Stories from the Streets: Overdose
We’re in the basement of a triple-decker in a run-down neighborhood, on scene with a man down, strong pulse, respirations 6 a minute. The house appears abandoned. It’s dark down there, rays of light creep through filthy windows, spiderwebs cast eerie shadows against the walls, mortar crumbles, dust mites abound.
The person who called for help is gone; it’s just us, the bugs and a man about to die. I put the pulse-ox monitor on his finger, 82%, and then key the mic.
“Rescue 1 to Fire Alarm, send a company to 2143 Elmwood for assistance.”
“Roger, Rescue 1. Nature?”
“Overdose.”
“Received. Will police be needed?”
“Roger that.”
Better to have more help on scene than not enough. You never know how these things will pan out.
A firefighter has been detailed from Ladder Company 8 to Rescue 1 for the night tour. He’s a good guy, trained as an EMT-Cardiac, which in Rhode Island is equivalent to an EMT-I: more training than a Basic but not as much as a paramedic. I have the same training but years of experience as well. This is Henry’s second shift on the rescue.
“We need to bag him,” I tell my partner while I fish through the med bag for the goodies. I hand the meds to him and open the bag-valve mask, attach the face piece, fill the reservoir, place it over the patient’s nose and mouth, and squeeze. Henry looks at me, waiting for instructions.
“What do you see?” I ask.
“A guy dying in a basement,” he answers.
“Look harder.”
I’m not at all comfortable with this scenario, but I’ve got a potentially good Cardiac with me, great attitude, a willingness to learn and a knack with people. A little confidence and some more experience, and we might just have another good rescue guy to add to the dwindling ranks of people who want to be part of the EMS division of the Providence Fire Department. We can use all the help we can get; the burnout rate on the rescues in Providence is critical.
“His 02 sat is going up as you bag him. His pulse is strong and steady. Track marks on his arm. Probably an overdose,” Henry ventures, his body language indicating he’s taken a lead role in the treatment plan.
Precious time ticks, but it is imperative that Henry think for himself. I’ve treated more overdoses than I can remember and am fairly certain I have things under control.
“OK, what now?”
“Nasal Narcan.”
“Don’t have any.”
“Really? It’s in the protocols!”
“Optional. What next?”
“Start an IV and push 2 mg.”
“That will work, but he’s crashing. What if you blow the IV?”
My heart rate is increasing; I can feel the pressure in my head rising. All I want to do is pass the bagging over to the new guy, draw up the meds and give them to the patient IM. Easy as pie.
“I can administer 2 mg IM,” he says, and I feel the pressure recede. A little.
“Perhaps you should do so.”
He fumbles through the compartment where we keep the syringes and needles, agonizingly slow, opens the packaging and connects the needle to the syringe. I’m bagging away, monitoring the heart rate and pulse ox. The heart rate is increasing, but the pulse ox stays steady at 96%.
I can’t keep the memory of a similar situation from flashing through my mind. I was a new guy, second or third shift on the rescue. The medic I was working with had seen it all, done it all and wanted to do as little as possible until he retired. We had the patient on the stretcher and were transporting to the ER. I asked why he didn’t give the Narcan, and he replied, “Because they puke.”
Henry flips the top off the vial.
“What’s the date on that?” I ask.
He’s nervous but slows down.
“November 2013.”
“Good. Are you sure it isn’t Lasix?”
“Narcan.”
“Excellent.”
He gets ready to plunge the needle into the vial.
“Is that clean?”
He stops; stress and annoyance begin to seep in. We’re in a filthy basement in an abandoned house working on an addict with numerous track marks and probably hep C and who knows what else, but he rips the alcohol prep open and wipes the top, pushes the needle in and tries to fill it. I think I’m going to flip out if I have to watch this excruciatingly slow turn of events, but I take a deep breath and ask, “Do you know how much of that to administer?”
“Yup, 2 mg. It’s 0.4 mg per ml, so 5 ml.”
I think the basement actually brightens. Sirens break the eerie silence, penetrating the late afternoon atmosphere, closing in, help is on the way. Henry has checked the med, the expiration date and the dosage, has drawn the Narcan and is ready to go. He pinches the flesh of the patient’s triceps area and gets ready to stick him.
“Is the skin clean?” I ask. He opens another alcohol prep, wipes an inch of skin, turning the pad a sickly brown, pinches again and sticks the needle in, then depresses the plunger. He pulls the needle out and glances at me.
“You should have had a 2x2 ready.”
Engine 10 arrives on scene, the firefighters assigned there descend into the dingy basement. I stop bagging. The patient opens his eyes, sits up, looks around and swears at us.
I feel the tension leave my body, thanking the rescue gods this didn’t end like the other one, where the burned-out medic pushed the Narcan as we rolled into the rescue bay at the ER, only that patient didn’t respond. He never did, because he’d a heart attack, either before or after he’d overdosed. He died, and may have lived had his treatment begun when it should have.
Some people never learn. Thankfully, others do. Henry was beaming when our patient walked out of the basement.
Michael Morse, EMT-C, is captain of Rescue 5 in Providence, RI, and has served on the city’s busiest engine, ladder and rescue squads as a firefighter, rescue technician and lieutenant during his 21-year career. He is the author of the books Rescuing Providence and Responding.
