Heroin Overdose Epidemic - what is your perspective?

[willie]

I have no legal or humanitarian solution for the widespread heavy duty drug addiction presented here. I will say the obvious, though. In many ways we are enabling addicts to continue being addicts. Herculean efforts to treat and save "everybody" is in one sense legitimizing being an addict. I see that regions have their own drug sub cultures, and over time they will influence the main culture's world view. By this statement I mean that many of us--or our children and grand children--will accept the problem as a normal part of life. Remember that dopers can vote and will figure out one day that their numbers can give them clout.

[voodoo_man]

Had a guy OD on some bad heroin, passerby sees the guy ODing in the car, takes him out, cpr then narcan, when medics arrived random passerby gets up and walks away. Guy makes it.

What a world.

[ST911]

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.

[45dotACP]

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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[scjbash]

The local epidemic has made for an interesting few weeks. In 2015 there were 3 homicides here, and one of those was justifiable(dude shot a naked guy who was hallucinating on a mushroom smoothie and trying to break into houses.) So far this year there have been 21 homicides. Per capita the rate is identical to Detroit, which is fitting because many or most of the shootings involve dealers from there. Over the last few weeks things have been absolutely out of control so state and federal resources have been brought in to help. I woke up this morning to the sounds of a Blackhawk flying low over my house. The National Guard has had three of them over town all day. As VDM said, what a world.

[Rex G]

Well, I have now been officially trained to administer the nasal spray. I am so very glad that I am very near the end of my career.

[voodoo_man]

Well, I have now been officially trained to administer the nasal spray. I am so very glad that I am very near the end of my career.

Pro Tip: get a zip lock bag with several pairs of gloves a cpr mask, small pack of baby wipes and Clorox wipes, as well as either your favorite gum or mint. Not that you'll get anything in your mouth, but it helps to chew something that tastes better and smells better after dealing with an OD, especially if they start puking. You'll also always be short on gloves at the worst possible time, and the CPR mask inside the same bag as the narcan helps you be prepared for when/if the OD decides to stop breathing. Clorox wipes for the CPR mask and/or your clothing before you put everything back into the bag and baby wipes for various other reasons you can probably guess.

Enjoy dealing with the best of your community...

[Rex G]

Pro Tip: get a zip lock bag with several pairs of gloves a cpr mask, small pack of baby wipes and Clorox wipes, as well as either your favorite gum or mint. Not that you'll get anything in your mouth, but it helps to chew something that tastes better and smells better after dealing with an OD, especially if they start puking. You'll also always be short on gloves at the worst possible time, and the CPR mask inside the same bag as the narcan helps you be prepared for when/if the OD decides to stop breathing. Clorox wipes for the CPR mask and/or your clothing before you put everything back into the bag and baby wipes for various other reasons you can probably guess.

Enjoy dealing with the best of your community...

Thanks.

One convenient thing is that we are spread quite thinly, compared to the FD guys, so they usually get there first. I will only work a few more shifts before I am done. The odds are in my favor.

[voodoo_man]

Thanks.

One convenient thing is that we are spread quite thinly, compared to the FD guys, so they usually get there first. I will only work a few more shifts before I am done. The odds are in my favor.

Our record is 24 minutes from moment of getting done training and being issued the spray to having to use it. We have guys who are on their 50th+ use this year. Don't light that cigar just yet.

[Nephrology]

Pro Tip: get a zip lock bag with several pairs of gloves a cpr mask, small pack of baby wipes and Clorox wipes, as well as either your favorite gum or mint. Not that you'll get anything in your mouth, but it helps to chew something that tastes better and smells better after dealing with an OD, especially if they start puking. You'll also always be short on gloves at the worst possible time, and the CPR mask inside the same bag as the narcan helps you be prepared for when/if the OD decides to stop breathing. Clorox wipes for the CPR mask and/or your clothing before you put everything back into the bag and baby wipes for various other reasons you can probably guess.

Enjoy dealing with the best of your community...

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]

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.

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?

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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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...