1. First Responder Naloxone Grant Webinar
February 22nd, 2016
Brittni Reilly, MSW, Naloxone Pilot Program, Massachusetts Department of Public Health
Dr. Alexander Walley, MD, MSc, Medical Director, MDPH Opioid Overdose Prevention Pilot Program

2. Brockton
Police and Fire
Chelsea
Everett
Falmouth*
Haverhill
Lowell
Lynn
Malden
Medford*
New Bedford
Plymouth*
Revere
Salem*
Saugus
Police* and Fire
Somerville
Taunton
Worcester
Chicopee*
Fire
Fall River*
Leominster*
Quincy
Westfield*
Yarmouth*
Barnstable
Police
Beverly*
Fitchburg
Framingham *
Lawrence*
North Attleborough*
Weymouth
Winthrop

3. Goal of the First Responder Naloxone Grants
For First Responders to carry and administer naloxone in communities most affected by the opioid epidemic

4. Police and Fire naloxone rescues in MA 2010-2014 Massachusetts DPH First Responder Pilot
Rescues and deaths,

5. Updated Opioid-Associated Life Threatening Emergency (ADULT) Algorithm –
American Heart Association Guidelines, October 2015

6. Remember “Four Rights” for medication administration
Massachusetts Office of Emergency Medical Services Minimum Standards for First Responder Training in First Aid, Epinephrine Auto-Injector and Naloxone Use AR-2-100
Right Patient (opioid overdose)
Right Medication (Naloxone-check for clarity)
Right Date (check expiration)
Right Dose (spray half (1ml) in each nostril)

7. Naloxone formulations
Nasal with separate atomizer
“Multi-step”
NEW: Nasal Spray
“Single-Step”
Auto-injector

8. Nasal Naloxone with atomizer – Multi-step
Intranasal naloxone needs to be dispensed with the mucosal atomization device
If there is nasal trauma or bleeding, do not administer naloxone
Benefits of Intranasal Naloxone
Nose is an easy access point
Painless
Eliminates risk of contaminated needle sticks and needle dispensing
Key Point: Benefits of intranasal naloxone

9. Give Naloxone: Nasal with atomizer
Remove both yellow caps from the ends of the syringe
Twist the nasal atomizer onto the tip of the syringe
Remove the purple cap from the naloxone
Twist the naloxone on the other side of the syringe
Review how to put together naloxone kit.
Interactive: have participants put together demo naloxone kits

10. Give Naloxone: Nasal with atomizer
Push 1ml (1mg) of naloxone into each nostril
Administer the entire contents of the 2ml syringe with approximately one half (1ml) administered in each nostril
Administering one half in each nostril maximizes absorption

11. NEW: Nasal Spray

12. NEW: Nasal Spray Administration

13. Two important points for the New Nasal Spray Single Step
Do not prime the spray
you will end up wasting it
Insert the tip until your fingers are against the nose
One dose is one nostril
Nasal trauma will reduce the effectiveness

14. Auto-injector Naloxone
Each auto-injector contains only 1 dose
Inject into muscle or skin of the outer thigh
Can be injected through clothing if needed
Device injects intramuscularly or subcutaneously, delivers the naloxone, and retracts the needle fully into its housing
Needle not visible before, during, or after
Key Point: Benefits of intranasal naloxone

15. Auto-injector Naloxone
Practice with the Trainer to make sure you are able to safely use the auto-injector in an emergency
The Trainer does not contain a needle or medicine
It can be reused to practice your injection
The red safety guard can be removed and replaced on the Trainer
Key Point: Benefits of intranasal naloxone

16. Give Naloxone: Auto-injector
Review how to put together naloxone kit.
Interactive: have participants put together demo naloxone kits

17. Give Naloxone: Auto-injector
Review how to put together naloxone kit.
Interactive: have participants put together demo naloxone kits

18. Give Naloxone: Auto-injector
Review how to put together naloxone kit.
Interactive: have participants put together demo naloxone kits

19. Give Naloxone: Auto-injector
Review how to put together naloxone kit.
Interactive: have participants put together demo naloxone kits

20. How does a person respond to Naloxone?
Range of responses:
Gradually improves breathing and becomes responsive within 3 – 5 minutes
Immediately improves breathing, responsive, and is in withdrawal
Starts breathing within 3 – 5 minutes but remains unresponsive
Does not respond to first dose and naloxone must be repeated in 3 – 5 minutes (keep rescue breathing)
No response to multiple doses of naloxone
Very often those who become responsive won’t immediately realize they just overdosed

21. Withdrawal symptoms after naloxone rescue (2010-2014)
Program data –
Other = confused, disoriented, headache, aches and chills, cold, crying, diarrhea, happy, miserable

22. After Administering Naloxone
Continue rescue breathing with 1 ventilation every 5 seconds until EMS arrives
After 3-5 minutes, if the patient is still unresponsive with slow or no breathing, administer another dose of naloxone
Key Point: Continue rescue breathing, if still unresponsive and EMS has not arrived administer second dose of naloxone after 3-5 minutes

23. If victim is breathing, but unresponsive place in recovery position
If for any reason the victim needs to be left along place in recovery position

24. Naloxone Storage
Nasal with separate atomizer: Storage between 59°F to 86°F
Avoid extremes in temperatures for long periods of time
Replace every 6-12 months, before expiration date
New Narcan Nasal Spray: 59°F to 77°F
Replace before expiration
Auto-injector: 59°F to 77°F
Temperature excursions are permitted between 39°F and 104°F
Keep in outer case until needed
If solution through viewing window is discolored, cloudy, then replace
Replace before expiration date
Keeping inventory is important. Narcan has month shelf life
Storage in recommended temperatures is important

25. First Responder Naloxone Programs Lessons Learned
Ensure First Responders perform rescue breathing and wait 3-5 minutes between doses of naloxone
Do not administer multiple doses without a pause
Practice ambu-bag skills
Reinforce that the goal is to restore breathing not full alertness
911 call rates have increased as community and first responder naloxone have increased
Be sure First Responders follow assessment protocol – not every unconscious patient is in an opioid overdose
Integrate overdose response and naloxone administration into annual re-training

26. Help-seeking (calling 911 or EMS present) by people reporting rescues with MDPH naloxone
How is help-seeking defined?
Program data
Alex Walley Fellows Report
Alex Walley Fellows Report 26 26

28. Good Samaritan Law Policy

29. Example of incorporating MGL c.94C s34A into Department Policy

30. Grant Program
When paperwork is finalized the first check will be issued
In the April 1st and July 30th reports each Department will report on activities and the City/Town will report on expenditures
Reports must be signed by an authorized signatory
The second check will be issued at the point when each municipality submits a report that indicates full expenditure of the first half of the grant award and phase II spending plan.

31. Bulk Purchasing Program
As a First Responder department, you may purchase naloxone directly from the State Office of Pharmacy Services (SOPS)
The legislation establishing the trust fund authorizes DPH to reduce the cost of naloxone for municipal first responder agencies below the negotiated SOPS purchase price
Contact: Edward Cavallari
978‐858‐2153

32. Data Collection
Every time naloxone is administered by your department during the grant period you are required to complete and submit an MDPH First Responder Naloxone Report to DPH.
Why is this data important and what do we use it for?

33. Technical Assistance
Online Resources: MassTAPP Page: DPH-BSAS Page: