First Aid

Frist Aid, CPR, AED, Basic Life Support

Training for Response to Opioid Overdose

Open bottle of generic prescription medicine. Both prescription painkillers and street drugs contribute to the opioid epidemic in Maryland.

Both prescription painkillers and street drugs contribute to the opioid epidemic in Maryland. (Photo: Shutterstock.com/Leigh A. Williams)

On Oct. 16, Anne Arundel-Annapolis Community Emergency Response Team (AAACERT) hosted Mr. Paul Bowling, who provided training on the Maryland Overdose Response Program. Mr. Bowling is a Physician Assistant with over 40 years’ experience in Trauma, Critical Care, and Emergency Medicine and is also involved in Healthcare Emergency Management. Mr. Bowling currently serves as the president of AAACERT.

Mr. Bowling noted that Anne Arundel County has a particularly high rate of opioid overdose deaths. Anne Arundel’s total deaths by opioid overdose in 2018 exceeded those of some of the neighboring counties in Maryland.

An opioid is any drug that contains opium or its derivative. The opioid crisis began in the 1990s with the free flow of these substances due to liberal prescription practices by providers and promotion by drug companies. Opioids can be either prescription medications or illegal drugs, and are ingested by various means. The most common opioids are the prescription drugs oxycodone, hydrocodone, oxymorphone, morphine, and codeine; as well as the illegal drugs heroin and fentanyl.

Opioids vary in lethality per individual and circumstances. They are especially lethal for the elderly. Moreover, as opioids act on the brain, they become increasingly more toxic when mixed with another opioid, alcohol, benzodiazepines, and/or cocaine.

The effects of an opioid overdose can be reversed by naloxone (brand name Narcan). Naloxone reverses opioid overdose and restores breathing within a few minutes of being administered. It has no effects on a person who has not taken opioids (including the person giving it), so it is safe even if an overdose is mistakenly understood but has not occurred; moreover, the other side effects of naloxone for the person in overdose are minimal and rare. Naloxone can be given intranasally, intramuscularly, or intravenously. The drug onset is within 1-2 minutes, and it wears off in 30-90 minutes. Unfortunately, there are super-opioids on the street for which one dose of naloxone is not sufficient, so further dose(s) may be required.

Opioid overdose is characterized by several signs and symptoms. Like a person who is “high,” the victim’s pupils become very constricted (small). However, the victim may also display the following symptoms:

  • Loud snoring or gargling noises
  • A very limp body
  • Unresponsiveness
  • Pale or grey, clammy skin
  • Bluish lips and fingertips
  • A slow or erratic pulse
  • Slow, shallow, or no breathing
  • Unconsciousness

Due to the dangers of an opioid’s effects impacting the responder, it is imperative always to wear gloves when attempting to help the victim.

The following steps are recommended when responding to an opioid overdose victim.

  • Rouse and stimulate the victim by touching, shaking his/her shoulders, or (carefully) performing a sternal rub.
  • Call 911. *
  • Administer naloxone.
  • Perform further resuscitation. If the person is not breathing, or has shallow/short breaths, give rescue breaths (preferably with a barrier), or – if you are trained in CPR – chest compressions with rescue breaths.
  • Care for the victim until professional responders arrive.

*Administer the naloxone first if the person is unconscious; a second dose may be necessary after calling 911.

When administering naloxone, allow 1-3 minutes for the medication to work. If breathing is not restored after 2-3 minutes, give another dose, and continue resuscitation as necessary. Be sure to follow the 911 dispatcher’s instructions once you have called.

It is also important to stay with the individual until medical help arrives. S/he may feel ill or agitated or need to vomit. If the person cannot sit up, make sure they are in the recovery position (right side, arm supporting head, bent knee to support body). Help the person to stay calm, and encourage him/her not to take more opioids. Remember that a person “coming to” is often annoyed, confused, and/or combative, so be sure to stay alert and protect yourself.

If you administer naloxone, it is important to call the Poison Control Center (1-800-222-1222) within two hours after the event, as this entity tracks the lethality of various street drugs, where they are trafficked and used, and other key information about opioids.

Finally, if you respond to an opioid overdose in progress, be assured that you cannot be held liable for a good faith attempt to help someone. Under the “Good Samaritan” measures in the Code of Maryland, Health General, Section 13-3110, “an individual who administers naloxone to an individual believed to be experiencing an overdose shall have immunity from liability under Sections 6-603 and 5-629 of the Courts and Judicial Proceedings Article.” Additionally, the Code of Maryland, Criminal Procedure Article, Section 1-120 states that, “a person who seeks, provides or assists with medical assistance for another person experiencing an alcohol- or drug-related medical emergency cannot be arrested, charged, or prosecuted for possession of a controlled dangerous substance; possession or use of drug paraphernalia; or providing alcohol to minors.” Moreover, calling 911 will not affect the parole or probation status of a person attempting to help.

Naloxone is available as a prescription from any licensed healthcare provider with prescribing authority or an authorized ordering, referring, or providing (ORP) entity that dispenses naloxone. Per statewide standing order, any person can obtain naloxone at a participating pharmacy. For a list of pharmacies that stock naloxone, visit the Maryland Department of Health Behavioral Administration’s information page.

AAACERT trains volunteers in disaster response skills and emergency preparedness. AAACERT volunteers assist others in our community following a disaster when professional responders are not immediately available to help. When activated under the Anne Arundel County Office of Emergency Management, or the City of Annapolis Office of Emergency Management, AAACERT supports emergency response agencies. For more information, visit www.aaacert.org.

By Laurie Goodell

Biological Incidents and the Role of CERT

Lab technician with gloved hands
A CDC scientist works in the lab to study the flu virus. (Photo: James Gathany/CDC).

Ms. Arlene G. Crow, Emergency Manager for Anne Arundel Community College, recently provided training to the Anne Arundel-Annapolis Community Emergency Response Team (AAACERT) on the operational members’ potential role in a biological incident.

Ms. Crow began the session by outlining the various forms and categories of bio-agents that might trigger a need for prophylactic dispensing to the general public. Bio-agents can occur in one of three forms: bacterial, virus, or toxin. Bacterial agents are distinguished by, among other things, their ability to replicate cells independently. Viruses, however, cannot reproduce outside the host body. A third type of agent, toxin, is a potent poison with organic origin.

Bio-agents are categorized according to their ease of transmission or dissemination; severity of mortality potential; need for preparedness; and ability to threaten national security or day-to-day social functioning. Category A, the highest-risk agents, include anthrax, botulism, plague, smallpox, tularemia, and certain viral hemorrhagic fevers. Category B agents include ricin, salmonella, certain encephalitis fevers, waterborne threats such as vibrio cholerae, and others. Category C agents are those with an emerging pathway, and which could be engineered for harm to the public. These include influenza, rabies, drug-resistant tuberculosis, SARS, and others. Emergency managers must be prepared to respond to a potential outbreak of any category agent.

The next phase of the training focused on the origins and symptoms of Category A bio-agents that cause the highest threat to the public: anthrax, tularemia, plague, smallpox, and viral hemorrhagic fevers. Ms. Crow noted that nearly all of these agents’ initial symptoms are flulike, highlighting the challenge for medical responders and diagnosticians in determining exactly with what malady a patient may present.

In all cases of a potential bio-threat, health departments, in conjunction with emergency managers, would act swiftly to establish points of dispensing (PODs) to distribute prophylactic medicine from the Strategic National Stockpile on a large scale that could protect the public. PODs can be set up indoor, outdoor, or as drive-thrus. Ms. Crow noted the efficacy of drive-thru PODs due to their ease of use for the public, the police, and the medical community. She reminded CERT members of the need for logistical necessities for all who participate, either as customers or workers – i.e., a large space, full gas tanks, available bathroom facilities, food for workers, etc.

CERT members have an important role in the smooth functioning of a POD. Among the functions CERT teamers can carry out during a POD are traffic control/lane controllers; set-up and tear-down; administrative support; communications/runners; data collection; resupply; greeters; logistics; and, in some cases, even dispensing or assisting with the dispensing of medication.

For more information on bioterrorism and response, visit the Centers for Disease control (CDC’s) information page.

Mental Health First Aid Course Informs Members

Photo: Shutterstock.com

Anne Arundel-Annapolis Community Emergency Response Team (AAACERT), in partnership with the Anne Arundel County Mental Health Agency, recently hosted an instruction on Mental Health First Aid.

Mental Health First Aid is a national, 8-hour course that teaches people to identify, understand, and respond to signs of mental illnesses and substance abuse disorders.  Similar to the more familiar CPR and somatic First Aid courses, Mental Health First Aid teaches people to reach out and provide initial support to someone who may be developing a mental health or substance use problem and help connect persons at risk to appropriate care.

The applicable training course taught AAACERT members, Upper Marlboro CERT members, and others the common signs and symptoms of mental illnesses and substance abuse, how to interact with a person in crisis, and how to connect that person with the help that they need.

Per the instruction, if a person is determined to be in need of help, the helper should apply the “ALGEE” action plan:

  • Assess for risk of suicide or harm
  • Listen non-judgmentally
  • Give reassurance and information
  • Encourage appropriate professional help
  • Encourage self-help and other support strategies

Anne Arundel County boasts a robust mental health system that serves as a model to other jurisdictions across the country.

Crisis Response System – A 24/7 Warmline [(410) 768-5522] exists and can activate Mobile Crisis Teams; provide information, support, and referrals; and serve as a link to first responders.

Crisis Intervention Teams – A police officer and a clinician are ready to respond immediately to people in crisis, making sure they get the care they need.

Safe Stations – A person needing treatment for addiction can visit any police or fire station, at any time, to seek care.  The person is able to dispose of paraphernalia without fear of legal action and get the help they need.

Robust Training – Every police officer, dispatcher, and school nurse, as well as most school principals in the county, have received this training.  The Fire Department is next on the list to get fully trained.

Those that took the course gained substantial knowledge and resources to assist them handling a mental health emergency. Multiple students left with information on how to schedule the course with other organizations and groups that they are affiliated with.

For more information on the course, or to find a course near you, go to mentalhealthfirstaid.org.

Anne Arundel-Annapolis Community Emergency Response Team (AAACERT) trains volunteers in disaster response skills and emergency preparedness. AAACERT volunteers assist others in our community following a disaster when professional responders are not immediately available to help. When activated under the Anne Arundel County Office of Emergency Management, or the City of Annapolis Office of Emergency Management, AAACERT supports emergency response agencies. 

CPR trained citizens can help save lives in Anne Arundel County

Anne Arundel County and City of Annapolis has joined the growing list of communities participating in a project to help save lives of sudden cardiac arrest. The PulsePoint app (available for Apple and Android devices) alerts CPR trained individuals who are nearby allowing CPR to begin before the arrival of Emergency Medical Services (EMS).

If you are interested in CPR training information is available at www.aacounty.org/cpr.

Get Trained, Get the App, Save a Life!

Read more:
PulsePoint
HELP SAVE A LIFE: PULSEPOINT NOW IN ANNE ARUNDEL COUNTY
Anne Arundel app connects anyone CPR trained with nearby heart attack victims

Chemical Suicides Create Dangerous Environments for First Responders

Three law enforcement officers in Georgia were hospitalized in May after being exposed to toxic fumes at the scene of a possible chemical suicide. Chemical suicides involve people mixing easily-attainable chemicals to produce a toxic gas, which can kill rather quickly. Often this is done in an enclosed space such as a car; occasionally people use “exit bags”: plastic bags placed over the head, connected to a gas supply. Instructions are,  unfortunately, readily available on the internet.

car in dark alley

In many but not all chemical suicide incidents, the victim leaves a written warning for whomever will find them. Typically, the first instinct when faced with an unconscious person in a car is to open a door or break a window; in a home or hotel, rushing in after gaining access is also the norm. Though well intended, these actions also endanger first responders or anyone else attempting to render aid.

It is important to gain situational awareness and take time to perform a quick evaluation of the scene for responder safety — even if time is critical:

  • Look for signs taped to doors or windows warning of any danger.
  • Look in the windows for chemical containers or chemical fog.
  • Take notice of any faint chemical odors.
  • Look for tape sealing the edges of doors, windows or vents.

For more information, see the Chemical Suicide Case Study and training for first responders offered by HazMatNation.com. The International Association of Fire Chiefs also offers resources and a webinar on chemical suicide response.

This article appeared in the May 24, 2018 InfoGram PDF ~160 KB. |  Subscribe to the InfoGram

Other articles include:

  • Emergency management planning for schools
  • Coordination between emergency management and water utilities
  • EMS Week: Stronger Together

Symptoms of Depression Among First Responders

I’ve seen it among my co-workers, depression and PTSD. Working in a high stress environment where one sees the worse of the worse will take it’s toll! We are not superhuman. Recognize some of  the symptoms. Talking to others is NOT a sign of weakness. Many, myself included, find that talking to others that have “been here, done that, bought the t-shirt” is a great way to deal with the stress.

Additional information for first responders / first receivers can be obtained from American Addiction Centers

Depression manifests itself differently in every individual but as a whole it can affect one’s ability to work, sleep, eat and enjoy once pleasurable activities. Symptoms of depression can include:

  • Persistent sad, anxious, or “empty” feelings
  • Feelings of hopelessness
  • Feelings of guilt, worthlessness, and/or helplessness
  • Irritability, restlessness
  • Loss of interest in pleasurable activities, including sex
  • Fatigue and decreased energy
  • Difficulty concentrating, remembering details and making decisions
  • Sleep issues including insomnia, early-morning wakefulness, or excessive sleeping
  • Overeating or appetite loss
  • Thoughts of suicide, suicide attempts
  • Persistent aches or pains, headaches or other physical distress

 

American Heart Association First Aid / CPR / AED

The Heartsaver® First Aid CPR AED course is designed to prepare students to provide first aid and CPR and use an automated external defibrillator (AED) in a safe, timely, and effective manner. Heartsaver courses are intended for anyone with little or no medical training who needs a course completion card for job, regulatory (e.g., OSHA), or other requirements. These courses can also be taken by anyone who wants to be prepared for an emergency in any setting.

After successfully completing this course, students should be able to:

  • list the priorities, roles, and responsibilities of the first aid rescuer
  • describe the key steps in first aid
  • describe the assessment of and first aid actions for the following life-threatening conditions: heart attack, difficulty breathing, choking, severe bleeding, shock, and stroke
  • use an epinephrine pen
  • control bleeding
  • recognize elements of common injuries and illnesses
  • recognize the legal questions that apply to first aid rescuers
  • describe how high-quality CPR improves survival
  • explain the concepts of the Chain of Survival
  • recognize when someone needs CPR
  • perform high-quality CPR for an adult alone or as a team member during multi-rescuer CPR (child and infant CPR modules are optional)
  • give effective breaths using mouth-to-mouth or a barrier device for all age groups
  • demonstrate how to use an AED on an adult (child and infant AED modules are optional)
  • describe when and how to help a choking adult or child (infant choking module is optional).

Upon successful completion of the course, including a first aid skills demonstration and a CPR and AED skills test, students receive a Heartsaver First Aid CPR AED course completion card that is valid for two years.

Each student will receive:
– AHA HeartSaver CPR/AED First Aid Training Manual
– First Aid training material
– Certification (upon successful completion)

This course is normally $125.00 but is being offered to CERT MEMBERS ONLY for $31.00 plus fees.

Basic Disaster Life Support (BDLS) Training

Registration is now open for a Basic Disaster Life Support (BDLS) training being conducted specifically for Medical Reserve Corps members in Prince George’s and Montgomery Counties.

The class will be held on March 31, 2016 at the Prince George’s County Fire Service Building at 6820 Webster Street in Landover Hills, from 8:00am until 5:00pm. Lunch will be provided.

Register soon, as space is limited. Please let Ms. Molineaux know if you have any questions.

ceecee.molineaux@maryland.gov

Medical Preparedness and Response for Bombing Incidents (MPRBI)

Overview: This course will equip pre-hospital and hospital medical personnel with the skills needed to deliver and sustain a safe and effective response to bombing incidents. Utilization of case studies as well as tabletop exercise will reinforce course material.
This Course will enable participants to:
– Identify terrorist targets
– Understand explosives and characteristics
– Identify pre-attack indicators associated with bombing incidents
– Recognize bombing incident-related injury patterns and treatment

This course will be held:
Northwest Hospital
5401 Old Court Road
Randallstown (Baltimore County), MD 21133
2016 January 13 – 14
08:00 – 17:00 (Both Days)
Registration 07:00 – 08:00

Registration will begin in October 2015. Download Flyer here.