Transcript Presentation: (MAJ) Daniel Schwartz, MD, FA, FACEP

BLS AND FIRST RESPONDER
NALOXONE PROGRAMS:
DEVELOPMENT AND IMPLEMENTATION
(MAJ) Daniel S Schwartz, MD, FS, FACEP
EMS Medical Director
Forbes Hospital
Page 1
Background
•
13 ALS Agencies
– Paramedics
– EMT’s
•
•
9 BLS-Only Agencies
4 Police Departments
•
•
2 Tactical Medical Support Programs
Tactical Support Physician: Pittsburgh FBI / SMRT
PA AG Office SOG
•
US Army Reserves
–
–
–
–
Page 2
Emergency Physician
Medevac Flight Surgeon
Infantry Battalion Surgeon
OIF / OEF
Forbes Hospital
Naloxone Programs (Since July 2014)
•
•
First Police Program In Pennsylvania: Pitcairn Police Dept
Police:
–
–
–
–
–
Pitcairn PD
Monroeville PD
Westmoreland County Sheriff
East McKeesport PD
Pending:
• North Huntingdon PD
• PA Attorney General Special Operations Group (West)
•
Fire First Responders: 5 Agencies
•
BLS Agencies: 4 Agencies
•
20 Paramedic Instructors
•
Regional EMS Conference: 31 Students
Page 3
Emergency Service Designations
•
DOH
– Bureau of EMS
•
EMS Agencies
–
–
–
–
•
ALS
BLS Ambulance
BLS Squad
First Responder
Fire
– No oversight by Bureau of EMS unless certified
– May be certified as ALS or BLS
• Falls under BEMS oversight
•
Police
– No oversight by Bureau of EMS
– Some DOH Regulations apply
– Naloxone oversight falls to PA Dept of Drug and Alcohol Programs
Page 4
Advanced Life Support (ALS)
• Paramedic Level Care
• Already Authorized to Utilize Naloxone
• Scope practice defined by BEMS
• Protocols for use defined by BEMS
Page 5
Basic Life Support
• EMT-Basic
• Scope of practice generally limited to Non-Invasive care
– No IV administration
– State Protocol
• Some limited medications
– Strong safety profile
– Ease of administration
– Critical need (life-saving intervention)
• Authorized to use Naloxone
– IntraNasal
– IM as autoinjector ONLY
Page 6
PA 2015 State Protocols
831 – Toxic Exposure
State Protocol Procedure Requirements
1. Establish BLS Airway / Ventilation FIRST
2. Administer High-Flow O2
A. NRB if spontaneously breathing well
B. BVM if assistance needed
3. Establish Pulse Oximetry
4. Request ALS if indicated
5. Determine Need for Naloxone
6. Give naloxone
A. Intranasal (IN)
B. Intramuscular (Autoinjector Only)
PA State Protocol Warning
Ventilation with BVM takes priority over naloxone administration.
If any of the following exist
cyanotic
decreased respirations
hypoxia (SpO2 < 95%)
You Must:
Ventilate with BVM and oxygen to adequate color/SpO2 while
preparing for administration of naloxone
EMT COMMAND PREREQUSITES
EMT and agency have authorization to use naloxone from their
medical director (optional protocol).
The following is current
EMT / EMR
CPR
Completed
EMT: CE course #007622 on the LMS
Completed Psychomotor Requirements (Practical Training)
– Regional Requirement
State Authorization
ACT 139
Act 139 Key Points
Caller Immunity
DOH Mandate
Revise BLS Scope of Practice
Make naloxone training available to first responders
Allows NON-EMS First Responder agencies to enter into
agreement with physician to
Carry Naloxone
Use Naloxone
Exemptions from Pharmacy act for Naloxone
Provides IMMUNITY for First Responders using Naloxone
“Caller Immunity”
May not prosecute minor drug offences if police became aware
of the drug possession / use as the result of a 911 call for
medical help.
Designed to encourage people to call 911 for overdoses rather
than fear prosecution
INCLUDES the person that called, not just the patient
Does not apply to major drug offences (i.e. intent to
distribute)
Does not apply to other crimes related to the drug offence
139 First Responder Authorization:
Police and Fire Immunity
(F) (1) A PERSON AUTHORIZE D , LAW ENFORCEMENT AGENCY, FIRE
DEPARTMENT OR FIRE COMPAN Y UNDER SUBSECTION (B)(2 ) OR (C ) WHO ,
ACTING IN GOOD FAITH AND WITH REASONABLE CARE,
ADMINISTERS NALOXONE TO ANOTHER PERSON WHOM THE PERSON
BELIEVES TO BE SUFFERING AN OPIOID-RELATED DRUG OVERDOSE
(I) SHALL BE IMMUNE FROM CRIMINAL PROSECUTION, SANCTION UNDER
ANY PROFESSIONAL LICENSING STATUTE AND CIVIL LIABILITY FOR SUCH
ACT.
(II) SHALL NOT BE SUBJECT TO PROFESSIONAL REVIEW FOR SUCH ACT.
(III) SHALL NOT BE LIABLE FOR ANY CIVIL DAMAGES FOR ACTS OR
OMISSIONS RESULTING FROM SUCH ACT
NON-EMS First Responder
Oversight of Non-EMS Naloxone Programs
Training Responsibility for Non-EMS Naloxone Programs
Nothing to do with DoH
NON-EMS First Responder Training
Act 139 requirements:
Must be approved by PA DDAP
Must be Available Online
Must be Free
ONLY APPROVED CLASS FOR
Non-EMS FIRST RESPONDERS
www.getnaloxonenow.org
ONLY APPROVED CLASS FOR
Non-EMS FIRST RESPONDERS
Narcan – Three Step Check
LOOKS LIKE AN OPIOD OVERDOSE
1. Check For Responsiveness and Breathing
2. Check For Pulse
3. Check for Contraindications
July 2014
• Pitcairn Police Department
• First Law Enforcement Naloxone Program in Pennsylvania
• First Naloxone Save: December 2014
October 2014
• Monroeville Police Department
• Completed Naloxone Education for All officers
Sounds Easy, Right?
• ALL PROGRAMS ARE OPTIONAL
• No Mandate for BLS Naloxone
• No Mandate for Fire Dept Naloxone
• No Mandate for Police Naloxone
• BUY-IN Needed
•
•
•
•
•
•
•
Departments
Municipalities
Individual Department Chiefs
Medical Directors
Hospitals
INDIVIUDAL POLICE OFFICERS
INDIVIDUAL FIRE FIGHTERS
Changing Role Perceptions
• Law Enforcement Role
• Medical Role
• First Responder Role
• “If I wanted to do medical care I’d be a paramedic”
• “Break the law, face the consequences”
Page 25
Myths and Perceptions
• “Now that they have naloxone available, they don’t care if
they overdose. They will just use more knowing someone
will reverse it if they take too much.”
• “The drug trade is the biggest source of violent crime in my
community. Why should I let it grow?”
• “People can wake up agitated and violent, is that a good
idea without a paramedic?”
• “Giving medication without advanced education is
dangerous”
Page 26
Credibility Of the Viewpoint
• People do not change attitudes, perceptions, habits, or
beliefs because a law was passed
• People hold to their beliefs even when give new information
• Perception of Reality
• If you don’t understand the culture, you can’t change
it
• The message is often lost if the MESSENGER has no
standing or credibility
– Doesn’t Speak the language
– Not part of the culture
Page 27
The Messenger
• 2 Tactical Medical Support
Programs
• Tactical Support Physician:
Pittsburgh FBI / SMRT
PA AG Office SOG
• US Army Reserves
–
–
–
–
Page 28
Emergency Physician
Medevac Flight Surgeon
Infantry Battalion Surgeon
OIF / OEF
Medical Director
• EMS Physician Recommended
• Police prefer physician they can relate to
• Responsible for education and program oversight
Page 29
Medication Supply
• Department Purchase
• Hospital Supply
– Most common model
– Medication supplied by Command Hospital
• Requires a Command Agreement
• Requires a Medical Director
• EMS Agency Supply
– First Responder agency may obtain supply from an
ALS EMS Agency
• Requires Agreement
• Requires a Medical Director
• **MOST ALS Agencies in PA receive meds from hospitals
Page 30
Kaleo Grant
• Requires EMS Agency to have agreement with Supplier
• No resupply
• Expiration Date?
Page 31
Medication Supply: Cost Considerations
• Naloxone Prefilled Syringe: $20
• Mucosal Atomizer Device (MAD) for IN Delivery: $15
• Total: $35 / Dose
• AutoInjector: $525 / Dose
Page 32
Intranasal Naloxone
Page 33
EMS vs Non EMS TRAINING Requirements
EMS Agency
First Responder
• BLS Providers are Medical
professionals
• BLS Providers are NOT
Medical professionals
• BLS Providers NOT
COVERED under act 139
• COVERED under act 139
• BLS Providers Restricted to
BEMS-Define
• Do not fall under BEMS
Regulations
• BEMS Mandated Training
• STATE Mandated Training
• Regional Mandated
Psychomotor Training
• Regional Mandated
Psychomotor Training
– SCOPE
– Protocol
Page 34
– 139-Defined Scope
– 139-Defined Use
Development of Prehosptial Naloxone Program:
Fundamentals
• You can’t force an optional program
• Change perceptions before you can change practice
• Consider the Messenger, not just the message
• Know the status of the agency
– BLS
– First Responder
– Police
• Must have physician oversight
• Supply Source Identified
• Training Completed
Page 35
Page 36