DrugInfo seminar: Overdose: the ambulance perspective


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Presentation by Kate Cantwell to the DrugInfo seminar: Heroin and other opioids, on 27 September 2011 in Melbourne, Australia.

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  • This figure demonstrates the changes in the dispatchers CPR instruction to bystanders following the upgrade in the AMPDS software. Prior to August 15th 2007 the dispatcher instructed on the traditional Airway-Breathing-Circulation techniques that are taught in basic CPR courses. With a ratio of 2 breaths for every 15 compressions. Following the update in the AMPDS version the dispatcher CPR instructions changed to Airway –followed by an assessment for breathing and 400 compressions before any mouth-to-mouth breathing. The subsequent ratio was 2 breaths for every 100 compressions. Which simplifies CPR steps and reduces the interruptions to compressions.
  • DrugInfo seminar: Overdose: the ambulance perspective

    1. 1. Harms related to heroin and other opioids<br />Overdose: the Ambulance perspective<br />Kate Cantwell<br />Ambulance Victoria<br />
    2. 2. Overview<br />Trends in heroin overdose as seen by Ambulance Victoria<br />Challenges to Ambulance Victoria and the heroin using community<br />
    3. 3. Surveillance using routinely-collected data<br />Heroin-related deaths in Victoria 1991-1999<br />
    4. 4. Prevalence of A&D-related harms<br />Non-fatal drug-related cases<br />Ambulance attends drug–related case and Patient Care Record (PCRs) completed at scene<br />Turning Point compiles database of PCRs to document clinical case characteristics<br />Allows for examination of all drugs recorded<br />
    5. 5. Ambulance calls by time of day<br />
    6. 6. Heroin Overdose by month of year<br />
    7. 7. Heroin Overdose by LGA<br />
    8. 8. General Overdose Characteristics<br />71% of patients are male<br />Average age 33 (range in 2009/2010 was 13-98)<br />Outdoor space 58%<br />Police co-attendance 13%<br />Transported to hospital 32%<br />
    9. 9. Heroin Overdose that responded to Naloxone<br />
    10. 10. Calling 000<br />Calls answered by ESTA. <br />Calls are sorted into priority codes using Advanced Medical Priority Dispatch System (AMPDS)<br />AMPDS is used by 3000 ambulance call centres around the world<br />Heroin overdose cases can be sorted into two main priorities<br /><ul><li>Heroin overdose
    11. 11. Cardiac arrest</li></li></ul><li>What are the challenges for the future?<br />Calling 000<br />If caller states that it is a heroin overdose and that the patient is breathing more than 6-8 breaths per min then an ambulance is sent (lights and sirens)<br />If caller states that patient is unconscious and with less than adequate breathing then it is classified as a cardiac arrest. This gets an ambulance, a MICA ambulance and a fire truck (all vehicles lights and sirens)<br />
    12. 12. AMPDS D-CPR instruction change<br />Presumed cardiac aetiology & age ≥ 18 yrs <br />←August 15th 2007 -><br />
    13. 13. 000 Call Taking<br />Need to say that heroin was used<br />This will change the post dispatch instructions<br />From 400 compressions to 400 compressions with 2 rescue breaths<br />
    14. 14. Risks and Benefits<br />Quicker Response Time<br />More people likely to get chest compressions- Risk of CPR to someone who doesn’t need it versus benefit of CPR to someone who does<br />Less ventilations advised prior to ambulance arrival, has this made a difference?<br />MICA level of care for complicated heroin overdose- does this lead to better outcomes<br />
    15. 15. Heroin Overdose: standard treatment<br />Heroin Only<br />No aspiration<br />No hypothermia<br />
    16. 16.
    17. 17.
    18. 18. Heroin that didn’t received naloxone<br />
    19. 19. Heroin Overdose that responded to Naloxone<br />
    20. 20. Heroin that didn’t received naloxone<br />
    21. 21. Clinical Presentation<br />Heroin Overdose who walks away<br />Heroin Overdose with complications<br /><ul><li>Aspiration
    22. 22. Hypothermia
    23. 23. Presumed head injury
    24. 24. Instead of 32% transport to hospital it is 50%
    25. 25. Rapid Sequence Intubation</li></li></ul><li>
    26. 26.
    27. 27. Future Challenges<br />There needs to be more research into this cohort of patients. <br />Why has the percentage of patients not getting naloxone increased and has the clinical presentation of these patients changed over time<br />
    28. 28. Future Challenges<br />Paramedics, Drug Users, Alcohol and other Drug Workers, Researchers<br />Can we come together to do better?<br />