Emergency Medical Responders and Law Enforcement

2. Naloxone use Emergency Medical Responders andLaw Enforcement

3. Objectives • In this slide set, you will learn: • What naloxone (Narcan) is • How it works when administered to a person who has overdosed on opioids • How to recognize the signs of a opioid overdose • When to give naloxone to a person who has overdosed on opioids

4. Statistics • Death resulting from heroin overdose has double in the past two years • Death resulting from overdose of prescription pain killers has quadrupled in the past 10 years • Nearly 8,000 people a year die from heroin overdose and 16,000 from overdose of prescription pain killers

5. Definition • Opioid substances are chemicals that interact with a specific receptor in the brain and cause an expected effect of respiratory depression, sleepiness and small pupils among other things • Examples include heroin, morphine, codeine, dilaudid, oxycodone

6. Why do people die? • Too much heroin or other opioids causes people to become very sleepy. • Opioids cause a reduction in breathing rate by acting directly on the brain. • This leads to low oxygen levels which causes damage to the heart and brain. • Eventually, the heart slows down and stops

7. Steve’s Law • In 2014, the Minnesota State Legislature passed “Steve’s Law” allowing firefighters and other first responders to administer naloxone to a person who is exhibiting the signs of an opioid overdose. • The bill also allows non-medical, trained lay-persons to administer the medication in the right setting

8. Authorization • EMR or law enforcement groups who want to provide naloxone will need to get authorization from a licensed physician, physician assistant or advanced practice nurse. • An EMR group must be registered with the state of Minnesota.

9. Naloxone • Naloxone is a medication available in all hospitals and most ambulances. • It acts in the brain to immediately reverse the effects of the opioid in the person’s system • It last about 45 minutes before it is cleared from the body

10. Side effects • Naloxone has no side effects and very few people have shown an allergy to the medication • The person could develop vomiting, sweating or shortness of breath once the medication wakes them up • These are essentially symptoms of withdrawal from the opioid and are not unexpected

11. What does an overdose look like? • Signs and symptoms of an opioid overdose • blue lips and fingernails, • a slow pulse • very small pupils • absent or very slow breathing • inability to be woken up.

12. Act Fast • When you find someone who you think as overdosed, look for the tell tale signs. • Are they sleepy and cannot be woken up? • Is there breathing very slow or absent? • Are their pupils very small?

13. Treating the patient • Ensure the scene is safe • Assess ABCs and treat any immediate life threats • Provide supplemental oxygen as needed • If inadequate respiratory effort • open airway • attempt to place an oral airway • support the patient’s breathing with ventilations using a pocket mask or BVM

14. Administer Naloxone • If the patient has inadequate breathing as well as other signs of opioid overdose, prepare to give Naloxone. • The medication can be given intranasally, intramuscularly or intravenously. • Most EMR groups will use the nasal version while laypersons will likely use the intramuscular version of the medication.

15. The EVZIO auto-injector of naloxone • Think combination EPI-Pen and AED • Available by prescription • Cost is high, around $500-$700. • The SRHF has received some as a donation

16. EVZIO - Use • The device has audible instructions that start when the safety cap is removed • Follow the very simple directions

17. EVZIO • The EVZIO naloxone is no different that other sources. • It is a 0.4mg dose, just like what is given in the typical IM dose. • Use the same injection locations such as thigh or upper arm • The device is ONE-USE ONLY.

18. Using Naloxone intranasally

19. Why the nose • The nose is a perfect place to absorb medication • Nasal mucosa gets more blood flow per unit of area than the liver or brain

20. Many forms of Nalxone • Best used for nasal • Best used for intramuscular 1 mg in 1 ml of fluid 0.4 mg in 1 ml of fluid

21. Higher concentrated version • Recommendations are to use no more than 0.5 to 1 ml of fluid in a nasal administration since the absorption is worse if more fluid is put into the nose

22. Nasal Administration • Ensure the persons nose is relatively clear • Attach the medication vial to the syringe • Attach the atomizer to the syringe • Place the atomizer snuggly against the nostril opening. • Briskly push the medication vial into the syringe, dispensing ½ of the medication

23. Nasal Administration • Place the atomizer snuggly against the opening of the other nostril • Briskly push the medication vial into the syringe and dispense the second half of the medication • Continue rescue breaths and recheck the person’s alertness in 2 minutes • Administer a second dose of naloxone if the person is not breathing.

24. After care • Prepare patient for transport • The patient should be transported to an Emergency Department due the relative short-term effects of Naloxone.

25. Save a life • You can not harm someone by giving them naloxone • In many cases, you will safe a life.

26. FOR MORE INFORMATION VISIT OUR WEBSITE AT WWW.SteveRummlerHopeFoundation.org EMAIL US AT Hope@SteveRummlerHopeFoundation.org Find us on Facebook or Twitter @SRHopeF