Policy: 02-02-11
Intranasal Naloxene Administration

Issued By:Fire Chief/Director

Print
Purpose
To describe the indications of Intranasal Naloxone treatment for Firefighters within the St. John’s Regional Fire Department.


Background
Background Context There has been an upward trend in the use of opioid drugs in our region over the past few years. A number of years ago, most abuse was occurring via the oral route involving Codeine and Demerol. A few years ago Oxycodone became the drug of choice. Again, it was generally used orally or nasally. Over the past couple of years, intravenous drug use has become much more common. Locally morphine and hydromorphone were the drugs of choice but heroin use has been on the rise. Now there are a large number of illicit opioids available. A great percentage of these illicit drugs are being laced with Fentanyl. Fentanyl on a weight basis is 100 times more potent than Morphine. In a therapeutic setting, Morphine 10 mg parenterally is equivalent to Fentanyl 100 ug. The very high potency of Fentanyl has led to a concern about intoxication from an accidental exposure in frontline emergency first responders. Presentation Opioid intoxication can present in a variety of manners. Classically, there will be a decreased level of consciousness that can be proceeded by a degree of euphoria. The decreased level of consciousness is accompanied by respiratory depression. Objectively, there may be pinpoint pupils and a decreased blood pressure. The respiratory depression is the feature that needs to be treated urgently to prevent hypoxia and eventual death. This is a new policy.


Policy Statement
When to Administer Naloxone

Naloxone is to be used only in the management of severely symptomatic individuals with a confirmed or suspected exposure to a potent opioid. The following conditions should also be present:

Ø Impaired Level of Consciousness
Ø A respiratory rate of less than 10 breaths per minutes
Ø A need for assisted ventilation


How to Administer Naloxone

Naloxone will be supplied in 4mg pre-loaded atomizers.

Ø Place the individual on their back
Ø Remove the Narcan nasal spray from the box
Ø Peel back the tab to open
Ø Hold the Narcan nasal spray with your thumb on the bottom of the plunger and your first & middle finger on either side of the nozzle
Ø Tilt the individual’s head back and gently insert the tip of the nozzle into one nostril until your fingers on either side of the nozzle are against the bottom of the nose
Ø Press the plunger firmly to give the dose of Narcan Nasal spray
Ø Remove the Narcan Nasal spray from the nostril

The Narcan Nasal spray can be repeated on in 2-3 minutes if there is no improvement in the respiratory effort


Important Points


· Naloxone should only be used in the case of a suspected opioid exposure with respiratory suppression.

· Standard Basic Life Support Care should take preference over the administration of Naloxone.

· Naloxone will generally be effective for 30-60 minutes depending on the concentration and level of exposure. If Naloxone is required, there is a need for careful monitoring until transferred to a higher standard of care.

· Naloxone kits are for the protection of firefighters of SJRFD and NOT for administering to the public. Any firefighter administering the antidote to a member of the public will bear total responsibility for his or her actions and does so without the sanction of the St. John’s Regional Fire Department or the City of St. John’s, or its medical authorities.

· The decision to administer the nasal dosage to a firefighter at the scene of an exposure rests with the Incident Commander or unit Officer ONLY.

· All existing SJRFD exposure control and universal precaution protocols will continue to be in effect when dealing with potential or confirmed exposures to illicit drugs, drug paraphernalia or drug storage spaces.


NOTE

All Operational Guidelines are provided as a guideline only and may be altered by the OIC to meet extenuating circumstances.


Approvals
Fire Chief/Director


Responsibility
St. John's Regional Fire Department


Appendix/Appendices
None


Back