I was in Baltimore about 5 years ago and standing outside a bar and it was a little hot out that night and we were all waiting for our ride to get there to pick us up.
This rough looking (I would guess, homeless drug addict) guy stumbles up and is mumbling, falling all over everyone and is basically just trashed on something. He falls down eventually onto some steps of a row house and is reaching out and talking to his invisible friend in an incoherent manner. Someone calls the ambulance, they get there and while he’s laying on the ground they just gave him a shot of something in a needle and he immediately pops up, says “wow” and just walks off.
In your opinion, what do they usually give heroin addicts who are lethargic and laying on the street while overdosed when they get to the scene. Well, I take it that he was on heroin, who knows. I wouldn’t say that you get really doped out like that on a crack overdose.
My late father in law once got overprescribed some kind of narcotic which sent him into never-never land. The EMTs didn’t give him anything on site, but in the ER they gave him a shot of some kind of “narcotic-neutralizer.”
No idea what it was, and no idea if an EMT in Florida would give something on site, but it might have been something like this.
If he just got a shot- as in an intramuscular (IM) or subcutaneous injrection (SQ),
than I agree it was most likely Narcan and I’m surprised they let him walk off.
On the other hand, if the patient was a hypoglycemic diabetic, it could have been a couple other things. One would be Glucagon, an IM injection that treats hypoglycemia by stimulating a release of glycogen from the liver. Another possibility would be starting an IV and giving D50- a 50% solution of dextrose.
Based on what you described, that doesn’t sound like someone that needs Narcan to me.
Either way, I’m amazed that they would let him walk away. I’m just outside Baltimore (where the situation in the OP took place), and I’m sure protocol is to transport.
I forgot to mention in my last post that we almost never transport hypoglycemics after a D50 wakeup. Probably 98% stay home or with family. It seems like a waste of resources- they go to the ER, get some food and 2 d-sticks then go home lighter a few hundred bucks.
This may be a safe course for some patients who are insulin-dependent, but anyone on oral diabetes medications or not diabetic should be evaluated in the ED.
Yup, they sure did. he got up and walked right off. They packed their shit up, got in their ambulance and rolled off like it happens ten times a day. Probably does though…
I do some veterinary work for local law enforcement (drug dogs). The canine officers I work with carry a vial of Narcan and a few syringes. They are trained to administer, but so far have not had to. It could save me a few hours sleep some night.
Narcan, and if he refused treatment and refused to be transferred, all that the EMTs can do is write it up as such.
Cyn, RN, who has stolen a buzz or two with Narcan
Opiate addicts tend to be pretty unhappy after narcan administration.
It may be life-saving, but it’s also quite the buzzkill, and often causes instant withdrawal symptoms (which are not life threatening, unlike the overdose symptoms).
I’ve seen many patients get so ornery after getting their opiate intoxication reversed that they walk out, refusing all treatment. A few have tried to assault staff. One refused to allow the exam to be completed (a significant neck injury was suspected), ripped off his cervical collar (applied by staff when he was unconscious), stormed off, and shortly thereafter made himself a quadriplegic by turning his head to yell at the staff who were asking him to come back.
I suspect you witnessed a “frequent flier” interaction. The medics likely knew the guy’s problem and his typical reaction.
The medics probably were supposed to transport him, but knew he’d refuse. Just my guess.
