DHEC Bureau of EMS
DAODAS
The LEON's goal is to provide a comprehensive
training to law enforcement agencies across
South Carolina that focuses on
 The identification
 The treatment
 The reporting
of drug overdoses attributed to opiates, such as
heroin and narcotic pharmaceutical drugs.
 The program was created pursuant to the 2015
passing of the South Carolina Overdose
Prevention Act (S.C. Code Section 44-130-60).
 The Act seeks to grant immunity from both civil
and criminal prosecution, to doctors, pharmacists,
caregivers, and first responders, who are
engaged in the prescription, dispensation and
administration of Naloxone (Narcan) in an opioidoverdose suspected case.
Objectives
 Discuss prescription and opioid drug abuse
 Recognize the signs & symptoms of an opiate overdose
 Identify indications & contraindications of Naloxone (Narcan)
 Explain the possible adverse reactions of Narcan
 Describe how to manage adverse reactions
 Prepare and administer Narcan via approved routes
 Describe the on-going management of subject after the
administration of Narcan
 Describe the storage and carrying of Narcan
 Discuss the legal standing of law enforcement as “first
responders” and Narcan administration.
Prescription & Opioid Abuse
 Drug overdose is currently the leading cause of
accidental death in the U.S., with 62,497* lethal
drug overdoses in 2016 or an average of one life
every 8½ minutes.
 In 2016 there were 5.2 million opioid prescriptions
dispensed in South Carolina (population 4,961,119).
 In 2016 there were 366** murders in South Carolina
but 616*** opioid deaths.
*
New York Times, 6/5/2017
** FBI Annual Crime Report, 10/18/2017
*** DHEC Vital Statistics
2016 Opioid Related Deaths
616 Opioid Deaths
366 Murders
243
709
168
311
132
103
188
132
117
147
509
167
94
109
117
4,610 people
262
Per 100,000 people
Pickens
199.7
Horry
164.6
Greenville
144.2
Spartanburg 104.6
Anderson
96.6
Charleston
67.3
Richland
36.1
Yearly Narcan Usage by EMS
South Carolina EMS
Narcan Administration – 2016
1,043
111 and Above
Per 100,000 people
Horry
342
Pickens
274
Greenville
160
Spartanburg 160
Anderson
142
Charleston 119
Richland
62
81 to 110
51 to 80
Less than 50
6,427 people
… 39% increase over 2015
Yearly Narcan Usage by EMS
S.C. EMS Usage of Narcan in 2017
To date 10% increase over 2016
Comparative Response Times
 For many reasons, EMS is usually not the first
emergency responder of the scene of medical
emergencies.
 Average current response time for EMS to all 9-1-1
calls in S.C. is 11.9 minutes (2016 – 675,514 calls)
 Average response time for FD’s running medical
first response 6.41 minutes (2016 – 40,775 calls)
 Average law enforcement response is 3-5 minutes
depending on setting (rural/urban/suburban).
Opioids
1. Opioids are a class of drugs chemically
similar to opium poppies.
2. These drugs act on the Central Nervous
System as a depressant:
• decrease the perception of pain
• decrease the reaction to pain
• increase pain tolerance
3. Prescribed for acute, debilitating, or chronic pain
(as part of palliative care (e.g., hospice, cancer)
4. May be abused to induce euphoria or “high”
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Prescription Opioids
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Buprenorphine
Butorphanol (Stadol®)
Codeine
Fentanyl (Duragesic®
patch)
Hydrocodone (Vicodin®)
Hydromorphone
(Dilaudid®)
Meperidine (Demerol®)
Methadone
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Morphine
Nalbuphine (Nubain®)
Norco ®/Lortab ®
Oxycodone
(Percocet®/Percodan®)
Oxymorphone
Pentazocine (Talwin®)
Paregoric
Propoxyphene (Darvon®)
Signs & Symptoms of Opioid
Overdose:
 Unresponsive to sternal rub
 Depressed respiratory system
o Agonal respirations
o Respiratory arrest (not breathing)
o Cyanosis
 Constricted Pupils
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Agonal Respirations
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Cyanosis
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Constricted Pupils
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Overdose Evidence
 Unresponsive
 Not breathing/agonal
 Track marks
 Drug paraphernalia
How Narcan Works?
What is an Overdose?
The brain has many receptors for opioids. A overdose occurs when too
much of an opioid, like heroin or morphine, fits in too many opioid
receptors slowing and then stopping the breathing.
Opioid
Opioids fit exactly on receptor
THIS IS
A BRAIN CELL
Opioid Receptors in your Brain
How Narcan Works?
Narcan has a stronger affinity than opioids in the brain receptors and
temporarily displaces the opioids like heroin. This reverses the Opioid
Effect and allows the person to breathe again. But Narcan has a shorter
half-life than many opioids.
Displaced Opioids
Narcan
Narcan replaces Opioids on receptors
THIS IS
A BRAIN CELL
Opioid Receptors in your Brain
Treatment: The Basics
 Airway
 Check Pulse and CPR
 Some subjects present with a bad airway
(snoring respirations) and no pulse. This
can occur any time during contact.
 Provide airway care and CPR per your
Department policy and training.
Treatment: Narcan
 AKA “Naloxone”
 Approved by FDA in 1971
 It is the medication of choice in the emergency care
of opioid overdoses
 Effective only opioid drugs/medications
 Not Effective on benzodiazepines (Valium, Xanax,
etc.), cocaine, alcohol, or meth
 It has little to no side effects other than the reversal
of opioids
Indications for Narcan Use
• Respiratory Arrest or Agonal
Respirations
• They may also have evidence of
opioid/opiate use:
• Bystander statements
• Drug paraphernalia
• Opioid prescription bottles/patches
• Needle “track marks”
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FYI: Narcan Usage
 Narcan is only used on
subjects with depressed
respirations or apnea, not
depressed mental status.
 Opioid use alone (without
depressed respirations) does
not merit the use of Narcan.
 If subject lethargic & hard to
arouse but still breathing
effectively, it’s not an
overdose – they are just
“high”
Personal Protective Equipment
 While there may be little or no blood seen at the
administration site, it is always safe to don
gloves prior to using the device and rendering
aid to victim
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Narcan Nasal Spray
Needleless Narcan Administration
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Nasal Narcan Administration
 Place in subject’s nostril
 Squeeze entire contents
 If no response (subject doesn’t wake up with first
dose) within 2 minutes, repeat administration
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Points to Remember
 The effects of Narcan may not last as long as the
effects of the opioid.
 Be prepared for a return of overdose signs &
symptoms.
 People often mix opioids with other drugs and/or
alcohol (example: “Speedballs” = Cocaine + Heroin)
 More recently - Heroin mixed with fentanyl or
other synthetics such as carfentanil and “Pink”
making it several hundred times more powerful.
2 milligrams of carfentanil can kill you
Typical Reactions
With LEON nasal administration opiate withdrawal
typically causes:
• Restlessness & nervousness
• Irritability
• Nausea /Vomiting
• Patient may still be very groggy
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Adverse Reactions
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BOLO EMS administered Narcan via IV route
Rapid opiate withdrawal
Restlessness & nervousness
Agitation, irritability, vomiting
& violent behavior
 Be prepared to deal with an
angry/agitated patient!
 Tactics and safety first then
that of the subject you're aiding
(i.e. may need to restrain patient
or other unruly subjects, etc.).
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Narcan may work slowly…
…most of the time
Narcan may work rapidly…
…some of the time
Addressing Officer Safety
 LEON program emphasizes Tactics and Safety: there may
be situations where it may not be safe to use Narcan. It is
100% up to the individual officer’s discretion.
 Because of the high potency of the illicit fentanyl and opioid
analogues such as “Pink”, we recommend officers to carry
Narcan to save fellow officers who inadvertently come in
contact or inhale the powdered forms.
 The dosage and route given by LEON is enough to keep an
overdosed person breathing and alive.
 None of the 158 deployments to date have resulted in a
problem. Law Enforcement data from other states concur.
Addressing Officer Safety
 Narcan can also save a canine officer’s life: powdered
opioids like fentanyl and carfentanil can be inhaled by
them as well as absorbed through the pads on their feet.
After the Administration
(on scene)
 Make sure EMS is en route
 Make sure subject is breathing
 If not breathing, airway care and CPR per
your Department protocol and training
 Turn the subject on their side (Recovery
Position).
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Recovery Position
After the Administration
 Write down the subject’s information, the time Narcan
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was given & its effect
After EMS transports subject, be sure to log into reporting
portal (NFADF) and record the Narcan administration
Contact the LEON team.
The team will contact the assigned pharmacy to restock.
Show the pharmacist your electronic receipt for refill
IT IS IMPORTANT TO THE PROGRAM’S SUCCESS AND
OFFICER IMMUNITY THAT THE OFFICER REPORT ON
THE PORTAL AFTER NARCAN IS GIVEN
After Administration
https://www.scemsportal.org/nfadf
1234-5678
●●●●●●●●
town$o2*
Enter user name (SCCJA number)
Enter user password (Law enforcement agency specific)
Naloxone Field Administration Data Form
Documentation
Naloxone Field Administration Data Form
Enter New Form
View Past Forms
Documentation
Naloxone Field Administration Data Form
Time stamped automatically
when starting New Form
John Smith
First Name & Last Name
of individual
Gender
201 Main Street, behind building
Our Town
Address where Narcan
is administered, not their
home address
Documentation
Naloxone Field Administration Data Form
01/19/2017 00:00:00
x
Date & Time of Call
Date & Time of Arrival
Drop down Boxes
Indicators of OD
Check Boxes
x
x
Response to Medication
How long to take effect?
Drop Down Responses
Documentation
Naloxone Field Administration Data Form
Other Actions Taken
Check Boxes
x
x
x
Richland County EMS
17-09845
On arrival found subject
unresponsive and blue inside
a cardboard appliance box.
Write in EMS Agency
responding to scene
from EMS Database
LEO Agency Incident
Number
Narrative (free form)
Naloxone Admin Portal
This is the number given to the designated pharmacy to
get your Narcan “refill”
Narcan Storage
 Narcan is a fairly stable medication, with a shelf life
between 18 months and two years
 Narcan should be kept away from direct sunlight
 In most law enforcement settings, Narcan can be
stored in the cab or trunk of the vehicle in a soft
lunch bag or back pack
 Store at controlled room temperature 59°F to 77°F
 Excursions permitted between 39°F to 104°F
 Some officers choose to carry in person on belt or
vest pouch
Narcan Storage Ideas
Belt Pouch
Tactical Bag or Back Pack
AED Bag
Tactical Vest Pouch
Soft Lunch Box
Legal Stuff: S.C. 44-130-60
(A) A first responder may administer an
opioid antidote in an emergency if the
first responder believes in good faith
that the person is experiencing an
opioid overdose.
S.C. Overdose Prevention Act of 2015
Legal Stuff: S.C. 44-130-60
(B) The first responder must comply with all
applicable requirements for possession,
administration, and disposal of the opioid
antidote and administration device. The
Department (DHEC) may promulgate
regulations to implement this section, including
appropriate training for first responders who
carry or have access to an opioid antidote.
S.C. Overdose Prevention Act of 2015
Legal Stuff: S.C. 44-130-60
(C) A first responder who administers an
opioid antidote in accordance with the
provisions of this section to a person whom
the first responder believes in good faith is
experiencing an opioid overdose is not by an
act or omission subject to civil or criminal
liability or to professional disciplinary action.
S.C. Overdose Prevention Act of 2015
Frequently Asked Questions
 What happens if the victim never awakens or nothing
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happens?
What happens if I am wrong about the overdose?
Can the Narcan hurt the victim if they really did not
need it?
Should I do CPR or the Naloxone first?
What do I do with the spent device?
Am I liable if I do nothing and there’s a bad outcome?
Can I give Nasal Narcan to a child?
Who do I call if I have a question?
LEON Team Contacts
Arnold Alier
SC Bureau of EMS
Mobile 803-760-5493
aliera@dhec.sc.gov
Richard Naugler
SC Bureau of EMS
Mobile 803-760-8533
nauglerc@dhec.sc.gov
Scott Stoller
W Pelzer Police Dept
Mobile 864-844-3008
sstoller@acems.us
Jeff Ward
Greenville County Sheriff’s
Office
Mobile 864-546-0257
jward@greenvillecounty.org
Joseph Shenkar
Legal Counsel
SC DAODAS
Mobile 803-315-3357
jshenkar@daodas.sc.gov
Kenny Polson
DHEC Narcan Coordinator
Mobile 803-429-9636
polsonkb@dhec.sc.gov
Parting Video
Questions?
Arnold Alier
EMS Division Director
DHEC Bureau of EMS
aliera@dhec.sc.gov
803-760-5493
Joseph Y. Shenkar
Legal Counsel
SC DAODAS
jshenkar@daodas.sc.gov
803-315-3357
Kenny Polson
Narcan Coordinator
DHEC Bureau of EMS
polsonkb@dhec.sc.gov
803-429-9636
South Carolina
https://www.facebook.com/SCLEONprogram