High Risk

The dispatch is for an unresponsive overdose, likely fatality.  We are coming from a fair distance, but we are the only unit available.  There no updates.  No PD dispatcher asking if we are a medic unit or the message that CPR is in progress.  PD and fire have beaten us to the scene, but as we pull in, we know the story.  Friends and family members are gathered outside the triple-decker as word has no doubt gotten around the neighborhood.  The firefighter standing by the engine, nods to us.  A police officer comes out of the house and walks towards his cruiser.  I still grab my red in-house bag and cardiac monitor, and hike up the narrow stairs, and then through the open apartment door, down a hallway and into a bedroom where a man lays back against the bed like he was sitting up, and then just fell immediately backwards.  He has rigor and lividity.  Asystole in all three leads.  I announce the time.  It doesn’t take long to get the picture.  On a small table is a cardboard box, the kind glassine envelopes come in, and on top of the box is a small pile of white powder.  A broken off ballpoint pen case with which to snort the powder lies next to the box.  In the trash can is a torn heroin bag with a faded red stamp I don’t recognize.  Word is the patient overdosed a couple days ago and was brought to the ED.  In the corner of the room is a hospital gown with two electrodes still stuck to it.

Patients who have had a nonfatal overdose are at the highest risk of having a subsequent fatal overdose.  When a patient is brought to the hospital after an overdose, as long as they are alert and oriented, they are generally watched for a couple of hours and then discharged home, often with a mimeographed sheet of paper listing area treatment programs, many of which have long waiting lists.  Many patients aren’t interested in getting treatment, particularly since the addiction and craving that brought them to overdose in the first place remains unabated.  Some hospitals in the country, try to get patients immediately onto suboxone or methadone, but not around here.  There is a lot of paperwork and regulations involved, and it is after all, dispensing an opiate, albeit one less deadly than heroin or morphine.

Most opiate users who EMS revives with naloxone and brings to the hospital are sent home or back to the street within 2-4 hours of their arrival at the hospital if they don’t leave AMA before then.

I don’t know the details of the dead man’s last experience at the ED, but I suspect it was similar.