Heroin Overdose Epidemic - what is your perspective?

[TGS]

Thoughts/seeing... Mass naloxone fielding is the new thing, great panacea for the opioid epidemic, and everyone is doing it. 4mg nasal spray is most popular. Helpful if needed, a diagnostic if not. Big talking point for LE buy-in has been accidental exposures to rescuers. BVMs are great, but getting cops and lay rescuers to bag properly can be a neat trick esp if the patient is of less interest to the rescuer. An average of current SOPs: suspect opiate OD, safety first, give first dose, no effect give second, stand by for BLS tasks and EMS. Most LE won't have airway adjuncts or more than two doses. Patients can refuse if AO for EMS, or go to jail for applicable charges with LE after medical clearance. Addicts with scripts use them more than we know/track, and never report their OD incident. If an emergency call is generated, expect an increasing amount of folks to have their own like nitro and epi pens. There is room for discussion of good sam uses and public-access, but safety issues abound and it isn't an IFAK item in my view.

Agreed. Immediate CPR/Defibrillator access is still paramount in a code according the Red Cross. Mentally fumbling with whether or not to give Narcan when you should be doing CPR or attaching an AED might be detrimental to the the survival of someone having a medical emergency not related to overdose.

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If your PD will issue it and/or it's not cost prohibitive to you personally, I'd just buy the masks in bulk and treat them as disposable.

For gloves I am always a big fan of the 5-6 mil thick N-Dex gloves. They offer some degree of puncture resistance and most importantly are not as likely to tear when you put them on , which is a big PITA if you only have a few pair on you ....

For smells, his trick is admittedly less practical in the field, but you can take two procedure masks and stack them together, smearing toothpaste of your favorite flavor in a thin layer between the two. Put them on as one unit and voila! not only do you have PPE for potential droplet/aerosol risks (like fentanyl...) but it also smells way better than your external environment.

Nursing taught me that last one [emoji6]



How many OD patient's aren't "of less interest to the rescuer?"

Actually, speaking of which, in the collective "your" anecdotal experience, what roughly would say is the proportion of addicts using Rx narcotics vs heroin?



Given that the majority of trained and presumably motivated medical students do not give effective chest compressions, I agree that simple is best for untrained or minimally trained bystanders rendering 1st aid...

Let's not forget the safety aspect that ST911 mentioned.

A lone bystander has zero business taking a junkie off their high.

Fuck that. They made their choice to OD. Nobody should be risking themselves assault or getting their junkie AIDS spit into their membranes because sumdood you just saved is now a raging fucking asshole that wants to beat the shit out of you for ruining their high.

[Shoresy]

For smells, his trick is admittedly less practical in the field, but you can take two procedure masks and stack them together, smearing toothpaste of your favorite flavor in a thin layer between the two. Put them on as one unit and voila! not only do you have PPE for potential droplet/aerosol risks (like fentanyl...) but it also smells way better than your external environment.

I know/knew several FF/EMTs who would use dust masks (the kind you'd find in a hardware store) + Vick's Vaporub to covers smells encountered on the medical side of the job.

[Skroob]

Flavored chapstick on the inside of a mask works just as well. And you can still use the chapstick throughout the day.


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[TGS]

Philadelphia Dedicating EMS Unit to ODs

Looks like a combination EMS/mobile social worker outreach unit.

I think this is going to be useless, personally.

[Gray222]

Philadelphia Dedicating EMS Unit to ODs

Looks like a combination EMS/mobile social worker outreach unit.

I think this is going to be useless, personally.

[Nephrology]

Let's not forget the safety aspect that ST911 mentioned.

A lone bystander has zero business taking a junkie off their high.

Fuck that. They made their choice to OD. Nobody should be risking themselves assault or getting their junkie AIDS spit into their membranes because sumdood you just saved is now a raging fucking asshole that wants to beat the shit out of you for ruining their high.

Yeah I mean all judgment about their life choices aside, there is no way I'd narcan someone I didn't personally know without at least other 1st responders (ideally LEOs) on scene. I'm fine providing first aid, but not when it's to someone who likely has an extensive criminal history and a proclivity towards antisocial behavior. No thanks.

Philadelphia Dedicating EMS Unit to ODs

Looks like a combination EMS/mobile social worker outreach unit.

I think this is going to be useless, personally.

LOL. Another feel good "public health" intervention that will do squat.

Somewhat tangential but still relevant : I was in a CVS with a buddy of mine and we were talking about healthcare. He pointed at the blood pressure station and asked me what I thought about public health interventions like that. I asked him if he saw anyone in line to use it. I then asked if he's EVER seen anyone use one. He got my point.

You can do a lot of good for people who want help and are willing to meet you halfway, but you can't save people from themselves...

[Nephrology]

BTW... @voodoo_man

'It's all fentanyl': opioid crisis takes shape in Philadelphia as overdoses surge

Danny, a long-term Kensington drug user, said high OD rates were initially caused by dealers not knowing how to handle fentanyl. According to police one brand, AK-47, caused nine deaths in 36 hours and was part of a batch that left 35 people dead.

“When fentanyl came on people didn’t know about it,” Danny said. “They didn’t know what they were messing with. They OD-ing all over. Once the dealers saw people dropping like flies, they were going, ‘Wow, we’re doing something wrong.’ Now they getting the cut right.

“Nowadays, if anyone’s dying its mostly visitors who just got out of jail or rehab. They think they can do three bags. They can’t … they’re done.”

Street dealers compete for customers, selling high-purity drugs.

“We’ve seen purity of heroin jump from 63 to 93%, which is fucking insane,” said [Officer] Trainor. “There’s no greater endorsement for a trafficker than when his product kills somebody. That’s not mythology. We see it all the time. We’ve had wiretaps of drug traffickers bragging how many people their drugs killed.”

Another longtime Kensington resident and addict, also named Danny, countered: “They blame the dealers but it ain’t them. The people are doing to themselves. It’s people coming down here from outta county thinking they can do whatever they want.”

[OlongJohnson]

Pill mill working its way through the legal system:

https://www.myajc.com/news/crime--la...zRVVAlFam8BSI/

[Nephrology]

Pill mill working its way through the legal system:

https://www.myajc.com/news/crime--la...zRVVAlFam8BSI/

That isn't really a "pill mill" per se - this is just a creeper who abused his medical license and will likely use it. It doesn't seem like he was writing Rxs for a lot of different people in order to make a profit. As the ME he doesn't even really have a traditional medical practice (hard get away with writing a lot of oxycodone Rxs do when all of your patients are already dead ...). No idea how he thought he'd get away with that in an era of controlled Rx auditing .

[UNM1136]

I have not read the entire thread...

25 years ago I was an EMT-I and we had a protocol to follow. 2mg naloxone IV push, titrated to respirations. The medics on the trucks could give 2mg IVP, 2mg sub q, and 2mg IM. A common discussion who was the ED Charge nurse responsible for receiving the patient. Cool nurse got ODs titrated to respirations. Crappy nurse got patients who got the remainder of the narcan IVP as we entered the facility, sending the patient into immediate withdrawls, with all the accompanying issues. Not very ethical, and I can honestly say that I have not done it myself, but there it is. Lives saved, petty beefs handled.

That is why I am now a cop and not a medic.

pat