Melanie Higgins, BS, NRP Captain – EMS Quality Assurance Division of Emergency Services 16232 Elliott Parkway Williamsport, MD 21795 (cell) 301-491-2454 (office) 240-313-4376 (fax) 240-313-4375 From: Chisholm, David E. <[email protected]> Sent: Wednesday, May 10, 2023 5:03 PM To: Doyle, Terry <[email protected]>; Eisenhower, Joshua <[email protected]>; Gismondi, Sara <[email protected]>; Hartsock, Shawn <[email protected]>; Hayter, Michael <[email protected]>; Hoffman, Gary <[email protected]>; Hoopengardner, Robert <[email protected]>; Hopkins, Lauren <[email protected]>; Sauser, Nathan <[email protected]>; Higgins, Melanie <[email protected]>; Smith, Keli <[email protected]>; Woods, Billy <[email protected]>; Yates, Eric <[email protected]>; Fraley, Christopher <[email protected]>; Hamrick, Darron <[email protected]>; Abbott, David <[email protected]>; Baker, William <[email protected]>; Breeding, Daniel <[email protected]>; Eppley, Benjamin <[email protected]>; Esler, Dylan <[email protected]>; Glessner, Ryan <[email protected]>; Greenlee, Connor <[email protected]>; Heim, Aaron <[email protected]>; Hoopengardner, Benjamin <[email protected]>; Hose, Keith <[email protected]>; Johnson, Charles P. <[email protected]>; Kopp, Mark <[email protected]>; Lewis, Kyle <[email protected]>; Lewis, Ralph <[email protected]>; Lovell, Hayden <[email protected]>; Ludwig, Duncan <[email protected]>; McKnight, Casey <[email protected]>; Milewski, Corey <[email protected]>; Moe, James <[email protected]>; Mongan, Konrad A. <[email protected]>; Morrell, Zachary <[email protected]>; Moser, Jacquelyn N. <[email protected]>; Myers, Roy D. <[email protected]>; Neal, Isaiah <[email protected]>; Neal, Jason W. <[email protected]>; Ostrowski, Mark <[email protected]>; Picking, James <[email protected]>; Rentzell, William <[email protected]>; Resh, Robert <[email protected]>; Royer, Edwin <[email protected]>; Schindel, Benjimin <[email protected]>; Shealy, Clay T. <[email protected]>; Snodderly, Trevor <[email protected]>; Speelman, Matthew <[email protected]>; Stottlemyer, Clinton <[email protected]>; Troutman, Christopher <[email protected]>; Wiley, Tricia <[email protected]>; Wood, Andrew <[email protected]>; Yates, Scott <[email protected]>; Arnold, Douglas T. <[email protected]>; Ball, William <[email protected]>; Bingaman, Donnie <[email protected]>; Burgesser, Michael <[email protected]>; Burleson, Charles <[email protected]>; Carpenter, Allen <[email protected]>; Eby, Steve <[email protected]>; Eckstine, Jason <[email protected]>; Haupt, Michael <[email protected]>; Henry, Brian <[email protected]>; Hoover, Robert <[email protected]>; Hopkins, Adam <[email protected]>; Jeremy Smiley <[email protected]>; [email protected]; Lyons, Pete <[email protected]>; McCuaig, Kyle <[email protected]>; Myers, Roy D. <[email protected]>; Nokes, Michael <[email protected]>; O’Connell, Matt <[email protected]>; Sipes, Craig <[email protected]>; Snyder, Ethan D. <[email protected]>; Stevens, Matthew <[email protected]>; Alex Kelly <[email protected]>; Amos, Christopher N. <[email protected]>; Eric Ramacciotti <[email protected]>; Donnie Bingaman <[email protected]>; Dwayne Kitis <[email protected]>; Hays, David <[email protected]>; Martin, Dr. Janelle <[email protected]>; Jimmy Sprecher III <[email protected]>; Jamie Drawbaugh <[email protected]>; Janelle Martin <[email protected]>; Joanie Gerber <[email protected]>; Lewis, Kevin <[email protected]>; Priscilla Morgan <[email protected]>; Paul Virden <[email protected]>; Robert Buck <[email protected]>; Steve Barnhart <[email protected]>; Todd Smith <[email protected]>; Will Ball <[email protected]>; Andrew Oyster <[email protected]>; Adam Buamgardner <[email protected]>; Alan Matheny <[email protected]>; Amos, Christopher N. <[email protected]>; Ann Jochum <[email protected]>; Aubrey McKittrick-Troop <[email protected]>; Bev Witmer <[email protected]>; Billy Eichelberger <[email protected]>; Bobby Follin <[email protected]>; Brandon Neuenschwander <[email protected]>; Breeding, Daniel <[email protected]>; Casey McKnight <[email protected]>; Caleb Carter <[email protected]>; Amos, Christopher N. <[email protected]>; Christian Rejonis <[email protected]>; Christopher Carmody <[email protected]>; Charles Smith <[email protected]>; Colten Matheny <[email protected]>; Cory Lescalleet <[email protected]>; Chaston Clatterbuck <[email protected]>; Deanna Adkins <[email protected]>; Dennis Browne <[email protected]>; Hays, David <[email protected]>; Dillon A Sanders <[email protected]>; Donnie Bingaman <[email protected]>; [email protected]; Doyle, Terry <[email protected]>; Eisenhower, Joshua <[email protected]>; Yates, Eric <[email protected]>; Eric Ramacciotti <[email protected]>; Erin Keefer <[email protected]>; Evan Bowman <[email protected]>; Jennifer & Tim Gargana <[email protected]>; Gismondi, Sara <[email protected]>; Hartsock, Shawn <[email protected]>; Hoffman, Gary <[email protected]>; Hopkins, Lauren <[email protected]>; Jeff Martin <[email protected]>; Jennifer Crippen <[email protected]>; Jennifer Hineman <[email protected]>; Jeremy Ardinger <[email protected]>; James Grove <[email protected]>; Joshua Hook <[email protected]>; Jeremy Mackrell <[email protected]>; Janelle Martin <[email protected]>; [email protected]; Jonas Zeigler <[email protected]>; Joey Muller <[email protected]>; James Ulrich <[email protected]>; Justin Ruppenthal <[email protected]>; Katie Dixon <[email protected]>; Kevin Demmons <[email protected]>; Kimberly Mose <[email protected]>; Kristen Gray <[email protected]>; Lacey Cocharan <[email protected]>; Lehman, Donald <[email protected]>; Lewis, Kevin <[email protected]>; Luke Giancola <[email protected]>; Mark Harrington <[email protected]>; Carol Thomas <[email protected]>; Adam Metz <[email protected]>; Jeff Metz <[email protected]>; Max Mullen <[email protected]>; Natalie Coffman <[email protected]>; Sauser, Nathan <[email protected]>; Nathan Bowers <[email protected]>; Paul Virden <[email protected]>; Deanna Pelton <[email protected]>; Priscilla Morgan <[email protected]>; Priscilla Morgan <[email protected]>; Abraham Jefferson <[email protected]>; Rachel Moran <[email protected]>; Ricky Smith <[email protected]>; Rob Matschat <[email protected]>; Robert Buck <[email protected]>; Robert Scott <[email protected]>; Robert Snider <[email protected]>; Robin Lessig <[email protected]>; Rachel Rosebrock <[email protected]>; Randy Spies <[email protected]>; Ryan Lesko <[email protected]>; Scott Cooney <[email protected]>; Scott Deibler <[email protected]>; Skyler Hall <[email protected]>; Higgins, Melanie <[email protected]>; Stephen Knoyer <[email protected]>; Smith, Keli <[email protected]>; Steve Barnhart <[email protected]>; Steven Corioni <[email protected]>; Terry Doyle <[email protected]>; Theda Dofflemyer <[email protected]>; Danielle Schorn <[email protected]>; Tom Schryver <[email protected]>; Angie Wolff <[email protected]>; Woods, Billy <[email protected]>; Zac Culler <[email protected]>; [email protected]; Adam Hopkins (2nd email) <[email protected]>; Ben Breeze <[email protected]>; Ben Hoopengardner <[email protected]>; Brian Henry <[email protected]>; Brian Lowman <[email protected]>; Brittany Canterbury <[email protected]>; Chad Shindle <[email protected]>; Dale Fishack <[email protected]>; Daniel Hawbaker <[email protected]>; Chisholm, David E. <[email protected]>; Hays, David <[email protected]>; David Yankey <[email protected]>; Donald Bingaman <[email protected]>; Ed Ernst <[email protected]>; Henri Jones <[email protected]>; HFD Fire Command <[email protected]>; James Sprecher Jr <[email protected]>; James Sprecher Sr. <[email protected]>; Jamie Drawbaugh <[email protected]>; Jason Eckstein <[email protected]>; Jeffrey Martin <[email protected]>; Jerry Keplinger <[email protected]>; Josh Eisenhower <[email protected]>; Keith Abrecht <[email protected]>; kerrington Gray <[email protected]>; Lewis, Kevin <[email protected]>; Kevin Trevey <[email protected]>; [email protected]; Mark Kopp <[email protected]>; mark miller <[email protected]>; Michael Nokes <[email protected]>; Natalie Coffman <[email protected]>; Oley Griffith <[email protected]>; Patrick Baker <[email protected]>; Priscilla Morgan <[email protected]>; Ricky Fleming <[email protected]>; Robert Buck <[email protected]>; Hoopengardner, Robert <[email protected]>; Robert Rinkinen <[email protected]>; Roger Otzelberger Jr <[email protected]>; Stephen Barnhart <[email protected]>; Steve Lohr <[email protected]>; Terry Stouffer <[email protected]>; Tommy Arnold <[email protected]>; Tony Veney <[email protected]>; Troy Loyd <[email protected]>; Vernon Wachter <[email protected]>; Will Ball <[email protected]>; Bill King <[email protected]> Cc: Griffith, Oley G. <[email protected]>; Hays, David <[email protected]>; Jacobs, Eric <[email protected]>; Lewis, Kevin <[email protected]> Subject: Overdose Treatment
All,
We continue to encounter patients that are presenting as violent when they wake up. We accept that this will be an ongoing trend for the foreseeable future. With that in mind, we will be returning to the administration of Narcan in this patient population with some modifications.
BLS and ALS Transport Units
1. Manage airway and support ventilations as appropriate and monitor pulse oximetry and end tidal carbon dioxide (ALS) 2. Once you have restored pulse oximetry and end tidal levels (ALS) to within normal limits or have ventilated for 3 to 5 minutes, you may administer Narcan. Narcan should be administered as follows. Dilute the 2 mg/2ml syringe of Narcan in 8 ml of NS or LR (0.2 mg/ml). Administer Narcan in 0.2 mg (1 ml) increments IV/IN, q 2 minutes until restoration of respiratory effort. 3. A minimum of 2 clinicians or a clinician and a law enforcement officer in the patient compartment for transport. 4. Pre-plan for a combative patient. 5. Versed is the medication of choice for sedation if the patient becomes violent. First Responder Units
Follow steps 1 and 2 with the exception of narcan administration. If after completing airway and ventilatory support for 3 to 5 minutes, you may administer your regular dose of intranasal narcan.
Questions, please ask.
David E. Chisholm, RN, BSN, NRP
Deputy Director – Operations
Division of Emergency Services
16232 Elliott Parkway
Williamsport, Maryland 21795
All,
We continue to encounter patients that are presenting as violent when they wake up. We accept that this will be an ongoing trend for the foreseeable future. With that in mind, we will be returning to the administration of Narcan in this patient population with some modifications.
BLS and ALS Transport Units
1. Manage airway and support ventilations as appropriate and monitor pulse oximetry and end tidal carbon dioxide (ALS) 2. Once you have restored pulse oximetry and end tidal levels (ALS) to within normal limits or have ventilated for 3 to 5 minutes, you may administer Narcan. Narcan should be administered as follows. Dilute the 2 mg/2ml syringe of Narcan in 8 ml of NS or LR (0.2 mg/ml). Administer Narcan in 0.2 mg (1 ml) increments IV/IN, q 2 minutes until restoration of respiratory effort. 3. A minimum of 2 clinicians or a clinician and a law enforcement officer in the patient compartment for transport. 4. Pre-plan for a combative patient. 5. Versed is the medication of choice for sedation if the patient becomes violent. First Responder Units
Follow steps 1 and 2 with the exception of narcan administration. If after completing airway and ventilatory support for 3 to 5 minutes, you may administer your regular dose of intranasal narcan.
Questions, please ask.
David E. Chisholm, RN, BSN, NRP
Deputy Director – Operations
Division of Emergency Services
16232 Elliott Parkway
Williamsport, Maryland 21795
Office (240) 313-4367
Cell (240) 500-5045
Fax (240) 313-4375