1. Grays Harbor EMS & Trauma Care Council October 2016
EMT Naloxone Program
Grays Harbor EMS & Trauma Care Council
October 2016

2. Naloxone Introduction
Purpose:
Early intervention can help reduce fatalities
The Emergency Medical Technician Narcan Program is designed to educate EMTs’ in recognizing signs and symptoms of opiate overdose and proper administration of life-saving Narcan

3. OBJECTIVES
At the conclusion of this training participants will be able to:
Identify Opioids/narcotics
Recognize signs and symptoms of opiate overdose
Initiate appropriate treatments and interventions
Assemble equipment needed to administer Narcan
Successfully administer appropriate dosing of Narcan

4. Background
Annually in Washington State approximately 600 individuals die each year from an opiate overdose according to the January 2016 Washington State Interagency Opioid Working Plan.
According to a recent statewide survey of syringe exchange clients, 57% of those who inject heroin said they were “hooked on” prescription opiates before they begun using heroin.
Timely administration of Narcan has proven to reduce the number of opiate related deaths

5. Definitions
Opioid – an opiumlike compound that binds to one or more of the three opioid receptors of the body
Opiate – a subset of the opioid family, and refers to natural, non-synthetic opioids
Narcotic – a drug that causes sleep or altered mental consciousness
Agonist – a chemical that binds to a receptor and activates the receptor to produce a biological response
Antagonist – a substance that interferes with or inhibits the physiological action of another

6. Naloxone

7. Naloxone Hydrochloride
Generic Name :
Naloxone Hydrochloride

8. Brand Name : Narcan®

9. Naloxone is.. An opiate antagonist which reverses opiate overdoses
Some commonly abused opiates are:
Heroin
Oxycontin
Percocet
Vicodin
Methadone
Morphine
Hydrocodone

10. Narcan®/Naloxone has been used in emergency rooms and EMS for more than forty years as an antidote for opiate overdoses.

11. Pharmacology
Opiates produce their effects as an agonist on the mu receptors in the central nervous system
Mu¹ receptors are responsible for a large portion of analgesic (pain management) effects
Mu² receptors are responsible for respiratory distress

12. Mu receptors Also known as Morphine receptors
Located in the Brain Stem and Medial Thalamus
Responsible for supraspinal analgesia, respiratory depression, euphoria, sedation, decreased gastrointestinal motility, and physical dependence

13. Naloxone is a opiate antagonist
Naloxone kicks opiates out of the brain by blocking certain receptor sites.
Naloxone occupies the receptor sites and prevents opiates from binding to the brain.
Naloxone in conjunction with rescue breathing has life saving potential.

14. Opioids/Opiates are; CNS depressants
Type of narcotic medications used to relieve pain

15. An opiate overdose is..
When opiates settle in the part of the brain that regulates breathing.
The immediate concern during an opiate overdose is respiratory depression.

16. BE PREPARED FOR THE PATIENT TO RELAPSE
The effects of Naloxone wears off between minutes after administration
Heroin lasts 6-8 hours
Methadone lasts 24 hours
Opiates outlast Naloxone
BE PREPARED FOR THE PATIENT TO RELAPSE

17. When am I supposed to give Narcan©?

18. Signs and symptoms of Opiate Overdose

19. Signs and Symptoms Weak/Thready pulse Slow or Absent Respirations
In addition to a known history of opiate abuse, responders should look for:
Weak/Thready pulse
Slow or Absent Respirations
Constricted Pupils
Weakness/Unresponsiveness

20. Indications Known narcotic or opioid overdose
Respiratory depression of unknown origin
Coma or Altered LOC of unknown origin

21. Routes IN – Intra-nasal (preferred route)
IM – Inra-muscular (secondary route)
SQ – Sub-cutaneous (this is not a route that the EMT will be using except in the case of an obese pt where the subcutaneous layer is larger than the needle is long
Note; Prior to administaring Narcan the EMT MUST first check the pts blood sugar level

22. Administration (preferred route)
The preferred administration route of Narcan will be Intra-nasally
A preloaded/prefilled syringe will be affixed with a mucosal atomization device (MAD)

23. Dosage
Adult: 1mg – repeat 1mg after 4 minutes if the pt did not respond to the initial dose
Peds: 0.5mg – repeat 0.5mg after 4 minutes if the pt did not respond to the initial dose Note: A ped becomes an adult at the time of puberty
May repeat dosing after 15 minutes and only if the pt is responding to the initial two doses

24. Factors that affect absorption IN
Vasoconstrictors
Epistaxis
Nasal congestion

25. Contraindications to the preferred route
Excessive Epistaxis
Nasal trauma
Septal abnormalities
Nasal congestion with mucous discharge
Destruction of nasal mucosa from surgery or past cocaine abuse

26. Advantages to the preferred route
Absorption almost as fast as IV
Very near to 100% amount of drug absorbed
Decreased potential for needle stick injuries

27. Administration (secondary route)
The secondary administration route will be Intra-muscular (IM). May be sub-cutaneous (SQ) due to the pts build I;E, obese pts
A needle (21g 1 1/2 “ minimum) will be attached to a preloaded/prefilled syringe

28. Administration (routes)
IM injection sites
Deltoid – upper arm
Dorsal Glutereal – butt muscle
Vastus Laterolis – anterior surface of upper leg
Rectus Femoris – lateral surface of upper leg

29. Contraindications secondary route
Hypersensitivity to Naloxone

30. Adverse/side affects Tachycardia Diaphoresis Hypertension N/V
Dysrhythmias
Withdrawls

31. Schedule
Naloxone is not in the DEA schedule of drug classes, yet requires a prescription
Naloxone has no potential for abuse

32. Naloxone has no other purpose besides reversing an opiate related overdose.
Naloxone has no mind altering effects

33. Naloxone is the only treatment in medicine that literally cannot hurt anyone.
The only possible effect is the individual may become dope sick (withdrawal).
Naloxone is specific, safe, and effective

34. Epidemiology
People coming out of jail or treatment have highest risk of overdose.
Most deaths are among opiate users who are in their late twenties to early thirties and have been actively using for the past five to ten years.
Only 17 % of opiate related deaths are among new users.

35. Nobody needs to die from an opiate overdose
Bottom Line
Nobody needs to die from an opiate overdose

36. Questions??? Opioid life-threatening response Algorithm
Test time – must score an 80% to pass
Practical assessment – student will be given a scenario and must pass with an 80% and have no critical criteria failures