Opioid Overdose Treatment
Naloxone (Narcan) for suspected opioid/narcotic overdose
⚠️ All Crew Members: Public Health authorizes lay-persons to administer naloxone. All SAR members can give naloxone for suspected opioid overdose.
Indications for Naloxone
Give naloxone if history/suspicion of opioid use AND:
- Decreased level of consciousness
- Moderate to severe respiratory depression
- Shallow respirations
- Not maintaining own airway
- Respiratory rate <10/minute
- Cardiopulmonary arrest
Priority Actions
- Call for dispatch assistance, backup, or 911
- Brief evaluation - reverse immediate threats
- Protect airway, provide ventilations & oxygenation
- Initiate CPR if needed
- Establish history of opioid use (confirmed or probable)
Naloxone Dosing
All Providers (Including First Aid)
Give: 1 dose naloxone spray 4 mg intranasally
OR: 0.4 mg naloxone IM
Repeat: Every 3-5 min if no improvement (max total 1.2 mg IM OR 2 nasal + 2 IM/IV doses)
Provide continuous ventilations throughout
PCP, ACP, LPN, RPN, RN, PA, NP, MD
Adult Advanced Dosing:
| Dose Number | Amount |
|---|---|
| 1st dose | 0.1-0.4 mg IM/IV |
| 2nd dose | 0.1-0.4 mg IM/IV |
| 3rd dose | 0.4-0.8 mg IM/IV |
| 4th dose | 2-8 mg IM/IV |
| Additional | May repeat q3min prn x 3 more doses |
| Max Total | 10 mg (not including intranasal) |
Pediatric (1-8 years):
- 0.1 mg/kg (max 0.4 mg)
- May repeat q3min prn
- Max total: 2 mg
If not reversed: Consider other causes for altered LOC
Cautions
- Rapid delivery of high doses: Patient may awaken abruptly and be agitated/combative
- Acute withdrawal: Can cause seizures (extremely rare)
- Pregnancy: NOT a contraindication - give naloxone
- Cardiac arrest: Naloxone is NOT a priority intervention - focus on CPR/AED
- Duration: Symptoms may return; naloxone only lasts 30-90 minutes, repeat dosing may be required
Disposition
⚠️ Critical: Resuscitation responsive to naloxone is evidence of a near-death opioid exposure.
- Recommend transfer to acute/addiction services
- Return to event has significant liability potential
Contact dispatch to arrange:
- Movement from scene to field clinic
- If HLC not onsite, activate 911
- Plan for final disposition based on clinical presentation
Refusal of Transport
Some patients roused with naloxone will refuse further care and may wish to leave AMA (Code X).
- Call clinical lead or medical direction designate
- Document comprehensively
- Refer to Refusal of Care protocol
Transfer Considerations
If transferring to hospital, consider:
- Does patient need airway protection for trip?
- Is IV well placed/secured?
- What medications might be needed?
- Should ACLS provider accompany patient?
⚠️ Remember: Universal precautions always. Report every use of naloxone to Operations Lead.
Source: Odyssey Medical Consulting
Version: 2023-06-21