or embolic stroke, electrolyte abnormalities
like hyperkalemia, and sepsis.
Hypothermia may arise from a persistently
unresponsive state in a cool environment. In
addition, patients who have been lying immobile in an opioid-induced stupor may be subject to rhabdomyolysis, myoglobinuric renal
failure and compartment syndrome.
After securing the airway and providing
adequate oxygenation and ventilation, EMS
providers should expose the patient and look
for underlying traumatic injuries, bleeding,
firmness and/or swelling of muscle groups
that could indicate compartment syndrome.
Patients then should be covered with warm
blankets and IV fluid therapy should be initiated to correct any underlying electrolyte or
WHAT CAN WE DO?
In the U.S., drug overdose deaths nearly tripled to 47,055 between 1999 and 2014, with
60.9% involving an opioid. A study of nationally representative data on U.S. ED visits found
that the population-based rate of ED visits for
opioid overdose nearly quadrupled between
1993 and 2010.13
EMS providers on the frontlines of the
opioid overdose epidemic have a unique
opportunity for public education and death
prevention. Given the profoundly increased
risk of death antecedent to one overdose event,
EMS providers can identify at-risk individuals
and provide them with the necessary resources
and educational material on how to obtain nal-
oxone along with available drug rehabilitation
programs in the areas they live in.
Recognition of these high-risk individuals
may also lead to additional focus on discharge
planning processes for patients who have been
treated and released by EMS providers after
an overdose event. In some systems, there are
likely opportunities to track ambulance contacts and even send follow-up teams for every
patient that receives naloxone. EMS and ED
providers may even establish this as an opportunity for opioid or naloxone education.
Although prehospital cardiac arrest care is
a poor parallel for opioid overdose, the need
for rigorous review and prudent solutions is
similar. We must look for solutions to prevent overdose and offer further treatments—
specifically in a population that’s already had
an overdose event.
There’s a great deal of chatter from a vari-
ety of media outlets discussing which overdose
patients deserve care and which ones don’t.
EMS providers must ignore this. When a
patient presents to you, they must be treated
appropriately, regardless of whether it’s their
first overdose or their 100th. Every time
patient contact is made, there’s an opportu-
nity to impact a life and precipitate change.
We must not let our prejudices determine who
we attempt to help and who we give up on.
Today, heroin kills more people in the U.S.
than guns. 14 In October, the U.S. Department
of health and Human Services declared the
opioid crisis a public health emergency to help
mitigate the situation. 15
Though the wheels of bureaucracy are slow to
turn, EMS providers across the country are on
the frontlines doing battle. As a profession, we
must move beyond just administering naloxone.
We must provide comprehensive care where an
understanding of the disease process and common associated comorbidities leads to thoughtful,
patient-centric clinical decision making.
Finally, it must always be remembered
that the true victims of this disease are those
unfortunate individuals who suffer from
We must look for solutions to prevent overdose and offer further treatments—specifically in a population that’s already had an overdose event. Photo by Matthew Strauss
— Continued on page 45