This document discusses guidelines for CPR and opioid overdose treatment. It references debates between Dr. Vaillancourt and Mr. Thompson regarding 2015 CPR guidelines and Ottawa's naloxone program. Dr. Vaillancourt and Dr. Morrison supported chest compressions-only CPR and naloxone programs to treat overdoses, while Mr. Thompson objected and referenced alternative medical guidelines. The document shares emails between those involved discussing their differing viewpoints on the best treatment approaches.

1. Dr.Vaillancourt wrote 2015 ILCOR CPR guidelines Dr. Morrison wrote
2010 CPR guidelines correct. 2015 wrong and misleading. Dr.
Vailancourt refers me to Dr. Morrison see last email.
Quote Dr. Vaillancourt "Not sure we have this in Ottawa"
Ottawa Citizen Aug 29, 2014 http://ottawacitizen.com/news/local-
news/combatting-overdose-in-the-capital
Quote "It launched two years ago [Aug. 31, 2012] to coincide with the
annual International Overdose Awareness Day"
"death was classified as respiratory failure, and while medically
accurate" A reliable source told me Dr. Vaillancourt was involved in
Ottawa's Naloxone program, why I questioned only him in Ottawa.
From Christian Vaillancourt01/16/14 at 11:14 PM
To Gary Thompson
I still do not fully understand your objection to this program.
Not sure we have this in Ottawa, but naloxone programs such as this
one have been implemented to save the lives of opioid addicts who
overdose.
I believe the naloxone is meant to be administered quickly by a fellow
addict or case worker or family member trained to do so.
Many such patients die in alleys with no case at all, and simple CPR
will not work in the case of an opioid OD.
Perhaps best to contact a cardiac arrest champion from Toronto if you
are looking for support with some of your objections...have you tried
Dr. Laurie Morisson?
Christian

2. From Christian Vaillancourt 01/08/14 at 1:56 PM
To Gary Thompson
Most recent resuscitation guidelines (attached) moved to recommend
compression-only CPR for citizen (not for health care professionals)
mostly because it was perceived to be one of the major barrior for
people to initiate CPR…it is also the most difficult part of the
technique to learn.
For witnessed arrests (those having a cardiac arrest with immediate
CPR initiation), since victims already have some oxygen in their lungs
that can passively be absorbed, another argument is that any time
spend doing ventilations is time lost circulating that oxygen with chest
compressions.
In the case of overdoses and children cardiac arrests, the etiology is
commonly a respiratory arrest.
Although they would be most likely to benefit from ventilations, once
again – barrier to CPR initiation (reluctance to do so) favor an
approach encouraging chest compressions alone until professional
help arrives.
A few very large studies also seem to support this strategy (no
difference in survival comparing chest –compression alone to
traditional CPR)
Hope this answers some of your questions?
Christian Christian Vaillancourt MD, MSc, FRCPC, CSPQ
Associate Professor, Department of Emergency Medicine
Senior Scientist, Ottawa Hospital Research Institute
Research Chair in Emergency Cardiac Resuscitation, University of
Ottawa
Associate Medical Director, Regional Paramedic Program for Eastern
Ontario

3. From Christian Vaillancourt01/07/14 at 7:32 AM
To James Thompson
Thank you for this information Mr. Thompson, but it would help me
respond if I understood your concern better.
Are you concerned with the naloxone program described, or with the
recommendation for compression-only CPR?
Christian
On Jan 7, 2014, at 2:28 AM,
<jgary.thompson@mail.utoronto.ca> wrote:
Dr. Vaillancourt:
Toronto Public Health is doing a live human study, teaching the
general public chest compressions only for poisoning (drug OD). See
attached CJPH 2013;104(3)e200-4
Omitted from the article Signs & Symptoms of opioid poisoning. See
attached from the training literature
www.instantpresenter.com/ohtn/E956D7808049 Slide 31.
I know of deaths 14 yr. old juvenile onset diabetes case; 70 yr. old
unconscious choking victim plus poisoning (drug OD) deaths.
Responders were doing as instructed, unconscious, cyanotic, laboured
breathing give chest compressions only?
Any comment would be appreciated, I am at a loss understanding
this practice.
Thank You & Remember the Mysteries
Gary Thompson
From Laurie Morrison MorrisonL@smh.ca Oct 8, 2012

4. To James Thompson
CC 'Aaron Orkin (aorkin@gmail.com)'
Hi James
Yes I helped craft them in accordance with the guidelines and feel the
approach to chest compression only is the right way to go for many
reasons. Happy to discuss with you at any time. Aaron Orkin (copied
here) and Toronto public Health were more involved than I was as I
was just the expert brought in to help out.
Cell is 4165245434 or we could set up a face to face by email if you
prefer.
Laurie
From: James Thompson [mailto:jgary.thompson@mail.utoronto.ca]
Sent: Wednesday, October 03, 2012 5:02 PM
To: Laurie Morrison
Subject: naloxone training
Dr. Morrison:
I have just found out that RESCU was part of Toronto Public
Health's naloxone protocols. I think they should be changed, as there
is no scientific evidence for chest compressions only in opiate
overdose.
See Attached ILCOR andAmer Heart Assoc. Guidelines 2010
Please reply ASAP
Remember the Magic
Gary Thompson @GaryCPR
Dr. Morrison was not happy to discuss when told brining a tape
recorder. She phoned the police. Get a phone call “Gary can you
come to the station” “Sure be right there” Police constable “Gary I
want to shake your hand you have been saving lives, bad news is Dr.
Morrison wants no contact.” “Fine by me she is a nut”

5. Dr. Laurie Morrison Co-Chair AHA & ILCOR Guidelines on toxic
ingestions
2010 AHA Guidelines Part 12.7:
http://circ.ahajournals.org/content/122/18_suppl_3/S829.full#sec-80
ILCOR 2010 Part 8.5 Drug Overdose and Poisoning
http://www.resuscitationjournal.com/article/S0300-9572(10)00453-
3/fulltext#sec2260
UNDOC/WHO 2013 Opioid overdose Page 7 layman’s language
https://www.unodc.org/docs/treatment/overdose.pdf
Compressions only CPR AHA Guidelines 2010 Part 4
http://circ.ahajournals.org/content/122/18_suppl_3/S676.full.pdf+html