Opioid Overdose Response Training

Learn about opioids, recognizing opioid overdose, and responding to emergencies in this educational training by Shepherdstown Fire Department. Get insights on opioid receptors, hierarchy of opioids, chemical anatomy, and factors putting individuals at risk. Equip yourself with the knowledge to administer naloxone, provide rescue breathing, and seek help effectively in opioid overdose situations.

• Opioids
• Overdose Response
• Training
• Shepherdstown Fire Department
• Naloxone

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1. Overdose Response Training Shepherdstown Fire Department, Inc. Educational Institution April 2019

2. Agenda 1. Know how opioids work 2. Recognize an opioid overdose 3. Respond to opioid overdose o Getting help o Rescue breathing o Administering naloxone 4. Questions

3. Marshall DeMeritt, MS, NREMT Grew up on a goat farm in Luray, VA Undergraduate Degree from Shepherd University Joined Shepherdstown Fire Department in 2006 Elected as EMS Chief in 2014 Master of Science from WVU WV Office of EMS Emergency Medical Technician National Registry Emergency Medical Technician National Association of EMS Educators Instructor WV Office of EMS Instructor Firefighter, Fire Officer II, and Rescue Technician Father of 3 (2 + a dog), Husband to Krystle

4. Opioid Receptors, brain Opioid How Opioids Work Shepherdstown Fire Department Educational Institution Overdose Response Training

5. Opioids By Definition Opioids are sedative narcotics They are used in medicine mainly to relieve pain Opioids repress the urge to breathe- When someone is having an opioid overdose, they stop breathing

6. Hierarchy of Opioids Opioids Semi-Synthetic Opioids Fully Synthetic Opioids Natural Opioids Heroin Opium Morphine Codeine Fentanyl Methadone Hydromorphone Hydrocodone Oxycodone

7. The Chemical Anatomy File:Oxycodone.svg File:Hydrocodone.svg File:Heroin - Heroine.svg Oxycodone Hydrocodone Heroin

8. Opioid Receptors, brain Opioid Opioids Overdose Shepherdstown Fire Department Educational Institution Overdose Response Training

10. What puts people at risk for ODs? Mixing drugs- including alcohol Changes in Tolerance Physical health deterioration Previous experience of non-fatal overdose Variation in strength and content of street drugs

11. Really High or Overdose? Overdose Really High Pupils pinned Nodding, but arousable Responds to sternal rub Speech is slurred Sleepy, intoxicated, but breathing 8 or more times per minute Pupils pinned Not arousable No response to sternal rub Breathing slow or stopped Less than 8 times per minute May hear choking sounds or a gurgling/snoring noise Blue lips, blue fingertips

12. Pinpoint Pupils: #1 EMS Indicator (a) Pinpoint and diaphoretic; (b) normal

13. General Overdose Symptoms Blue skin tinge Body very limp Face very pale Pulse (heartbeat) is slow or not there at all Throwing up Diaphoretic (Sweaty) Passing out - unresponsive Choking sounds or a gurgling/snoring noise Breathing is very slow, irregular, or has stopped SOAKING WET or ICE CUBES

14. Opioid Receptors, brain Opioid Respond to Overdose Shepherdstown Fire Department Educational Institution Overdose Response Training

15. Recognize overdose symptoms + Recognize drug paraphernalia/Recognize the drug Recognize need for Naloxone Look for symptoms, but if uncertain- land on the side of Naloxone

16. NALOXONE (Narcan) Naloxone knocks the opiate off the opiate receptor- it does nothing other than blocking opiate receptors Temporarily takes away the high, giving the person the chance to breathe Naloxone works in 1 to 3 minutes and lasts 30 to 90 minutes

17. NALOXONE (Narcan) Naloxone can neither be abused nor cause overdose, only contraindication is known sensitivity, which is very rare. Naloxone can cause IMMEDIATE withdrawal symptoms such as: Anger / Combative Behavior Depression Suicidal Tendencies

18. Narcan Restores breathing

20. 5 Step OD Process 1. Maintain Scene Safety 2. Alert EMS 3. CPR Rescue Breathing 4. Administer naloxone 5. Monitor and Support

21. Overdose Treatment Scene Safety is paramount 1 patient is easier to manage than two Assess victim s signs & symptoms Call for EMS support Stimulate the person - sternal rub If not breathing, do not delay rescue breaths

22. Overdose Treatment Checking for a pulse. No more than 10 seconds. If no pulse? Then initiate CPR 100-120 per minute Rescue Breathes Use A Mask/barrier 30:2 ratio with compressions

23. Overdose Treatment Administer Naloxone (Narcan) Prefilled ampule of naloxone Mucosal Atomization Device (MAD) Luer-lock syringe

24. Overdose Treatment Administer Naloxone (Narcan) STOP: Practical Application

25. Narcan Administration Atomize Narcan into Nose 1mg per nare (half per nare) Delivery route has advantages: Its easy and convenient The nose is a very easy access point for medication delivery (even easier than the arm, especially in winter) No shots are needed It is painless It eliminates any risk of a needle sticking to you

26. Overdose Treatment Monitor and Support If breathing remains absent or slow (< 8 per minute), continue rescue breathing administer 2nd dose If breathing restored, then recovery position Get an AED just in case

27. Recovery Position

28. General Questions Will Naloxone work on an alcohol OD? No What if it is a crack/cocaine or speed/methamphetamine overdose? Narcan won t work, but won t hurt. Are the ambulance and hospitals using the Nasal Naloxone? Yes and No.

29. Questions? Shepherdstown Fire Department Educational Institution Overdose Response Training Contact Information: Marshall DeMeritt, MS, NREMT EMS Chief, Shepherdstown Fire Department emschief@shepherdstownfiredepartment.com (540)742-8190