Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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 ∥ ◀ ▶ july 2014 ∥ 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 ∥ www.apcointl.org ◀ ▶ july 2014 ∥ ◀ ▶ 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 • CLASS SCHEDULE APCO Institute | 351 N. Williamson Blvd. Daytona Beach, FL 32114-1112 | 888-272-6911 | 386-322-2500 Fax: 386-322-9766 | [email protected] | www.apcoinstitute.org Save More Lives • CDE Exam #36489: Rethinking Overdose Response Communications Training Officer 5th Ed., Instructor 38018 Online Starts July 30 $459 Comprehensive Quality 37908 Online 37295 New Orleans $329 Starts July 23 Aug. 02 Crisis Negotiations for Telecommunicators 38224 Minneapolis July 15 38225 Minneapolis July 16 $199 Active Shooter Incidents for Public Safety Communications 37196 Columbia City, Ind. July 07 37877 Online Starts July 09 37296 New Orleans Aug. 07 $199 CALEA Public Safety Communications Accreditation Manager 37887 Online Starts July 16 $499 Customer Service in Today’s Public Safety Communications Center $199 37912 Online Starts July 09 $199 Communications Center Supervisor, 4th Ed. 37939 DeKalb, Ill. July 01 37891 Online Starts July 23 37292 New Orleans Aug. 01 37742 Columbia City, Ind. Aug. 25 $349 Disaster Operations & the Communication Center 37917 Online Starts July 16 Emergency Medical Dispatcher 5.2 37723 Online Starts July 16 $379 $349 Emergency Medical Dispatch Instructor 37952 Online Starts July 30 $459 Communications Training Officer 5th Ed. 38010 Online Starts July 09 37678 Nelsonville, Ohio July 15 38243 East Peoria, Ill. July 16 37197 Columbia City, Ind. July 21 37992 Online Starts July 23 37293 New Orleans Aug. 01 Fire Service Communications 2nd Ed. 38139 Online Starts July 02 38140 Online Starts July 02 37959 Online Starts July 23 $379 The City of Lakewood seeks an experienced and motivated radio system technician to help maintain its P25, 700/800 MHz, digital trunking radio systems’ equipment and network. Duties include, network configuration, circuitry repair, radio alignment and programming, equipment installation, diagnosing Illuminations 36718 Online Illuminations—EMD Track 37863 Online and repair of repeaters and radio system infrastructure. Candidate must possess knowledge of: basic electronics theory, land mobile radio systems, trunking, AC/DC electrical systems, cabling, and dispatch consoles at a minimum. Preferred minimum educational requirement: bachelor’s degree in electronics or related technical field. Public safety related communications experience is a plus. Public Safety Telecommunicator 1, 6th Ed. 38041 Online Starts July 09 38043 Online Starts July 16 38042 Online Starts July 23 $309 Public Safety Telecommunicator 1, 6th Ed. Instructor 37958 Online Starts July 30 $459 Stress in Emergency Communications 37903 Online Starts July 16 $199 • APCO Institute Presents Web Seminars For a complete list of convenient, affordable seminars on topics vital to your agency, visit www.apcointl.com/institute/webinars.htm. Current APCO members receive a $20 discount. Dates, locations and prices are subject to change.Students who enroll in Institute Online classes will be assessed a $50 Distance Learning fee. Tuition is in U.S. funds. For more information: www.lakewood.org 40 PUBLIC SAFETY COMMUNICATIONS ∥ ◀ ▶ july 2014 ∥ ◀ ▶ www.apcointl.org 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. Starts July 01 **By application only. Compensation based upon experience and education. 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 Fire Service Communications 2nd Ed., Instructor 38141 Online Starts July 02 38142 Online Starts July 02 38021 Online Starts July 30 Employment Opportunities RADIO SYSTEM TECHNICIAN CITY OF LAKEWOOD, CO 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 the CDE tests for recertification, complete this section and return the form when you send in your request for recertification. Do not send in the tests every month. There is no cost for APCO-certified personnel to use the CDE article program. 2.Answer the test questions online or using this form. Photocopies are acceptable, but don’t enlarge them. APCO Instructor Certificate # 3.Fill out the appropriate information section(s), and submit the form to: APCO EMD Basic Certificate # APCO Institute 351 N. Williamson Blvd. Daytona Beach, FL 32114 Questions? Call us at 888/APCO-9-1-1. You can now access the CDE Exam online! Go to http://apco.remote-learner. net/login/index.php to create your username and password. Enter “article” in the search box. Click on “2014 Public Safety Communications Magazine Article Exams,” then click on “Rethinking Overdose Response (36489)” to begin the test. Once the test is completed with a passing grade, a certificate is available by request for $15. Expiration Date: Expiration Date: If you are not APCO certified and would like to use the CDE tests for other certifications, fill out this section and send in the completed form with payment of $15 for each test. You will receive an APCO certificate in the mail to verify test completion. (APCO instructors and EMD students please use section above also.) Name: Title: Organization: Address: Phone:Fax: E-mail: I am certified by: ❑ MPC ❑ PowerPhone ❑ Other If other, specify: ❑ My check is enclosed, payable to APCO Institute for $15. ❑ Use the attached purchase order for payment. ∥ www.apcointl.org ◀ ▶ july 2014 ∥ ◀ ▶ PUBLIC SAFETY COMMUNICATIONS 41