EMERGENCY MEDICAL SERVICES

PROGRAM

RECOGNITION, RESPONSE AND

ADMINISTRATION OF NALOXONE
Opioid Overdose 101
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

LEARNING OBJECTIVES

Obtain baseline understanding of the prescription drug

overdose problem
Understand how opioids work
Identify an opioid overdose
Learn how to respond to an opioid overdose
Learn how to administer naloxone,
an opioid antidote
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

UNIT ONE
Importance of Overdose Prevention
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

Scope of the Problem

 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101
Death-All 30Merced 5.39 2.84 9.50
Opioid Lower Upper 31Santa Barbara 5.23 3.23 8.12 California Deaths - 2014
County Overdose 95% CL 95% CL 32Nevada 5.07 1.39 13.76
1Mariposa 25.45 5.34 79.87 33California 4.92 4.71 5.15 All Opioid Overdose - Age-
2Lake 25.39 13.90 43.78
3Plumas 20.52 4.34 66.67
34Yolo
35San Benito
4.63
4.60
2.20
0.93
8.96
16.74
Adjusted Rate per 100k
4Humboldt 19.84 13.04 29.41
5Mendocino 16.96 9.12 29.37
36Contra Costa
37Yuba
4.52
4.46
3.36
0.85
5.98
14.42
Residents
6Santa Cruz 16.43 11.84 22.39
7Amador 14.75 5.77 37.66 38Tulare 3.96 2.28 6.53
8Modoc 14.20 0.36 89.88 39Trinity 3.89 0.10 52.65
9Tuolumne 13.68 5.12 31.03 40Sacramento 3.85 2.92 4.99
10Lassen 13.34 4.29 36.87 41Napa 3.75 1.21 9.13
11Shasta 11.91 7.21 18.94 42El Dorado 3.59 1.32 8.37
12Glenn 11.17 2.24 36.33 43Stanislaus 3.23 1.83 5.34
13San Joaquin 9.61 7.45 12.27 44Sutter 3.22 0.63 10.31
14San Francisco 8.57 6.85 10.82 45Monterey 3.00 1.58 5.33
15Kings 8.40 4.30 15.45 46Alameda 2.96 2.20 3.94
16Kern 8.33 6.51 10.59 47Santa Clara 2.80 2.12 3.66
17Fresno 7.63 5.91 9.73 48San Bernardino 2.70 2.04 3.54
18Orange 7.56 6.64 8.58 49Los Angeles 2.70 2.39 3.03
19Ventura 7.34 5.62 9.48
50San Mateo 2.26 1.36 3.62
20Del Norte 7.25 0.83 29.89
51Tehama 2.18 0.26 11.50
21San Diego 6.93 6.08 7.89
52Placer 1.95 0.81 4.12
22Madera 6.77 3.21 12.82
23Imperial 6.77 3.44 12.26 53Calaveras 1.76 0.21 17.26
24Siskiyou 6.63 0.94 25.28 54Marin 1.52 0.47 4.26
25San Luis Obispo 6.58 3.80 10.86 55Alpine 0.00NA 850.09
26Solano 6.51 4.31 9.54 56Colusa 0.00NA 24.43
27Riverside 6.14 5.17 7.25 57Inyo 0.00NA 31.75
28Butte 5.79 2.96 10.56 58Mono 0.00NA 41.76
29Sonoma 5.73 3.85 8.32 59Sierra 0.00NA 280.05
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

UNIT TWO
Opioid Basics
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

Opioids are used primarily in medicine for pain relief,

treatment of opioid use disorders, and cough relief.
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101
Naloxone
 Knocks the opioid off the opioid receptor
 Only blocks opioid receptors; no opioids = no effect
 Not harmful if no opioids in system
 Temporarily takes away the “high,” giving the person the chance to
breathe
 Works in 1 to 3 minutes and lasts 30 to 90 minutes
 Can neither be abused nor cause overdose
 Only known contraindication is sensitivity, which is very rare
 Can cause withdrawal symptoms such as:
nausea/vomiting  muscle discomfort
diarrhea  disorientation
chills  combativeness
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

UNIT THREE
Identifying an Opioid Overdose
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

Identify an
Opioid
Overdose
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

UNIT FOUR
Naloxone Intervention
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

RESPOND TO AN OPIATE OVERDOSE

1.Stimulate
2.Alert EMS and 911 system
3.Administer naloxone
4.CPR – Rescue breathing/ventilations
5.Repeat 3 & 4, if necessary
6.Recovery position, if breathing
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

RESPOND TO AN OPIATE OVERDOSE

Safety Precautions
Prior to administration of naloxone, review ABCs
Assess for other causes of altered mental status and/or
respiratory depression
The half-life of naloxone is relatively brief
Monitored closely for recurrent symptoms
 Altered mental status, respiratory depression, etc.
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

RESPOND TO AN OPIATE OVERDOSE

Safety Precautions Continued

The Medical Director should include parameters within the

protocols for EMS personnel on how to address these adverse
effects:

 Agitation  Nausea
 Tachycardia  Vomiting
 Pulmonary edema  Seizures
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

RESPOND TO AN OPIATE OVERDOSE

Risk Factors with Opioid Overdose
Hypercarbia
Aspiration
Cardiopulmonary arrest
Incidence of risk factors increases with use of other
substance
 Alcohol, benzodiazepines, or other medications
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

RESPOND TO AN OPIATE OVERDOSE

Naloxone can only be administered

if authorized by
your Local EMS Agency Medical Director
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

Pre-filled
ampule of
naloxone
Mucosal
Atomization Luer-lock
Device (MAD) syringe
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

Intranasal delivery route has advantages:

Uncomplicated and convenient

Nose is an easy access point for medication delivery
It is painless
No shots needed
It eliminates any risk of a needle stick
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

1. Remove yellow caps 2. Remove purple cap from

from delivery device medication vial
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

3. Thread atomizer on to 4. Gently screw the medication vial

the top of the delivery into the delivery device until you
device feel it catch
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

5. Spray half (1 ml) up one

nostril and half up the
other nostril.
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

Intramuscular delivery route has advantages:

Consistent delivery
Similar to other auto-injectors used by pre-hospital personnel
Fast acting
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

1. Ventilate patient
2. Remove auto-
injector from case
(voice prompt is
now activated)

3. Pull off Safety Guard

 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

4. Black end of auto-

injector on thigh
5. Press firmly and
hold in place for
five (5) seconds
6. Remove auto-injector
and dispose properly
using Sharps Container
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

ADDITIONAL TRAINING RESOURCES

3-minute video

“Naloxone Administration for Opioid Overdose”

https://www.youtube.com/watch?v=vV3HR_J3Ws8

11-minute video

“Opioid Medication Safety: The Role of Naloxone”

http://vimeo.com/37778160
 RECOGNITION, RESPONSE AND
ADMINISTRATION OF NALOXONE
OPIOID OVERDOSE 101

QUESTIONS?