When I started as a paramedic in Hartford in 1995, only paramedics carried Naloxone. Today, BLS ambulances carry it as well as our first responding Hartford Fire Department. A month from now, our Hartford Police Department officers will also carry it. This is a good thing.
Many times I have shown up at a car accident scene or a report of a man down where the first arriving police officer has shouted to me, “You’re going to need your Narcan!”
Hartford is a drug mecca for our surrounding suburbs, as well as states in northern New England. Substance users drive in to buy the drug going now on our streets for just $4 a bag or $35 for a bundle of ten bags. Unable to wait till they get home, they shoot up in their cars and crash or pass out at the wheel in the middle of intersections. Some who come in on public transit OD at the bus stop or in public restrooms.
The white powder is potent too. Increasingly, the dealers are selling Fentanyl mixed with, or in place of, heroin. Its not just one or two bad batches that are killing people. Many experienced users refuse to buy any bag that carries “white heroin” because they fear the Fentanyl. Others, of course, flock to it for the chance of a stronger high. The novice user or the person whose tolerance is not what it used to be thanks to rehab or a prison stretch are extremely vulnerable. The police carrying Narcan will no doubt save some lives. They may save some of the same lives repeatedly, but substance use is what it is. People are subjugated by one of the most addictive drugs in the world, a drug that damages and permanently rewires their brain. The job of the strong is to help the weak. A man’s life is worth saving the second and third times as much as it is the first.
Those against giving first responders Narcan can say it doesn’t matter that as long as a responder who is capable of bagging gets there, the Naloxone will eventually arrive, but not all first responders are great at bagging. Bagging is hard for a single cop, much less two EMTs or two paramedics. I was at a heroin cardiac arrest when after 2 minutes of CPR we converted a brady PEA rhythm into vfib, which we then blasted with 200 joules and 1 mg of epi into a perfusing rhythm. The man still wasn’t breathing and my partner and the firefighter were bagging and having difficulty getting good chest rise. I helped them reposition the head. I oversaw what I thought was excellent bagging. Good seal, good chest rise, good compliance. When our patient still wasn’t breathing on his own despite Narcan, I finally decided to put a tube in. The ETCO2 was 70, but came down to 40 within a minute. In other words, despite excellent bagging the patient wasn’t ventilated nearly as well as he was with the tube in place. I have seen that on other occasions. A typical heroin overdose I put ETCO2 nasal capnograpgy on, and often find initial readings of 90 or 100. I can bag it down sometimes to the 50s or 60’s, but when they start breathing on their own, their ETCO2 plummets to the normal range of 30-40. If the cops get their first, let them get the Narcan in and get these people breathing/ventilating on their own sooner.
So welcome to the battle, Hartford Police!
The fact of the matter is we have all been late to the forefront in fighting this epidemic. EMS, Fire, police, and citizen — we are all uniting now to take on this terrible disease that is costing us so many lives — family, friends and strangers. Let no one die for lack of giving our best efforts or lack of having the best tools to fight with.