Grappling with naloxone issue

Grappling with naloxone issue
By Wayne Lowrie
Brockville Recorder
Link to article: Grappling with naloxone issue

Municipal governments across Leeds and Grenville have been grappling with the question of whether or not their volunteer firefighters should carry naloxone kits to treat patients who overdose on opioids.

And they have been coming up with different answers.

In the Township of Leeds and the Thousand Islands, for example, the council has voted to supply the life-saving antidote to its firefighters and have them trained in its use.

Likewise in the Town of Gananoque where both its firefighters and police officers have access to the kits and know how to use them. Mayor Erika Demchuk said her town’s police and fire departments have carried the kits for months, both for their own protection and that of the public.

But Edwardsburgh/Cardinal has adopted the opposite stance. Its council decided to reject the carrying of the kits on the advice of its fire chief.

Similarly, the volunteer firefighters of Elizabethtown-Kitley have decided they don’t want to administer naloxone and they have sent that recommendation to township council.

The last two municipalities are bucking a trend to see the drug more available in Ontario. The province now distributes the drug kits free to fire departments that agree to participate in the Ontario Naloxone Program. In fact, naloxone is now offered free to the public at many drug stores, both local school boards have the kits in schools and the City of Kingston recently decided to put naloxone in its public buildings alongside the defibrillators.

Chris Lloyd, chief of the counties’ paramedic service, said the provincial health ministry and the fire marshal’s office have been pressuring all first responders, including volunteer fire departments, to carry the kits and be trained in how to administer naloxone.

Lloyd said his department supports the idea that volunteer first responders carry naloxone, adding that EMS will work with any volunteer fire services that want to enter the program.

All counties ambulances carry naloxone and its paramedics are trained in its use, Lloyd said. But in rural Leeds and Grenville, volunteer firefighters are often first on the scene at medical calls. Their ability to administer the drug could enhance the chances of saving a life, he said.

First responders often don’t know whether or not an unconscious patient has been using opioids because callers don’t want to say for fear of getting police involved, he said.

But Lloyd said naloxone poses no danger to people who are unconscious for other reasons. The drug merely helps overdosed patients to breathe, he said.

He added much of the training is to teach first responders how to deal with patients once they become conscious. Overdosed patients sometimes will wake up angry that the first responders have ruined their pleasant high and become violent, he said. Or they will become sick and vomit.

Lloyd said that first responders without naloxone know to continue ventilation and CPR until EMS arrives with the drug.

Rideau Lakes Mayor Ron Holman, who chairs the Rural Ontario Municipal Association, said the naloxone debate is not unique to Leeds and Grenville. Municipalities across Ontario have struggled with the same issues and come up with different answers, Holman said.

Some volunteer firefighters say they signed up to protect their neighbours from fires, not to respond to medical calls and drug overdoses, he said. Other municipalities give the kits to protect their first responders from accidental exposure to opioids, not to administer to the public.

He urged municipal councils to look at liability issues before deciding on naloxone. For example, could a municipality be liable if it decided not to carry the kits and a resident died? Or what if they carry kits for their own use but fail to save the life of an unconscious person? Or what if a first responder mistakenly administers the wrong drug, resulting in death?

Holman said the municipalities should look at all of these questions before deciding on whether to join the naloxone program or not.

Lloyd said the United Counties of Leeds and Grenville so far have dodged the opioid overdose epidemic that has swept the country.

In Ontario from May to July 2017, there were 336 opioid-related deaths, which represents a 68-per-cent increase over the some period in 2016, he said.

There were no deaths in Leeds and Grenville during the same period, Lloyd said. Local paramedics did respond to 14 drug-overdose calls and they administered naloxone nine times. In five of those cases, firefighters were on the scene as well, he said.

Five of the calls were for Brockville while the others were scattered among Edwardsburgh/Cardinal, Augusta, Prescott, Merrickville and Athens, said Lloyd.

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