Three Minutes

“Engine 10 to Rescue 1, heroin overdose, we’re working him now.”

“Rescue 1, received the message, eta three minutes.”

A few years ago, the patient would have been dead by the time we arrived. Instead, the fire companies in Providence and most places now are Advanced Life Support equipped. Three minutes is a lifetime. A person who has od’d on a narcotic goes into respiratory distress first. It’s all part of the high, manageable most of the time, the drug user has a chance of coming out of it on their own. Their respiration’s start slowing, from 18-20/ minutes, down, down, down to about ten. If they are fortunate and have people nearby who are not too high to recognize a problem they have a chance. The other addicts sometimes drag the person to a shower and soak them with cold water. It must do something because over half of the overdose victims we respond to are in a bathroom, soaked, with puddles of water on the floor.

If there is nobody around, the patient dies, most of the time. The respiration’s slow to 8, then 6, 3-2-1…0. The heart keeps pumping oxygen starved blood through the body until it, too shuts down. The patient dies, a peaceful descent into the other world, never aware of their final moments.

“Engine 10 to Rescue 1, we’re bagging.”

“Rescue 1, received, on scene.”

The guys from the engine are assisting ventilation’s, the patient must have stopped breathing. A crowd watches as Steve and I get out of the truck with the blue bag and walk down some stairs into a basement apartment. The patient looks like a corpse, soaking wet, pink sputum leaking from his nose and mouth. The smell of vomit rises from a lumpy puddle next to his head. We work around it.

“I couldn’t get a line,” says bill, a twenty gauge catheter in his hand, the blue tourniquet still on the patent’s arm. Engine 10’s med bag is open, I draw up 5 ml of narcan into a 10 ml syringe and administer 2 mg. of Narcan into the patients left triceps muscle. IM works, it just takes a little longer than IV access.

Keith continues to bag the patient, who remains motionless on the filthy floor as we get the gear ready to carry him out. After what seems like an hour but was actually only two minutes I see signs of life. The eyes start to flutter. He coughs. He opens his eyes. Keith stops bagging. We get him on a board and carry him outside. The crowd watches, speaking Spanish, entertained by all the commotion as we wheel their friend past them and into the stretcher. He sees them as he rolls past, gives a weak wave and disappears into the back of the truck.

Nobody knows anything, of course.

2 Comments

  • Anonymous says:

    Hmm… They definitely kept him alive with the BVM, but it doesn’t sound like them being ALS was a factor. Unless they gave IM Narcan before you got there. Some places have “nasal Narcan” now. Boston EMS even has it on their BLS trucks. No need to screw around with needles on somebody who often has one or diseases you don’t ever want to get.

  • Anonymous says:

    Apparently they tried to start a line to give the Narcan IV. Figure the 3 minutes from the assessment/report to on scene time was when they were trying it. Fortunately the PFD has enough fire apparatus (read first responders) to fill the gaps due to the shortage of Rescues. And fortunately the ALS firefighters on scene correctly assessed and intervened, until the ALS rescue arrived. Airway management and attempting an IV is part of most ALS protocols, no? Or is it different where you are from? A missed IV on someone circling the drain of life is not uncommon. I’m sure given more time, a second IV attempt, or IM Narcan would have been performed by the capable men of Engine 10.

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