Naloxone Admin By EMT's

[Jim37F]

Also don't forget that EMT includes FF/EMT, not just private ambulance guys, so if the first in engine is all EMTs waiting on the medics coming in from out of district (not terribly uncommon here), even L.A. Co might eventually see the logic of making Narcan a BLS skill (then again we barely just got pulse ox monitoring a year or so ago and no consideration given to allowing us to do a test people do every day with an Over The Counter kit from the local CVS....So I wouldn't hold my breath lol)

 

[HWhite98]

I haven't personally given Narcan to a patient, mainly since I am new to the trade (Just found out today the state "officially" put my cert through ) but I have been to one overdose where a BLS provider was first on the scene in a rapid response vehicle and had given it. I guess it ultimately depends on location, and availability of ALS providers.

 

[chaz90]

Delaware started a pilot program for BLS administration of Narcan a couple months ago. The governor authorized LE across the state to carry it, so the powers that be decided that should probably open it up to BLS as well. They carry a MAD and can only administer it through the atomizer. I haven't seen it administered by BLS when I've been working yet, but I know a few have. They're very careful to emphasize that it should only be administered prehospitally to regain an effective respiratory drive. We, as the county ALS service, are typically only a couple minutes behind BLS, but there are cases where we're significantly delayed for some reason or it was initially a BLS dispatch. In those cases, I'm all for it.

 

[CALEMT]

The governor authorized LE across the state to carry it

Ive seen a couple posts on this thread about LE carrying and administering Narcan. Do they have to be a certified EMT? First Responder? or is it just a class/ training that they take?

 

[chaz90]

Ive seen a couple posts on this thread about LE carrying and administering Narcan. Do they have to be a certified EMT? First Responder? or is it just a class/ training that they take?

Separate class here. Some are EMRs or EMTs, but it's not required. As was mentioned earlier, it's gradually becoming more available OTC even to laypeople.

 

[CALEMT]

Interesting.

 

[HWhite98]

Ive seen a couple posts on this thread about LE carrying and administering Narcan. Do they have to be a certified EMT? First Responder? or is it just a class/ training that they take?

My local PD all of their officers are EMR's, however not all departments are like this. They do have training classes on the administration of Narcan.

 

[Bullets]

I hate it, i hate that NJ did what they did with it, and i hate the way the state DOH wrote the EMT policy regulating it. (2mg IN....thats it)

Thankfully we dont carry it on our trucks, but weve carried an opiate reversal for years, the BVM. While i admit that EMS is pretty terrible in using the BVM, the solution to that isnt giving us a drug and making us take a class on its use. Maybe a 4 hour class on airway/ventilation would be more productive.

 

[Flying]

What do you feel has gone wrong with the way Narcan has been implemented?

2 mg seems to be an effective dose for EMTs to have, and our goal should be to treat the cause of respiratory depression in these patients while supporting with good ventilation. The 4 hour class that you advocate would probably teach this as well.



Edit: Wait a sec, just four hours? I don't need another beer and chuckle session, lets make that an actual class.

 

[rwik123]

PD and BLS have it in my neck of the woods. BLS has the straight 2mg and cannot titrate. In regards to indication, I've even seen fellow ALS providers give it to patients who don't need to be receiving it. Unconscious+solid respiratory effort will never get narcan from me.

 

[Gurby]

I hate it, i hate that NJ did what they did with it, and i hate the way the state DOH wrote the EMT policy regulating it. (2mg IN....thats it)

Thankfully we dont carry it on our trucks, but weve carried an opiate reversal for years, the BVM. While i admit that EMS is pretty terrible in using the BVM, the solution to that isnt giving us a drug and making us take a class on its use. Maybe a 4 hour class on airway/ventilation would be more productive.

Sarcasm is hard to detect on the internet - you're joking right?

 

[Carlos Danger]

I hate it, i hate that NJ did what they did with it, and i hate the way the state DOH wrote the EMT policy regulating it. (2mg IN....thats it)

Thankfully we dont carry it on our trucks, but weve carried an opiate reversal for years, the BVM. While i admit that EMS is pretty terrible in using the BVM, the solution to that isnt giving us a drug and making us take a class on its use. Maybe a 4 hour class on airway/ventilation would be more productive.

I have never understood all the people who say "we don't need no stinkin' narcan - we should just ventilate." I think that completely misses the point.

If a 4-hour class were all it took to go from being "pretty terrible" to competent, then methinks we'd already have it covered.

 

[ThadeusJ]

I believe VA was investigating the administration of Narcan using a standard small volume neb and mask a few years ago. The reason for this approach was that it allows you to stop the treatment once effect has been reached. This is in comparison to nasal atomizers and IV administration where the dose is given and you hope you don't overshoot your goal. This approach might be seen as safer and therefore more appropriate for BLS crews. I believe the nasal atomizer approach is more cost effective as well.

 

[chaz90]

I believe VA was investigating the administration of Narcan using a standard small volume neb and mask a few years ago. The reason for this approach was that it allows you to stop the treatment once effect has been reached. This is in comparison to nasal atomizers and IV administration where the dose is given and you hope you don't overshoot your goal. This approach might be seen as safer and therefore more appropriate for BLS crews. I believe the nasal atomizer approach is more cost effective as well.

So you use PPV with the inline neb mask to get it into the lungs? This seems inefficient and cumbersome when the medication is meant to be administered to unconscious and apneic patients. IM/IN seems easy and safe to me.

 

[Bullets]

What do you feel has gone wrong with the way Narcan has been implemented?

2 mg seems to be an effective dose for EMTs to have, and our goal should be to treat the cause of respiratory depression in these patients while supporting with good ventilation. The 4 hour class that you advocate would probably teach this as well.


Edit: Wait a sec, just four hours? I don't need another beer and chuckle session, lets make that an actual class.

2mg flat dose is not appropriate. We should be allowed to tiitrate the dose for effect, instead of giving everyone a dose they may not need

Sarcasm is hard to detect on the internet - you're joking right?

Dead serious, i dont like narcan and i have issues with the way it came about and how its used.

I have never understood all the people who say "we don't need no stinkin' narcan - we should just ventilate." I think that completely misses the point.

If a 4-hour class were all it took to go from being "pretty terrible" to competent, then methinks we'd already have it covered.

If ventilation is sufficient to revive these patients, why give drugs front line? Dont we use vagal maneuvers before we go to meds? Meds before electricity? Just levels of treatment

Im not saying 4 hours is all it takes, currently the class the state has rolled out to LEO/EMS agencies who are looking to carry Narcan is 4 hours. I feel if you are going to only give 4 hours to treating this, the focus should be on proper ventilation and BVM use.

 

[Carlos Danger]

2mg flat dose is not appropriate. We should be allowed to tiitrate the dose for effect, instead of giving everyone a dose they may not need


Dead serious, i dont like narcan and i have issues with the way it came about and how its used.


If ventilation is sufficient to revive these patients, why give drugs front line? Dont we use vagal maneuvers before we go to meds? Meds before electricity? Just levels of treatment

Im not saying 4 hours is all it takes, currently the class the state has rolled out to LEO/EMS agencies who are looking to carry Narcan is 4 hours. I feel if you are going to only give 4 hours to treating this, the focus should be on proper ventilation and BVM use.

First, 2 mg is a perfectly appropriate dose - especially IN, with such unpredictable absorption anyway - if the choice is between that and allowing the patient to continue hypoventilating. It is not appropriate to expect EMT's and cops to "titrate" medication doses in a critical patient.

Second, opioid overdose is a life-threatening toxidrome with sequelae that includes more than just hypoventilation, and it can be easily and reliably and safely reversed with the administration of a single antidote. That's why you give it "front line".

Lastly, you already admitted in an earlier post that "EMS is pretty terrible at BVM ventilation", yet you keep insisting that our primary approach to managing these critical patients should be BVM ventilation? Uh.....OK.

My whole career I've heard people say what a bad drug naloxone is. Those people simply don't know what they are talking about.

 

[Flying]

Out of many, I know very few EMTs who have even heard of titration. The flat dose is there for a reason.

Having greater control over the dosage would be great, but we must design the system considering what we have, not what we want.

 

[medichopeful]

Any system should be able to put basic titration into effect. The way we do it where I work is one 1mg up a nare, then wait. If another dose is needed, we give it up the other nare.

 

[DesertMedic66]

Welcome to my county where the only thing medics are allowed to titrate without a base order is oxygen. Everything else we have to call.

 

[Carlos Danger]

Any system should be able to put basic titration into effect. The way we do it where I work is one 1mg up a nare, then wait. If another dose is needed, we give it up the other nare.

How long do you wait before giving the second dose?

That's great if you can manage the airway while waiting to see if the first mg is going to work. But do we really want cops and EMT's who don't know how to manage the airway waiting to see if the patient is going to start breathing before deciding whether to give the second dose?