At 09:19 AM 08/04/01 -0400, Mike Bjarkoy wrote:
>Hi John
>I know what I about to say probably only relates to prehospital and we should
>be talking of A&E, but...
>There is another reason for giving IV Naloxone which hasn't been mentioned
>yet, and has very little to do with patient care - if paramedics IV the
>naloxone and the patient gets up then the crew are able to walk into the back
>of the ambulance rather than the crew carrying them. I realise this is
>somewhat 'self centred' but it definitely has have an effect on street
>protocol.

Totally applies to your friendly local hypoglycemic Pt
The N-A  is more in the line of bagging Pt (NO, we do not intubate
suspected Narc ODs)
Securing Pt to stretcher
IV access (predominant) IM is also popular
Titrate Narcan to response & transport

The Aussies are more into the treat & release :

ABSTRACTS
Are heroin overdose deaths related to patient release after prehospital
treatment with naloxone?
Prehosp Emerg Care 1999 Jul-Sep;3(3):183-6 (ISSN: 1090-3127)
Vilke GM; Buchanan J; Dunford JV; Chan TC
Department of Emergency Medicine University of California, San Diego,
Medical Center 92103, USA
OBJECTIVE: Naloxone is frequently used by prehospital care providers to
treat suspected heroin and opioid overdoses. The authors' EMS system has
operated a policy of allowing these patients, once successfully treated, to
sign out against medical advice (AMA) in the field. This study was
performed to evaluate the safety of this practice.

METHODS: The authors retrospectively reviewed all 1996 San Diego County
Medical Examiner's (ME's) cases in which opioid overdoses contributed to
the cause of death. The records of all patients who were found dead in
public or private residences or died in emergency departments of reasons
other than natural causes or progression of disease, are forwarded to the
ME office. ME cases associated with opiate use as a cause of death were
cross-compared with all patients who received naloxone by field paramedics
and then refused transport. The charts were reviewed by dates, times, age,
sex, location, and, when available, ethnicity.

RESULTS: There were 117 ME cases of opiate overdose deaths and 317
prehospital patients who received naloxone and refused further treatment.
When compared by age, time, date, sex, location, and ethnicity, there was
no case in which a patient was treated by paramedics with naloxone within
12 hours of being found dead of an opiate overdose.

CONCLUSIONS: Giving naloxone to heroin overdoses in the field and then
allowing the patients to sign out AMA resulted in no death in the one-year
period studied. This study did not evaluate for return visits by paramedics
nor whether patients were later taken to hospitals by private vehicles.

Basically sound good to me.

Did have a call for an unconscious at train terminal (not quite bradypeic)
Started to work him up
Low & behold he's got EKG electrodes already attached
He did respond to Naloxon
Story :
ODed in Jersey City
Got worked up by the local Medics
AMAed
Took his train
Came to NYC
... probably doing another one of those EMS survey ! ?

Would he have Smurffed out on his own ?
Who knows ?

Charles Brault EMT-P

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