Alberta Health Services

Alberta Health Services

Article posted on February 1, 2023

Medical First Responders continue to help during the opioid crisis

Seven years ago, in 2016, the opioid crisis was suddenly on Alberta’s doorstep. Since then, first responders across the province have been trained to administer the antidote – naloxone, also called Narcan. As a result, many lives have been saved, and in the first responder and emergency medical communities, many lessons have been learned.

“Our crews have become much more comfortable with a novel skill they never expected they’d have to perform – intramuscular injections. It was so brand new and it was so foreign at first. At the beginning of this, I don’t know if anyone ever anticipated the number of injections they’d administer,” said Noon, training instructor with Edmonton Fire Rescue Services.

In response to the overdose epidemic, other steps throughout the larger provincial community have been taken as well. The public is now able to access naloxone intramuscular kits free of charge, and countless bystanders who recognized the signs of overdose have intervened with positive outcomes. Often, by the time first responders arrive, family or friends have already administered their own naloxone.

One exciting technological tool most people have access to through their phone is the Digital Overdose Response System (DORS). The app is available throughout Alberta and was developed because an estimated 70 per cent of overdoses take place in private residences, often when people are alone. A confidential program, the app prevents overdose deaths by dispatching emergency services if a user becomes unresponsive.

Supervised consumption sites have opened in Calgary, Edmonton, Red Deer, Lethbridge and Grande Prairie. People struggling with addiction are now able to have immediate phone consultations with physicians to start opioid replacement therapy. Importantly, the medical profession in general is more careful about prescribing opioids and the public is more aware of the addiction risk.

Despite all these advances, there are still backlogs for in-patient treatment programs and the demand for supervised consumption site support outweighs supply. First responders can attest to the volume of overdose calls, particularly in the winter months of 2021-2022.

“One of the things we’re trying to do better is giving people minimum amounts of naloxone in order to just get them breathing and not awake, not fighting, not having bad reactions and not going through withdrawal so we can get them to a facility that might be able to offer them some further supports,” said Dr. Kevin Hanrahan, a medical director with the AHS EMS Medical First Response program. “That’s a challenge for most MFRs because they have fixed-dose naloxone.”

If at an event where EMS is also on scene the paramedics should administer their naloxone, which can be titrated to very small doses while MFR supports the patient’s airway and breathing.

“When you wake them up abruptly, they go into withdrawal and then they might not have the capacity to think about how to get help after that,” explained Dr. Hanrahan.

In 2016, there were 554-opioid-related deaths in Alberta. In 2021 there were 1,614 and while the data for 2022 isn’t complete yet, there were 1,346 deaths recorded between January 1 and November 30.

The Naloxone Administration Intramuscular and Intranasal and Naloxone Administration Intranasal training modules on the MFR portal have recently been updated. Practitioners are encouraged to revisit one of these courses to refresh their training, and new practitioners can utilize the material as the required didactic training portion to administer naloxone in the field. The skills-based portion of the training must be completed in person by someone qualified to demonstrate, teach and assess these skills.

“Naloxone is great but when I teach classes, I emphasize how important airway management is,” said Kevin Leung, training instructor with Edmonton Fire Rescue Services. “EMS can start IVs, push medications, and do incredible things with their Lifepaks and it can seem so fancy to observers - and it is amazing - but it can be easy for other responders to discount the importance of the basics. Our crews, through repetition and practice have really owned the skills of airway management, oxygenation and ventilation which supports EMS and the patient when they need us the most.”

Since 2016, 6,459 people in Alberta have lost their lives to opioids. The ultimate hope for an overdose patient is to have them wake up in the hospital where there are resources the patient can access such as enrollment into an opioid replacement program. Anyone who has been addicted to nicotine knows it can take multiple tries before finally kicking the habit. Naloxone, with the right support, can allow someone struggling with opioid addiction another chance too.

Did you know?
The Alberta MFR program has an easy online form to request Community Based Naloxone kits.

Last Updated: Wednesday, February 01, 2023

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Edmonton, Alberta, Canada