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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DrugInfo seminar: Overdose: the ambulance perspective
- 1. Harms related to heroin and other opioids Overdose: the Ambulance perspective Kate Cantwell Ambulance Victoria
- 2. Overview Trends in heroin overdose as seen by Ambulance Victoria Challenges to Ambulance Victoria and the heroin using community
- 3. Surveillance using routinely-collected data Heroin-related deaths in Victoria 1991-1999
- 4. Prevalence of A&D-related harms Non-fatal drug-related cases Ambulance attends drug–related case and Patient Care Record (PCRs) completed at scene Turning Point compiles database of PCRs to document clinical case characteristics Allows for examination of all drugs recorded
- 5. Ambulance calls by time of day
- 6. Heroin Overdose by month of year
- 7. Heroin Overdose by LGA
- 8. General Overdose Characteristics 71% of patients are male Average age 33 (range in 2009/2010 was 13-98) Outdoor space 58% Police co-attendance 13% Transported to hospital 32%
- 9. Heroin Overdose that responded to Naloxone
- 12. AMPDS D-CPR instruction change Presumed cardiac aetiology & age ≥ 18 yrs ←August 15th 2007 ->
- 13. 000 Call Taking Need to say that heroin was used This will change the post dispatch instructions From 400 compressions to 400 compressions with 2 rescue breaths
- 14. Risks and Benefits Quicker Response Time 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 Less ventilations advised prior to ambulance arrival, has this made a difference? MICA level of care for complicated heroin overdose- does this lead to better outcomes
- 15. Heroin Overdose: standard treatment Heroin Only No aspiration No hypothermia
- 18. Heroin that didn’t received naloxone
- 19. Heroin Overdose that responded to Naloxone
- 20. Heroin that didn’t received naloxone
- 22. Hypothermia
- 24. Instead of 32% transport to hospital it is 50%
- 27. Future Challenges There needs to be more research into this cohort of patients. Why has the percentage of patients not getting naloxone increased and has the clinical presentation of these patients changed over time
- 28. Future Challenges Paramedics, Drug Users, Alcohol and other Drug Workers, Researchers Can we come together to do better?
Editor's Notes
- 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.