/

[Just Plain Ruff]

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'....

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.

Lone,  I'm sorry, but you are digging a hole here,  I love you man but if you are an advocate for leaving the medical stuff to the medical folks, then surely you advocate taking all the OTC meds away from the regular population because they aren't trained to give cough medicine, tylenol, advil, benadryl and all that other stuff becuase they are uneducated and improperly trained.  That can never be a good thing right?  

[itku2er]

I am on the fence on this one. I see the benefits especially in the area I live in rural, but I don't like the ideal of randy rescue with narcan. That is the thing that nightmares are made of. 

[scubanurse]

I'm all for treating it like an Epi-Pen, you need a prescription for it.  Like doc said, no side effect is worse than death so why not?

[triemal04]

I am on the fence on this one. I see the benefits especially in the area I live in rural, but I don't like the ideal of randy rescue with narcan. That is the thing that nightmares are made of. 

Yep.  In all honesty, I think it would be in a departments best interests if they were ALL on the fence about this until they took a good, hard look at their particular area and capabilities.

Giving it to cops is one thing; they have zero ability to ventilate a person and may be on scene for several minutes before anyone who can shows up.  Better withdrawal (if it was packaged in a 2mg dose) than an anoxic injury or death.

For EMT's...depends.  How well can they use a BVM?  How long would they be with the person before a paramedic arrived?  How often would this actually be needed?  Worth thinking about.  Where I am there isn't really a need; the majority of EMT's are proficient enough with a BVM to ventilate an apneic person (and let's not forget that many, many narcotic OD's are not apneic and can be temporarily managed with supplemental oxygen) and are usually only alone for a few minutes.  So...no need for them to have it.  In other places, in fact probably the majority, where EMT's are not proficient with a BVM...have to consider it.  Maybe.  Or if the lag time until a paramedic arrives is very pronounced.  

I think there is a "need" for this...but it's not as large as it's being made out to be, the solution will probably be done in a piss poor way, and will be done, in part, to allow a little more strut in the steps of EMT's.

[MCSOU]

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'...

I find that most people that start anything with "I have been *insert title* for *insert number of years* " usually aren't authorities. Use your statements to guide peoples thoughts on you.

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). 

Find a study that indicates significant clinical detriment as a result of IN narcan. Most (actually all) of the signs/symptoms you listed won't kill you, hypoxia will.

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'....

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.

So should diabetics not have access to their insulin? What about their family members giving them insulin? 

[Just Plain Ruff]

MCSOU,  I just taught my 12  year old son how to give me my glucagon for when and if I ever drop to a critical blood sugar level.  I taught him that he is only to give me this, AFTER he calls 911 and if 911 tells him that the response will be delayed.  He is to tell 911 that he has a glucagon injection and he is getting ready to give it per my doctors instructions.  The 911 operators on the phone are all paramedics (so I've heard) so they will be able to tell him if an when glucagon is appropriate for me.  

Now if we are travelling to my in-laws, which are 15 minutes (at least) away from the nearest ALS unit, he will give the glucagon, but only after calling 911.  (I only know this because I used to work for this service)

Should we not allow him to give this life assisting medication because he is not a medically trained person?  I think not.  

But I do agree with Triemal, Each service needs to evaluate their readiness of their emt's as to whether they should be able to give this medication, The proof will be in the pudding and if their skills with the BVM are sorely lacking, OR if they are going to be with the patient for a very long time before ALS arrives OR if they are only a BLS service, then maybe they should think about allowing to give this medication, but ONLY If they have ALS intercept agreements in place.  The worst thng to happen is that they give enough to get the person breathing or breathing well enough on their own, only to have the narcan wear off and they are back to square 1 which is not where they want to be.  

[1EMT-P]

I have looked at this issue from both sides & I see this as a public health emergency. I see no reason why Emergency Medical Technicians & Police Officers with the proper training shouldn't be allowed to administer Narcan to patients who have overdosed on drugs such as heroin.

 

 

[MCSOU]

MCSOU,  I just taught my 12  year old son how to give me my glucagon for when and if I ever drop to a critical blood sugar level.  I taught him that he is only to give me this, AFTER he calls 911 and if 911 tells him that the response will be delayed.  He is to tell 911 that he has a glucagon injection and he is getting ready to give it per my doctors instructions.  The 911 operators on the phone are all paramedics (so I've heard) so they will be able to tell him if an when glucagon is appropriate for me.  

Now if we are travelling to my in-laws, which are 15 minutes (at least) away from the nearest ALS unit, he will give the glucagon, but only after calling 911.  (I only know this because I used to work for this service)

Should we not allow him to give this life assisting medication because he is not a medically trained person?  I think not.  

But I do agree with Triemal, Each service needs to evaluate their readiness of their emt's as to whether they should be able to give this medication, The proof will be in the pudding and if their skills with the BVM are sorely lacking, OR if they are going to be with the patient for a very long time before ALS arrives OR if they are only a BLS service, then maybe they should think about allowing to give this medication, but ONLY If they have ALS intercept agreements in place.  The worst thng to happen is that they give enough to get the person breathing or breathing well enough on their own, only to have the narcan wear off and they are back to square 1 which is not where they want to be.  

I'm not sure we are on the same page here but I agree with you. My post was sarcasm in an effort to get the individual to see what they were saying didn't make sense.