Download “Information from your caller will help determine the appropriate

CDE #36489
New Forms of Treatment Require
an Updated Response
Photo Gert Zoutendijk
parties. Other individuals can develop an
addiction after being prescribed opiate
painkiller(s) following an injury or surgery.
The addiction to prescription painkillers
can begin with frequent doctor visits to
obtain more medication, reporting recurrent symptoms, lost or stolen medications—whatever it takes to get another
prescription. Eventually the addict will
run out of supply and need to find another
source to feed the addiction, often streetlevel heroin.
According to a fact sheet published
by the Drug Enforcement Administration (DEA), heroin is a highly addictive
drug that is the most rapidly acting of all
the opiates.4 The quick effects of heroin,
coupled with the low street cost, make it
By Michael Banks
t’s 3:30 p.m. and you receive a 9-1-1 call
from a home in a quiet neighborhood.
“Help! I just came home from work
and I found my son on the floor. He’s not
breathing!”
You dispatch medical units and send
law enforcement for backup. Upon questioning the caller further, she relays to you
that her 19-year-old son, Jason, is taking
Suboxone. She says he’s had some drug
issues in the past, but he’s been clean for
a few months. You attempt to gain control
of the caller’s emotions and have her
further assess her son, but she’s unable to
move him.
When paramedics and police officers
arrive on scene, they find Jason prone on
the floor in respiratory arrest. They roll
him over and find a spoon and a hypodermic syringe beneath him. Paramedics start
to manually provide respiration with a bag
valve mask (BVM) and high-flow oxygen.
They struggle to establish a peripheral
intravenous (IV) line and resort to starting
an intraosseous (IO) line into the bone
marrow of his right leg to deliver a dose of
Naloxone, better known as Narcan. After
the patient is loaded onto the cot and into
the ambulance, he starts to breathe on
his own and slowly regains consciousness.
By the time they reach the emergency
room, Jason is wide awake. He says nothing is wrong, despite the fact that he can’t
explain why he woke up in an ambulance
with an IO line drilled into his leg. Once at
the hospital, care is transferred to ER staff
members who try to convince Jason to be
truthful about what happened and what
he may have taken.
This type of call plays out over and
36 PUBLIC SAFETY COMMUNICATIONS
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over again throughout the U.S. Jason
is a heroin addict who, despite several
attempts at rehab, continues to relapse.
He was lucky his mother found him when
she did. The effect of a heroin overdose,
especially when coupled with other drugs,
can be deadly.
Heroin abuse is back, and is no longer
limited to a subculture of our society. The
spectrum of heroin abusers now transcends age, gender and socioeconomic
class. According to an article in The New
York Times, 88% of those who died from
heroin in 2010 were white, half were
younger than 34, and almost a fifth were
ages 15 to 24.¹ Recent notable deaths
from heroin overdose range from Oscarwinning actor Philip Seymour Hoffman
(age 46), to former U.S. Navy SEALs
Jeffrey Reynolds (44) and Mark Kennedy
◀ ▶ www.apcointl.org
(43).2 As the sharp increase in heroin
overdose becomes a pressing problem
for first responders on the street, it
likewise becomes an urgent issue for
telecommunicators to be aware of in
the comm center.
The Path to Addiction
What possesses a person to try heroin
for the first time? According to a study
conducted by the Centers for Disease
Control and Prevention (CDC), addiction
frequently begins with opiate painkillers
that are widely prescribed in many forms,
including morphine, Dilaudid, codeine,
Oxycontin and Vicodin.3 The study reveals
that younger people acquire opioid medications either from personal prescriptions
or those stolen from family members,
and use them in social settings such as
levels. Heroin abusers who successfully
complete rehabilitation and lose their
tolerance have an especially high risk
of overdosing if they relapse and start
using again.
New Tools
for Responders
Heroin acts as a powerful central nervous system suppressant. In mild dosages, the user simply enters a deep state
of relaxation. In increased doses, however, heroin suppresses the autonomic
nervous system, which controls organ
functions including the respiratory
drive. The suppressed respiratory drive
will affect the breathing rate, eventually
leading to respiratory arrest.
“Information from your
caller will help determine
the appropriate response”
very attractive to addicts. Heroin can be
injected, smoked or snorted, and comes
in many forms depending on where it
originates from and what steps have been
taken during the manufacturing process.
Dealers can “cut” the drug with other
products to stretch out the supply, or
introduce other potent drugs to enhance
the effects. A particularly dangerous strain
of heroin that has recently reappeared on
the street is cut with a much more potent
opiate called Fentanyl.
As addicts continue to abuse heroin,
they build an increasingly higher tolerance to the drug and require increasingly higher dosages in order to achieve
the same high. Sometimes the amount
needed to get high can exceed lethal
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Until recently, only paramedics and
emergency room personnel could deliver
an effective anti-narcotic drug, Naloxone
(commercially available as Narcan), to
treat a suspected opiate overdose. Naloxone blocks the body’s opiate receptors,
temporarily reversing the effects of opiates on the body. Unfortunately, Naloxone’s effects are only temporary and often
do not outlast the effect of the opiates
themselves.
Due to the stunning increase of deaths
attributed to heroin overdoses in recent
years, the federal government and several
states have opened discussions on who
should be allowed to possess and deliver
Naloxone. Many states have changed or
are considering changing the scope of
PUBLIC SAFETY COMMUNICATIONS 37
CDE #36489: Rethinking Overdose Response
received an anti-opiate drug and has recovered doesn’t mean the emergency is over.
The effective time for opiate antagonists is
30–60 minutes, and once it wears off, the
opiates in the patient’s system will once
again take over. These patients must be
evaluated by medical professionals.
A recent surge in heroin overdoses has prompted
public health officials to put Naloxone and educational
pamphlets in the hands of addicts and their loved ones,
in addition to police and first responders.
Conclusion
Heroin addiction has reached epidemic
levels across the U.S. Increased media
attention and public awareness has led to
heightened enforcement efforts, however,
heroin has been present on the street
in one form or another for decades and
will never fully go away. Remember that
the typical user is now not “just another
junkie”—callers should be treated with
the same level of respect as any other
caller and encouraged to aid the victim as
best they can.
Always remember that an unresponsive patient should be treated as any
other unresponsive patient per your
agency protocols. The possibility of drug
overdose should be considered, yet not
A tube of Naloxone Hydrochloride, also known as
Narcan, is a nasal spray used as an antidote for
opiate drug overdoses. Here, a tube is shown next
to a lipstick container for scale.
MICHAEL BANKS, RPL, is a communications training officer with Wadsworth (Ohio) Police Department. He also provides EMS part time. Contact him
at [email protected].
AP Photo/Elise Amendola
practice for EMTs to include the ability to deliver Naloxone. There are also
initiatives to let police officers and lay rescuers administer Naloxone so the medication can be delivered prior to EMS
arrival. Some jurisdictions that have already
enacted this policy have
reported many saves
that would likely have
led to death otherwise.5
The U.S. Food and
Drug Administration
(FDA) is currently fasttracking a commercial product, Evzio,
that will even put Naloxone into the hands
of family members and caregivers.6 Evzio
is an autoinjector that provides computerized voice prompts to walk the caregiver
through proper application of the device.
After it injects the medication, Evzio verbally prompts the user to contact emergency services. It is therefore imperative
that telecommunicators be aware of this
drug, as it could have a role in 9-1-1 calls
in the near future.
Putting anti-opiate drugs into the hands
of first responders and caregivers alike
will give many overdose victims a second chance at life. It is important to
emphasize, however, that Naloxone is
not an “antidote” to opiate overdoses.
Naloxone only provides temporary relief
(approximately 30–60 minutes) to opiate
toxicity. Once the drug diminishes in the
bloodstream, the opiates will take over
once again. Naloxone can only help ensure
that a victim stays alive and breathing long
enough to receive advanced medical care
and detoxification.
to-mouth or BVM, if available) must be
provided until more advanced treatment
is available.
If the victim is breathing, he/she should
be positioned in the recovery position
and the caller should be
prepared for the potential of vomiting. This is
especially important if
an anti-opiate drug has
already been administered, as this is a common side effect. Any
vomit should be cleared
from the mouth to reduce the possibility
of aspiration.
If the caller has yet to administer an
available prescription device for opiate
overdose, they should be asked to follow the directions on the device or as a
physician has directed. Depending on the
method of administration, the drug could
take several minutes to take effect. Be
sure to inform responders if such a device
is available and at what time it was used.
Remember that this medication will only
work for opiate overdoses and will have no
effect on the victim if they are under the
influence of another type of drug.
Dispatching law enforcement to the
scene should be considered, as there may
be illegal drug paraphernalia, and the
patient may become violent if they regain
consciousness from a euphoric state.
As stated earlier, just because a person
REFERENCES
1. Sontag D. (Feb. 10, 2014) Heroin’s
small-town toll, and a mother’s grief. The
New York Times. Retrieved on May 28, 2014
from www.nytimes.com/2014/02/11/us/heroins-small-town-toll-and-a-mothers-pain.
html?src=me&ref=general&_r=1.
2. Kulish N., Urbina I., Mazzetti M. (Feb. 25,
2014) Hired to fight pirates, but doomed by boredom. The New York Times. Retrieved on May 28,
2014 from www.nytimes.com/2014/02/26/world/
africa/hired-to-fight-pirates-but-doomed-byboredom.html?_r=0.
3. Jones C. (Feb. 2013) Heroin use and heroin
use risk behaviors among nonmedical users
of prescription opioid pain relievers—United
States, 2002–2004 and 2008–2010. Journal of
Drug and Alcohol Dependence. 2013;132:95–100.
4. Drug Enforcement Agency. (n.d.) Drug
Fact Sheet: Heroin. U.S. Department of Justice.
Retrieved on May 28, 2014 from www.justice.
gov/dea/druginfo/drug_data_sheets/Heroin.pdf.
5. Goodman J. (April 3, 2014) Proposal would
provide New York police with kits to combat
overdoses. The New York Times. Retrieved on
May 28, 2014 from www.nytimes.com/2014/04/03/
nyregion/new-york-program-to-help-police-geta-kit-to-combat-overdoses.html?_r=1.
6. U.S. Food and Drug Administration. (April
3, 2014) FDA approves new hand-held autoinjector to reverse opioid overdose. Retrieved
on May 28, 2014 from www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/
ucm391465.htm.
Overdose Response
In responding to a call for a potential
heroin overdose, 9-1-1 telecommunicators should remember the true danger
of opiate overdose: suppressed respiratory drive. Calltakers and dispatchers
should always follow their protocols for
unresponsive patients and airway control,
which may include utilizing CPR guidecards due to the lack of regular respirations. At a minimum, the airway needs
to be opened and respiratory support in
the form of manual respirations (mouth-
38 PUBLIC SAFETY COMMUNICATIONS
∥
◀ ▶ july
2014
∥
◀ ▶ www.apcointl.org
Photo Gert Zoutendijk
“Be sure to inform
responders if such a
device is available and at
what time it was used”
Opiate addicts should not think that
they can abuse as much as they want
because Naloxone is now more available.
Education is key to informing responders,
caregivers and addicts about the realities
of this medication and the importance of
further medical care after it is used.
automatically assumed; information provided from your caller will help determine
the appropriate response. As opiate antagonists become more readily available, we
may need to consider working this in to
our questioning processes. Be sure to discuss this topic with your agency leadership
and/or medical control to determine how
these emergencies are treated today and
what changes are on the horizon.
One day enforcement and prevention may reduce the incidence of opiate
overdoses, but we must always remain
vigilant for the next big product to hit
the streets and affect those who have
succumbed to addiction. ∥PSC∥
∥
www.apcointl.org ◀ ▶ july
2014
∥
◀ ▶
PUBLIC SAFETY COMMUNICATIONS 39
CDE #36489: Rethinking Overdose Response
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8. How long do the effects of Naloxone last?
a.Permanently
b. 30–60 minutes
c. 60–90 minutes
d. 24 hours
4. Naloxone is a drug that:
a. Should be used regularly to prevent addiction relapses
b. Provides temporary relief from the effects of overdose
c. Is a substitute for drug education programs
d. Prevents overdose victims from requiring medical attention
9. What is Evzio?
a. A generic form of Naloxone
b. A bag valve mask that enables manual respiration
c. A cure for heroin addiction
d. An easy-to-use autoinjector that delivers anti-opiate medicine
5. Which of these is a common side effect of Naloxone?
a. Increased heart rate
b. Body spasms
c.Vomiting
d. Low blood sugar
10. Widespread availability of Naloxone and Evzio means that opiate
addicts may continue to use heroin without fear of medical
repercussions.
a.True
b.False
Ordering Information: If you are APCO certified and will be using
1. Study the CDE article in this issue.
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Compensation based upon
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3. How does Naloxone reverse the effects of a heroin overdose?
a. It blocks the body’s opiate receptors
b. It increases the body’s adrenaline levels
c. It stimulates the heart to beat faster
d.It causes a chemical reaction in that delivers increased oxygen
levels to vital organs
Using the CDE Articles
for Credit
Starts July 01
6. What is the true danger that victims of opiate overdose face?
a.Hemorrhage
b. Injury caused by loss of consciousness
c. Respiratory arrest
d. Cardiac arrest
7. In the event Naloxone has already been administered
to the patient, telecommunicators should:
a. Follow protocols for airway control
b. Dispatch law enforcement backup
c.Alert the caller that patient may be violent
or sick upon regaining consciousness
d. All of the above
2. Which of these prescription drugs is not an opiate?
a.Dilaudid
b.Acetaminophen
c.Oxycontin
d.Vicodin
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1. Of people who died from heroin overdose in 2010, how many were
younger than 34 years old?
a.One-fifth
b.One-fourth
c.One-third
d.Half
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PUBLIC SAFETY COMMUNICATIONS 41