Naloxone Lay Training Program Debuts in New York State

On June 21, the Suffolk County EMS & Public Health, in collaboration with the Community Ambulance Company in Sayville, will officially launch the first-of-its-kind New York State Registered Opioid Overdose Prevention Program.

The new tool in the war on drugs brings life-saving intranasal Naloxone directly to families impacted by opioid drug addiction.

“The opioid crisis is very pervasive in our area,” says Robert Delagi, director of Suffolk County EMS & Public Health, noting that cost is a significant factor in opioid abuse. “A $5 to $10 bag of heroin is much more affordable than oxycodone or Percocet at $60 to $80 a pop. “Unfortunately, we have the dubious distinction of having the most opioid-related fatalities in the state.”

Since Suffolk County EMS was recognized as an Opioid Overdose Prevention Program Agency in November 2013, Delagi’s office has trained nearly 5,000 non-traditional providers. Also, Community Ambulance Company, the county’s EMS provider, has trained more than 60 EMTs to educate community members in six townships served—Sayville, West Sayville, Bayport, Bohemia, Oakdale and Fire Island’s Cherry Grove.

“We’re obviously not preventing the overdose; we’re preventing the death,” says Delagi. “When an overdose occurs, there’s a high likelihood the drug addict is breathing only 3-4 times a minute. Even on a good day, it takes an ambulance 6-8 minutes to get there. In that 6-8 minutes, most could die and their resuscitation by EMS will be much less successful.”

The Training Process

The training process is simple and accessible for anyone in the community who is interested and has 10 minutes to spare. The educational component includes a 5-minute video that may be viewed on any member’s smart phone, a review of a brief New York State Department of Health information card that’s located inside each kit, a quick study of the kit contents, and directions and diagrams.

“Training can be obtained in several ways—a traditional classroom-style setting, by making an appointment for one-on-one training, by stopping by one of our marked cars or on the scene of a call and requesting training,” says Jamie Atkinson, vice president of Community Ambulance Company, and director of its Opioid Overdose Prevention Program. “If we cannot do the training because our members are on calls or the scene is unsafe, we’ll give them a card, asking them to phone or email our agency to schedule training.”

Another option: once a week, the agency will open its doors three hours for drop-in community training. After training, a medication kit is dispensed to the trainee. If, after the initial training session, they have difficulty understanding, they may return to the facility for one-on-one training.  

“It’s that simple,” says Atkinson. “Anyone can be trained and walk away with this life-saving medication.”

Atkinson recalled a woman requesting training who read about the initiative in the local newspaper.

“We asked her why she was interested in receiving training, and she explained her friend has a child who’s having a hard time kicking the habit,” says Atkinson. “Her friend, she thought, should have a kit in the house – just in case. Her friend wanted one-on-one training but wanted to remain nameless. We made arrangements for that. This is what the program is all about. Here you have someone reaching out for help and we as a community organization will be able to provide that.”

Obviously, anytime you start something new there are reservations and concerns. “For instance, we all know that when giving Narcan there is a possibility of the patient waking up and becoming combative or vomit and needing airway management. We have told our members to educate on the importance of scene safety, the possibility of a combative patient after administration, and to ensure a clear airway is maintained,” says Atkinson. 

It’s policy to QA/QI all overdose calls. “All individuals who are given intranasal Naloxone must still be evaluated in the hospital. 911 must still be immediately called,” according to Brian Blaustein, MD, Medical Director and Attending Emergency Medicine Physician at Northwell Health - Southside Hospital.

Atkinson points out that all documentation will be sent for committee review that includes two physicians and two people from the community who are not members of the ambulance company. They will be evaluating to ensure appropriate use of the medication, and effectiveness of the program.

Initially, some community members were concerned about “messing up” administering Naloxone in an emergency. “Once they saw how easy it was, we overcame that challenge,” says Delagi, adding that when paramedics learned about the harm reduction strategy, they were quite enthusiastic. “Paramedics are uniformly excited when they get to prevent something bad from happening, as opposed to always responding to something bad when it happens.”

Setting the Stage

Two pivotal issues preceded the rollout of Suffolk County’s Opioid Overdose Prevention Program.

One, New York lawmakers made significant public policy changes to the Good Samaritan Act, the don’t-be-afraid-to-call-911 law, treatment options, insurance payments, prescribing rules, and hospital discharge case management strategies. These changes paved the way for trained community members to help save lives through harm reduction strategies.

Two, Naloxone, sold under the brand name Narcan among others, has progressed from a needle-injection tool only, used for decades by highly trained EMT providers, to 2006, when intramuscular injections became available for certain lay people to administer, and finally to 2012, when mucosal atomizer devices hit the market, removing the needle from the process and making it possible for lay people to administer the anti-dote.

Comparative Statistics

Last year, the EMS system in Suffolk County had 543 reversals, or lives saved. “A majority of those (administering nasal Naloxone) were policemen and EMTs,” explains Delagi. “Of those, about 10 were administered by lay people.”

The program is drawing attention from public health officials and emergency providers across the country. “Other ambulance services that wish to do this must have buy-in from their agency and paramedics,” he says. “They really must have universal support. That’s the key to the first step.”

Also, people who view this harm reduction strategy as a way to enable people to use drugs must be educated about the process.

“There’s a misperception, even among paramedics, that if you give people something like Narcan, it's going to encourage them to engage in risky behavior,” says Delagi. “In public health strategies, we don't look at it that way. We feel that people are doing the risky behavior and we need to give them the tools to prevent death. But if we don't save a life when the person is most vulnerable—when they're barely breathing on the floor—then everything else we do to combat drug abuse is for naught.”

Qualifications for Training as Overdose Responders

All adults who are 16 years old or older are eligible to be trained.

If a participant appears to be unable to understand adequately the training instruction, they should be provided a Community Ambulance Company Business card and advised to make an appointment at a later date.