Harm Reduction ⫸How To Use Emergency Medical Services⫷

[Orlando]

Dealing With Emergency Medical Services​

Special thanks to: BigTrancer, Catch-22, Exx_head, Halo99, nursey and phase_dancer

Many of us have been or will be present at a drug-related medical emergency (overdose). As scary as the overdose may be, calling for an ambulance or taking someone to the hospital can be just as frightening.

The purpose of this FAQ is to provide information to people so they know what to expect and how to conduct themselves should they ever have an emergency situation. The idea is that if people are somewhat familiar with the process, they will not avoid getting medical assistance due to fear or ignorance. This is not meant to be a first aid guide.

When should I ring an emergency number?

• If you think that you or someone else is experiencing an overdose or other serious medical condition.
• If the person has symptoms of advanced cardiopulmonary/nervous depression (unconscious, not breathing, changing colours or has a weak/nonexistent pulse)
• If the person has symptoms of advanced cardiopulmonary/nervous excitement (overheating (>39°C/102°F, may be difficult to tell), manic behaviour, heart attack, etc.)
• If the person requires medical care, and driving them to the hospital is impractical or would take too long

Basically, if the situation is a medical crisis that you cannot handle, then it’s time to make the call!​

If you have not already done so, please familiarise yourself with the emergency number in your area. This number is often different for hard lines and mobile phones, so take the time to learn both. The call is free to make from both mobiles and hard lines.

What will happen when I ring an emergency number?

If you are calling from a hard line, the call taker will be provided with your location and phone number. If you are calling from a mobile phone, this information may not be available.

The call taker will ask a series of questions. Try to stay calm, and speak in as clear and concise a manner as you can manage. Refrain from using slag, ie: my mate shot a point of blow (besides, who really talks like that?).

Answer the questions to the best of your ability, and be honest. Answer exactly the question that is asked, and do not confuse or impede the call taker with superfluous information.

Also, do not hamper the call-taker with questions of your own. They are a professional, and do this on a somewhat daily basis. They know what they need to ask, and do not need to waste time deflecting your questions. Often, help will be on the way while they are still asking questions. In most situations, call takers will gather enough information to make an accurate dispatch in approximately 30 seconds.

Never hang up on the call taker. Wait until they have terminated the connection, then hang up your phone.

What will the operator need to know? What will they ask me?

• What is the emergency? (Do you need medics, police, or fire-fighters?)
• Where is the emergency? They will ask this even if you are calling from a hard line, although in that case the question may be phrased: “Is this emergency at [location of phone from which you’re calling]?”
• What happened? This may come as a series of questions or as a broader single question. The call taker will probably ask a series of follow-up questions.
• When did this happen?
• Other questions – The call taker may ask your name, how many people are there, and if there are any other special considerations or obstacles that need to be noted.
• Instructions – They may provide you with instructions, such as clearing the airway or performing rescue breathing.

Can I dial the number and then run?

Yes. However, dialling and then running is not a good idea as the dispatcher will probably send police to investigate the call. This is bad both because you have now involved the police in a drug-related incident and because this will probably delay the arrival of emergency medical services.

What should I do after making the phone call?

There are two big post-call priorities:

1. Keeping the person alive – The call taker may give you some instructions to this end or you may be free to act on your own. If and only if you are capable of doing so, you should perform CPR/rescue breathing as necessary. If you elect to perform CPR, please be aware of the potential to receive or transmit disease via body fluids.

2. Sanitising the scene – Basically, this means getting your drugs out of sight. Although this is not nearly as important as the first item, it is probably unrealistic to think that people will not be concerned about this. Don’t waste time trying to diligently hide them, just discard them somewhere out of sight. If it is not practical to discard the drugs, then place them in a opaque bag and send them along with the casualty; indicating to the medics that the bag contains personal items.

This raises the possibility that a helper may fall on the wrong side of the law for handling controlled substances. phase_dancer shed some light on this problem (limited to Australia):

After expressing concerns that [harm reduction organisation] volunteers had in the past been faced with similar situations, I enquired at a departmental meeting as to what was considered the correct course of action to take i.e. of least consequence for both the helper and the casualty.

We were advised that if a situation occurred where workers had to remove personal items, and something came of it law wise, under duty of care the volunteer/worker would not be liable for prosecution. This did not come from a policeman, but the person was definitely someone who should be able to advise on such matters.

I would imagine this should also apply to the general public, but I couldn't be sure. To be honest I don't know whether this would stand up in court at all. There's never been a precedent that I'm aware of.

What if the person recovers before the ambulance arrives?

In this case, ring the emergency number again and tell them that the person seems to have recovered. Emergency calls are prioritised, and someone who has OD’d and is near death is a pretty big priority. Letting them know that the person now seems to be okay may free the ambulance to save another life.

The call taker will tell you if an ambulance is still being sent, if you should take the person to the hospital, etc.

Under what circumstances will the police become involved?

Usually, police will only become involved for one of these reasons:

• The medical personnel fear for their safety. This is applicable to emergency responders and hospitals. It is not uncommon for ambulances to request police escorts when entering dangerous parts of town, or going to a dangerous location. This means that calling from a party could bring the police.
• There is a reasonable suspicion that a crime has been committed. Although this is more likely come into play when responding to violent crimes, police have been known to attend calls responding to drug related incidents (this is usually not the case in larger cities).
• You hang up the phone and run; or just dial and run without telling the call taker what you need. In this case, police will most likely be sent.

What will happen when they arrive? Will I/we be subject to search?

At the time of this writing, the FAQ team was unsure of the legally correct answer to this question. The following answer is based on the experiences of people on all three sides of this situation (users, medics, police):

If the police accompany an ambulance, they are basically there to make sure that things don’t get out of hand. They will probably stay with the medics and only intervene if it is obviously necessary - like if someone becomes violent. They will most likely not search the location or your person, but will act if something is in plain sight (don’t leave your drugs in view).

When should I take someone to the emergency room

You should drive someone to the emergency room for the same reasons that you would ring an emergency number; except that in this case it is practical to drive them yourself.

If you have not already done so, please take some time to familiarise yourself with emergency-care centres in your area. This is not something you’ll want to figure out in the middle of an emergency.

Can I drop them off at the door and run?

Yes, but this is not recommended for several reasons:

• Treatment will be hampered. The medical personnel will have an incapacitated and uncommunicative person on their hands. This means that they will have to spend time and effort figuring out what’s wrong with them, as opposed to you being able to tell them what happened.
• The medical facility may make efforts to contact the person’s family, or the police, or both. In any case, this is probably an undesirable outcome.
• When they recover, the person may be awfully teed off about what you did.

Will the doctors call the police?

In almost every case: No. Most hospitals see their share of drug cases and never call the police. Medical personnel are more concerned with providing adequate treatment than they are with reporting crimes.

Besides, police involvement is usually an undesirable situation at a hospital as it adds confusion, saps resources, increases stress and possibly frightens other patients. Some reasons they may call the police are:

• You are acting in an unruly fashion. If you are causing such a scene that they would normally call the police (regardless of cause) or they fear for their safety, expect to see blue lights.
• They have a strong enough suspicion that another, more violent crime was committed. Most hospitals are required to report things such as gunshot wounds, stabbings, etc.

What information can my doctor share with police?

Your doctor cannot share any information with the police unless a court orders them to do so. Straight from Exx_head: “There is a doctor-client privilege that can only be broken by court order, and that is very difficult.”

 

[phr]

Added information:

In Australia (and in the UK as well, also I'd bet other countries too, just haven't had the time to actually check) there are policies about routine police attendance at overdose call-outs. In Australia, the police will only attend if there's a risk to the safety of the ambulance drivers. This might occur if they are being called out to an address where there is a history of violence, or if they are being called to a public place.

CPR is absolutely the best intervention for an unconscious person who has stopped breathing, such as in an opiate overdose. If someone has stopped breathing and their heart has stopped they are already dead - any attempt at CPR is better than nothing at all. There's a number of studies that have proven the benefits of bystander CPR in an overdose situation (see below). And ayjay is right, simple EAR (Expired Air Resuscitation) is all that's needed in most opiate overdoses.

If someone's stopped breathing and turned blue, but they still have a pulse, just putting them on their back, blocking off their nose and breathing into their mouth can save their life and prevent hypoxic brain injury. Someone can be kept alive for quite a while like this.

There are heaps of wesbites that have great CPR guides (here here here)

 

[phr]

Canada specific info that may be helpful:

duty of care provides the ability for a first responder to take control of an illegal substance or object from a person without fear of prosecution, generally. however, that means you need to turn it over to authorities. (getting the other person in trouble) Drugs can be destroyed quickly and discreetly however... and many LE staff would be sympathetic to your plight and take it away amnesty. But thats up to the LEO, dept policy and the scene overall.

Police often attend most/all 9-1-1 calls in major centers in Canada. However, unless its incredible (ounces of coke or illegal handgun) they are not likely to prosecute/charge. Once again thats situation Dependant. EMS staff and hospital staff will not share info with LE, unless its gunshot/stab wound/child abuse kind of thing.

and most of the time, the police will arrive well after EMS has left...simply due to having more pressing matters that are higher priority sequence on their mobile data terminal, that they are required to attend and clear first. it will only be high priority if caller indicates violence at the scene or EMS arrive and call for police. Otherwise, they'll perhaps roll up and take a short report and you'll never hear of it again. (theres levels from "holy shit! get over there now!!" to "after you finish your coffee, roll by"...a typical OD comes closer to the bottom of that scale) The priority is normally assigned by dispatch based on how serious the incident is, how many units are available, how useful is a police officer on that scene(really, whats the average LEO going to do on cardiac arrest call?), how urgent it is. (taking a tip for a murder still falls low, as the person and tip will be around later) They show up as a list in priority on the officers screen. He selects the highest priority call first, and responds and clears it, and so forth. Priority can be per-empted by dispatch up/down grading, The officer can usually pre-empt and toss back to dispatch a medium or low call if he's flagged down, or sees a crime in action or person requiring help...you can imagine what the call list looks like Saturday night at 0145 in downtown....they aint usually in a hurry to get to a call that poses no public danger, may not offer charges to press and where they'd be of little help anyways. It's a screen the public don't see...if your in the back of a car, its on the "on call" screen/menu waiting to be cleared with your release or your deposit at a holding cell. I gather US and other 1st world countries are similar to us.

(this is personal experience from working as joe blow MP for a short time before going where I am now(where I still get stuck with MP shifts should I have nothing else), from EMS having to attend OD's where I've been present and from co-workers (including civil police and civil EMS) and dept policy of various police forces and from staffing events on volunteer basis and being stuck on duty nco in the military health system cause I have the courses-even in there, we can't share info with LE nvm civi world!/)

main message: EMS calls in Canada for an OD tend not to become legal problems.

 

[Chris42393]

Firefighter/Paramedic here. When in doubt, call 911. A good thing to have (besides Narcan) is a BVM (bag-valve-mask) and OPA/NPA. If someone overdoses (whether it be a friend, family member or stranger) and they are not breathing..or if you don't think they're breathing.. you can get the BVM and place the OPA/NPA adjunct inside their mouth or nose and start breathing for them. This can be reused over and over again too. It's also good for cardiac arrests as well, you can breathe for them and do compressions. (adult compression to breathing ratio is 30:2 ... 30 compressions to 2 breaths and when breathing for an overdose, squeeze the bag every 5-6 seconds)

This has saved more peoples lives than I can even count. We go to a lot of overdoses and I started leaving these behind (after teaching them how to use it) and we'd return back to the place and they'd be using it on the person (saving their life). If you can afford to buy it, do it (they're pretty cheap). It can and WILL save lives.

Do not be afraid to call 911 (even if there are illegal substances there). We don't care and we don't even tell the police (at least in my state). Our goal is to treat the patient.

Great post, Orlando.

 

[JessFR]

Just as a little bit of insight as far as Australia is concerned. Ive been involved with a few calls to emergency services due to drug overdoses and ive never had police attend. Just paramedics. I've also had to drive someone to the hospital for a drug overdose. No police showed up then either.

For reference these experiences happened in NSW and QLD.

 

[nyvar]

Much of the US has drug overdose Good Samaritan laws, but unfortunately my state (Texas) and 2 other states do not.

"GAO found that 48 jurisdictions (47 states and D.C.) have enacted both Good Samaritan and Naloxone Access laws. Kansas, Texas and Wyoming do not have a Good Samaritan law for drug overdoses but have a Naloxone Access law." (US government accountability office website https://www.gao.gov/products/gao-21-248 )

I know in Texas, if you can be proven to have been the one to sold them the drugs, or if you helped administrator them, you can be charged for murder in the event they die. I was reading about one case where a woman gave her husband a miniscule amounts of her prescribed methadone when he asked for help falling asleep and he then took more without her permission and now she's in jail on a felony third degree murder charge ( https://drugpolicy.org/resource/DIH )
It's completely and totally fucked.

Does anyone one have any tips for individuals living in these states that are in no way protected in these situations? Of course I am all for calling for help if it will save a life, but the thought of a felony murder charge scares the shit out of me.

 

[opiateconnect369]

Much of the US has drug overdose Good Samaritan laws, but unfortunately my state (Texas) and 2 other states do not.

"GAO found that 48 jurisdictions (47 states and D.C.) have enacted both Good Samaritan and Naloxone Access laws. Kansas, Texas and Wyoming do not have a Good Samaritan law for drug overdoses but have a Naloxone Access law." (US government accountability office website https://www.gao.gov/products/gao-21-248 )

I know in Texas, if you can be proven to have been the one to sold them the drugs, or if you helped administrator them, you can be charged for murder in the event they die. I was reading about one case where a woman gave her husband a miniscule amounts of her prescribed methadone when he asked for help falling asleep and he then took more without her permission and now she's in jail on a felony third degree murder charge ( https://drugpolicy.org/resource/DIH )
It's completely and totally fucked.

Does anyone one have any tips for individuals living in these states that are in no way protected in these situations? Of course I am all for calling for help if it will save a life, but the thought of a felony murder charge scares the shit out of me.

My tip would be, the governments of these states want you to die, and not help your friends. Call for help, and if the police try to arrest you, exercise your 2nd amendment rights against goverment tyranny. Or, you know, just dial from a phone that isnt yours, and bail if there are no other witnesses. But you know, then your friend might die.

What a barbaric policy. I'm not surprised at all that those 3 states are the ones whose governments fail to do the bare minimum to preserve human life...