Amanda Mauck, an emergency medical technician with the Cranberry Township EMS, holds a vial of Narcan, a drug being used by paramedics and doctors to halt the effects of heroin overdoses.
Narcan used in heroin overdoses
Brian Dambaugh is a “born and bred” Zelienople resident, and as a paramedic supervisor with the Harmony EMS Service he has been on the front lines of a heroin problem that has caused deaths and the near loss of life from overdoses.
“It was pretty rough in the Zelienople Borough for a while,” Dambaugh said. “It's one of those things, I don't think people realize how bad it is.”
Dambaugh, who has been a paramedic with the Harmony EMS for more than six years, was part of a team of first responders who helped save one man's life after he overdosed on heroin.
Dambaugh said that since Jan. 1, the Harmony EMS Service has responded to three heroin overdose victims, all of whom were saved through the use of Narcan.
Overall, according to Zelienople Police Chief Jim Miller, there have been at least four people in Zelienople in recent months who can credit medical professionals for saving their lives with Narcan.“If it wasn't for the EMS,” Miller said, “These people would have died.”Dennis Bacher, chief executive officer of the Butler Ambulance Service, said there were four ODs that his service responded to in January.There have been at least three overdose deaths in the Butler area earlier this year.Investigators suspect fentanyl-laced heroin in one of the deaths and were waiting for toxicology reports to see if there were links in the other two cases.The most recent case came about 4:30 a.m. Friday at a house in Butler Township. A paramedic had to administer Narcan to revive a woman who is suspected of overdosing on drugs.“They're a lot more common now than they were a few years ago,” Bacher said of the overdose calls.He said that paramedics are trained to use Narcan. However, emergency medical technicians, EMTs, are not.
Narcan is the brand name of the drug naloxone hydrochloride which is used by paramedics and doctors across the nation to halt the effects of heroin and opioid overdoses.The drug is an opioid blocker, or antagonist, used to reverse narcotic-induced breathing problems, such as slow respirations or no breathing at all. The drug also can counteract other overdose effects such as coma and seizures.On each rescue call by Butler Ambulance Service, one paramedic and one EMT respond. Bacher said his staff administers a set dose to an overdose victim.When it comes to reviving people from overdoses, Bacher said it depends on how long the person has been unconscious and how long it has been since the person took the drugs. Either way, the sooner an ambulance arrives, the better.David Rottinghaus, medical director of the emergency department at Butler Memorial Hospital, said the drug specifically targets opiates, such as heroin, in a person's system and acts to reverse any symptoms caused by opiate overdose.“The downside is that it puts the patient in acute opiate withdrawal,” Rottinghaus said.These symptoms include sweating and nausea. The patient has to be monitored for these symptoms, which can be controlled with fluids and antinausea medication.If a person appears to be experiencing overdose symptoms, but actually is experiencing a different medical problem, Rottinghaus said that the drug would have no impact and would not have any detrimental effect.“It wouldn't be expected to do anything,” Rottinghaus said.He said the drug is metabolized by the body quickly, has few side effects and no long-term effects on patients if taken multiple times.“It's quite good. It's one of the best antidotes we have,” Rottinghaus said.Jeff Kelly, executive director of the Cranberry Township EMS and a paramedic, said he's seen his share of miracle recoveries, too, from the use of Narcan on overdose patients.Kelly said that since Jan. 1, there have been six heroin overdose incidents in the service's coverage area, which includes all of Cranberry, Seven Fields, and parts of Beaver County. Two of those overdose victims died, but the other four were saved with the help of Narcan, Kelly said, including a patient on March 7.“It's not just hitting urban areas,” Kelly said of the heroin epidemic. “It's also in rural areas and less populated areas. Not all of those areas are accessible by an EMS quickly. I've seen more good than bad with the Narcan.”
Heroin and other narcotics have a long history in the Pittsburgh region, law enforcement officials admit, however Dambaugh said heroin is a growing problem.“For the most part, you can't tell if someone walking down the street is using it,” he said. “Unfortunately, I think it's a growing thing. I think it's more accessible now and people know where to find it.”While the common perception of heroin use is often that of a user with a syringe, Dambaugh said the majority of overdose incidents he's experienced recently have come via snorting a powdered form of the drug to those addicts who go as far as chewing pain addiction patches to get high.Kelly said the number of recent overdose cases has prompted the Cranberry EMS service to add more doses of Narcan to its on-ambulance stocks.“Typically, we carried two to four milligrams,” Kelly said. “We've doubled that to eight milligrams.”
When a call is received by 911 operators for medical assistance, Dambaugh said, it is rare that the medical responders know that they are dealing with a drug overdose.“Not all callers say it is an overdose,” Dambaugh said. “Some people don't want to get the police involved.”On the scene, the paramedics must first determine if the victim is suffering from a drug overdose and not another ailment, such as a diabetic seizure or a trauma event. Dambaugh said paramedics look for an “altered mental status” in the victim and signs of a drug overdose such as pinpoint pupils, shallow breathing, unconsciousness or nonresponsiveness.Other times, more obvious signs of a drug overdose are present, Dambaugh said, such as needle marks on the victim's limbs, drug paraphernalia laying around, or even another person providing information about the victim.“Some sort of bystander on the scene will say the person has a history of drug use,” he said.Some addicts, he said, make detection more difficult by injecting the drug between their fingers or toes.
After determining the patient has overdosed on heroin or another opiate-based drug, a certain protocol must be followed by paramedics who use the Narcan, Dambaugh said.“We give 0.4 milligram until their respirations improve. We can give up to 2 milligrams before we have to consult a physician,” he said.The most common way for the drug to be administered is through the nasal spray that allows the drug to be sprayed as a mist into a victim's nostrils. The drug also can be administered via needle injection or through an IV.Each Harmony EMS ambulance carries a supply of four to five vials of Narcan — equivalent to about 10 milligrams. Once a patient has been taken to a hospital, the ambulance's supply of Narcan is replenished from hospital stocks, Dambaugh said.In previous years, Kelly said, Narcan was used in much higher doses, up to 6 milligrams, to bring a patient out of the overdose. However, due to unwanted side effects, the dosage had been lessened over time.“Historically, when you 'slam' them out of (the overdose) with Narcan, there are side effects such as vomiting,” Kelly said. “It can also be combativeness to some sort of aggressiveness. You'd take them from the high to right out of it. It can be a little overbearing.”Dambaugh said that one of the problems paramedics have faced with the recent batch of bad heroin is not knowing exactly what the victim took.Heroin with a higher purity than normal or heroin that is mixed with another drug such as fentanyl to make 'Theraflu,' leaves emergency responders to consider administering more Narcan than usual, he said.Kelly said that one other issue that arises with many overdose victims is that they are often former users who had been clean for a while and then take a lot of the drug to reach their former high. That excessive amount of the drug often leads to an overdose.
Once the Narcan has been administered to a patient, the results come quick, as fast as 30 seconds. Once the Narcan begins to work, the patient comes back to consciousness in a different environment than when he overdosed.“They are sort of lucid; they are not aware of what's going on around them,” Kelly said. “It takes a lot of coaching, reassurance from the EMS personnel. They need that reassurance.”He said that helping save a person's life after an overdose is what makes being a paramedic special.“With those people on the brink of death, we give them Narcan and see them come back to life,” Kelly said.Dambaugh said the suddenness of the revival surprises many overdose victims.“It's pretty crazy because they come out of it (the overdose) pretty suddenly,” Dambaugh said. “They wake up pretty quickly. Most of them are in denial. They wake up and there's a lot of people around them — the police, paramedics.”Dambaugh said he responded to one of the three overdoses so far this year in Zelienople and worked with paramedics to help save the man's life.“I got a call from a neighbor who I'd been friends with for years,” he recalled. “The kids kind of noticed him (the overdose victim) turning blue and ran to a neighbor's house and asked for help. He called me. I responded in my private vehicle.”Dambaugh said he was close to the location, arrived quickly and called for help from paramedics. He provided breathing assistance to the victim until paramedics arrived and gave him Narcan.Dambaugh said that helping save someone's life — especially a person he may know due to the small town nature of Zelienople — is obviously gratifying.“It's nice because it's an instant gratification. One minute they're out unconscious and then they magically come out of it,” Dambaugh said. “On the same token, you hope they get some help so you don't have to come back and do it again.”Eagle staff writer John Bojarski contributed to this report.
