Conn. firefighters to carry narcan

Stamford firefighters respond to every serious medical call in city; expected to complete narcotics overdose training by end of January

By John Nickerson
The Advocate

STAMFORD, Conn. — As the number of heroin overdoses increases, more first responders are being trained and equipped to use a life-saving drug.

In Stamford, schedules are being drawn up for training the city's 264 career firefighters in the use of naloxone hydrochloride, a drug commonly known as Narcan, that reverses the effects of opioids like heroin and oxycodone.

Assistant Fire Chief Trevor Roach said the firefighters, who respond to every serious medical call in the city, may all be trained to carry Narcan by the end of January.

Darien police, who respond to every medical call in town, are considering putting the drug in their cruisers, and New Canaan officers are now being trained to carry the opioid antidote.

Overdose deaths due to opioids in the state rose from 195 in 2012 to 284 in 2013. Heroin was the culprit in 86 of the deaths in 2012 and 109 deaths in 2013. In Fairfield County, heroin fatalities jumped over 50 percent from 21 in 2012 to 34 in 2013.

The turning point in first responders use of Narcan was the enactment on Oct. 1 of the state's so called Good Samaritan law, which provides civil and criminal immunity to anyone administering a drug such as Narcan to someone experiencing an opioid-related overdose. Before that, only licensed health care practitioners were allowed to administer the drug.

Dr. Douglas Gallo, the medical director of Stamford Emergency Medical Services, who supervises what medical care firefighters and police can provide on the job, said Stamford firefighters recognized the value of carrying Narcan, and he endorsed the idea.

"While the paramedic crew in Stamford are excellent and have been capable of administering Narcan for years, the fact is the faster the drug can be administered, the better and by having first responders acting in advance of medics, they can perform potentially live-saving interventions," he said.

Gallo said that in some cases when firefighters get to calls before medics, they could begin the treatment that could mean all the difference.

City police, who do not respond to medical calls in the city unless they are asked have no plans at this point to carry it, but the department is looking into the possibility, said Assistant Chief Timothy Shaw.

Greenwich Emergency Medical Services deputy director Art Romano said Greenwich paramedics have been carrying Narcan for 28 years.

He said paramedics have had excellent success rates in resuscitating overdose victims there. From Jan. 1 to Nov. 1 Narcan was administered to 26 overdose victims and they are universally successful in reversing the effects of opiate overdoses, if they get the call in time.

But Romano said in Greenwich, where police go to every emergency medical call, there are no plans to get police to carry the drug.

"We have had such a high level of success all these years, besides we literally go together on all these calls and we have a very high success rate," Romano said.

On Oct. 30, GEMS medics saved an 18-year-old Glenville man suffering from an overdose.

Danbury Emergency Medical Services Director Mathew Cassavechia said there are no immediate plans to put Narcan in police or firefighting hands in Danbury.

He said Danbury firefighters, who are all trained as emergency medical technicians and know how to spot opioid overdoses can begin resuscitation before medics arrive.

He said there has been some interest in getting Narcan to first responders, and they will assess each request and work with fire and police to properly vet those requests as they are made.

"We are confident in our first responders, that they can deal with any medical emergency prior to the paramedic's arrival," he said.

But Redding Police Chief Douglas Fuchs said his officers are well on the way to carrying Narcan. Because of the rural environment, Fuchs said his cruisers already carry defibrillators and oxygen and every one of his 17 officers are trained Emergency Medical Responders.

Because his officers are out there 24-hours a day and the town relies on a volunteer emergency medical staff, more often than not his officers get to medical calls first.

"We know this will afford us the opportunity to save a life," he said. By the end of next week, Fuchs said all his officers will be trained and Narcan will be added to the Redding cruiser inventory.

Dr. Jason Podber, chairman of Stamford Hospital's Department of Emergency Medicine, said Narcan competes with opiates to attach itself to certain receptors in the central nervous system. Once it is introduced, it keeps the opiate from attaching to the receptors and prevents the opiate response that can stop hearts from beating and lungs from breathing.

He said Stamford Hospital deals with about four to five overdoses per month and most of those are from prescription drug abuse. Podber said he has seen a little increase in heroin abuse, but it could be a lot worse, as it seems to be in other communities.

Some overdoses occur by accident. He said one patient was recently admitted to the hospital because he put too many fentanyl patches on his body. Podber said the man actually did not realize that he already had one patch on when he administered another. Medics found the man unresponsive, but with Narcan he was quickly revived.

"It is a wonder drug for people who make bad decisions," Podber said.

And there appears to be no serious down side. Podber said that if someone is given Narcan mistakenly, it does not cause a problem. He said he has yet to see anyone given the drug who did not need it come down with an allergic reaction.

Stamford Emergency Medical Services deputy chief of training Joe Larcheveque, said paramedics in Stamford have been carrying Narcan for about 30 years and use the drug between eight and 10 times a month.

Last July medics were called to a home on Stamford's East Side for an overdose. A 20-year-old man finally came down to dinner and was acting a little funny and slumped over in his chair and fell to the floor.

At 10:28 p.m. that night, firefighters got there and found needle marks on man's arm and "bagged" him by putting him on a ventilator to get him breathing again. The ambulance arrived two minutes later and at 10:32 p.m. administered the Narcan.

At 10:33 p.m. the man woke up and three minutes later he was talking to the medics and telling them that he wasn't using any illicit drugs. Larcheveque said the man actually tried to decline medical attention, which is a danger because the Narcan can wear off before whatever drug the man was on did. But Larcheveque said medics were able to convince him he needed medical care and brought him to Stamford Hospital.

Stamford paramedics administer Narcan with a needle or through an IV. But firefighters will be given a nasal sprayer, which is basically a syringe with a coned plastic cap at the end that makes a spray out of the liquid Narcan.

Just shove it into the nose of the overdose victim, depress the plunger and wait. It doesn't ordinarily take long.

"It's amazing when you administer Narcan, wait 30 seconds later and they open their eyes and look at you," he said.

Copyright 2014 The Advocate 

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