Engine Company EMS: Understanding Addiction and Naloxone

Ambulance

By Michael Morse

Professionalism, courtesy, and competence are three qualities that all firefighters and fire officers possess. These traits are inherent in the people who pursue a career in the fire service. Sometimes a little nurturing is needed to bring these qualities skills out; later on, more than a little nurturing might be needed to bring them back.

Responding to overdoses can be one of the most rewarding EMS calls an engine company EMS crew can see. To revive a nearly dead person is gratifying no matter what the cause of the near death may be. Being called upon to revive the same patient again and again tends to diminish some of that thrill. Yet ultimately the satisfaction gained from giving a fellow human being another chance cannot be ignored.

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Far too often, we forget how fortunate we are to be on the receiving end of 911 call. When the people we are sworn to protect seem not to care about their own lives, resentment seeps into our psyche. It happens slowly, without us realizing it. Before we know it, responding to another overdose becomes a nuisance; arrogance replaces empathy.

The person who is addicted to opiates often experiences a similar path. They may have foolishly experimented with heroin or pharmaceuticals and did not care if they became addicted. If that is the case, some underlying mental illness was likely present, and the drugs became a way of compensating for pain. They may have been prescribed pain medication and become addicted (easily done). Some people are just wired to uncontrollably crave the euphoria that opiates provide. The descent into full-blown addiction with life-threatening consequences is a gradual journey. The high is replaced with need, the euphoria becomes maintenance, and the thrill gives way to misery. None of us know if we will be that person until we get those drugs in our system. For the addicted, once is often all it takes for the train to leave the station. They become resentful, angry, depressed, and difficult to treat.

How a person became addicted is their business. Our business is to assist when called upon. It can be difficult to maintain our professionalism, courtesy, and competence when working in squalor and treating people whose behavior is less than exemplary, but it is essential that we do so. A career in the fire service is a marathon. Every task we accomplish has the potential to make us better firefighters and EMS providers or wear us down and slowly take away the parts of us that make us who we are. The descent is insidious, but only if we allow our disillusionment to fester.

One way to keep the misery away is to properly administer naloxone. Currently there are three delivery methods: nasal spray, intramuscular injection, and intravenously. Depending on your jurisdiction’s protocols, IV access may be warranted (always follow your protocols). If the patient is conscious, there is no need to either start an IV or administer naloxone. If the patient is unconscious but breathing with a steady, strong pulse, consider monitoring breathing and airway before intervening. Whenever a patient is in respiratory distress, assist ventilations with a bag valve mask

It is my preference to establish an IV on a suspected overdosed, unconscious patient, assist ventilations, and titrate naloxone until spontaneous respiration returns. Slamming the full dose of naloxone through an IV will likely revive the patient but often creates an unnecessary burden–an irate patient. Not giving enough or withholding naloxone to avoid a combative situation is equally negligent.

Understanding addiction and naloxone makes the experience of treating overdose patients far less stressful than simply following a protocol. Caring for the person, no matter what their circumstances happen to be, makes sense.  By doing the job correctly, with full understanding of the tools at our disposal, the best job in the world becomes even more satisfying.


Michael MorseMichael Morse is a former captain with the Providence (RI) Fire Department (PFD), an author, and a popular columnist. He served on PFD’s Engine Co. 2., Engine Co. 9, and Ladder Co. 4 for 10 years prior to becoming an EMT-C on Rescue Co 1 and Captain of Rescue Co. 5.

 

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