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Suspected Opioid Overdose Response Procedure

Effective Date: November 1, 2018
Downloadable Version: pdf icon Suspected Opioid Overdose Response Procedure
  This document is available in alternate format on request.

Purpose:

This Procedure outlines the proper emergency response and administration of Narcan (naloxone) nasal spray in the event of a suspected opioid overdose occurring on College property, along with reporting responsibilities for Designated Employees who have administered Narcan (naloxone) nasal spray in the event of an emergency. 

This document is available in alternate format on request.

Scope:

This Procedure applies to Designated Employees who have been trained to respond in the event of a suspected opioid overdose.

Definitions:

Designated Employees:  includes Department of Public Safety Security Personnel, Residence Assistants, Residence Life Coordinators, North Campus Emergency Response Team (“CERT”), Health and Safety Services Staff and regulated health professionals in the Student Wellness and Accessibility Centre.

Opioids: Opioids belong to a group of drugs known as depressants. Depressants slow the activity of the brain and the body. Commonly known opioids include: heroin, as well as prescription medications used to treat pain such as morphine, codeine, methadone, oxycodone, hydrocodone, fentanyl, hydromorphone and buprenorphine. 

Opioids exert their effects on the body in three (3) ways:

1) opioids decrease respiratory drive (the urge to breathe);

2) as breathing decreases (and eventually stops), there is less oxygen in the blood, leading to brain damage; and

3) oxygen starvation results in organ failure of the heart, the brain and eventually death.

Opioid Overdose: Opioid overdose occurs when an opioid or combination of substances with an opioid overwhelm the body and as a consequence the central nervous system (CNS) is no longer able to control basic life functions (i.e.: breathing, heart rate, body temperature, consciousness). Signs of an opioid overdose may include:

  • Loss of consciousness;
  • Unresponsive to outside stimulus;
  • Breathing is very slow, shallow, erratic, or has stopped;
  • Choking noises or deep gurgling noises;
  • Changes in skin tone to pale, grey or ashen;
  • Body is limp;
  • Pinpoint pupils;
  • Slowed pulse.

Narcan (naloxone): Narcan (naloxone) is an opioid antagonist, used in emergency situations to temporarily stop or reverse a known or suspected opioid overdose, displayed as respiratory and/or severe central nervous system depression. Narcan (naloxone) does not counteract overdoses due to non-opioid drugs. Narcan (naloxone) is available in two (2) forms:

i. injected intramuscularly (“IM”); and

ii. intranasal via nasal spray (“IN”).

Procedures:

1. How to Identify a Potential Opioid Overdose

If an individual is showing signs of loss consciousness, unresponsive to outside stimulus, slow or shallow breathing, choking, blue lips, and will not wake up, this is a medical emergency. Call 911 immediately.  Call the Department of Public Safety’s Emergency Line at ext. 4000 to request first aid assistance and to inform that 911 has been contacted. 

2. Responding to a Suspected Opioid Overdose

2.1. This procedure outlines two (2) distinctive processes:

Process # 1: Response in the absence of Narcan (naloxone) nasal spray; and

Process # 2: Response with Narcan (naloxone) nasal spray administration.

2.2. Process # 1: Responding to an overdose without Narcan (naloxone):

2.2.1. Upon discovery of a suspected overdose of an individual, the following steps should be initiated:

Step 1: Stimulation

Try to wake the individual.

Shout their name.

Shake their shoulders.

If you cannot rouse the individual, try rubbing their sternum (rub your knuckles on their chest bone for about 5-10 seconds).

Step 2: Call 911

If the individual does not respond to stimulation, call 911 immediately.

State the name and address where the overdose has occurred.

Specify location (floor, closest entrance).

Describe signs and symptoms observed, treatment administered, individual’s status.

Provide information to responding emergency services personnel.

Step 3: Call Department of Public Safety at ext. 4000 to request first aid assistance

The Department of Public Safety will immediately dispatch a Security Personnel and/or Supervisor to attend the location to administer first aid and coordinate the emergency response.  When available, the North Campus Emergency Response Team (“CERT”) will also be dispatched to assist with the medical response.

Step 4: If trained, initiate CPR/Rescue breathing

Use appropriate Personal Protective Equipment (“PPE”), including non-latex gloves and rescue breathing barrier to reduce the risk of exposure to infectious disease.

Upon arrival of the Security First Response, they will take charge of the incident response and will control the scene overseeing the administration of first aid to the patient until Emergency Services (Paramedics and / or Fire Department responders) arrive or are relieved by a more competent/higher trained responder.

2.3. Process #2: Responding to an overdose with Narcan (naloxone) nasal spray

2.3.1. Narcan (naloxone) nasal spray is stored in the following designated locations:

i. First Aid Kits on each floor of Humber Residence buildings;

ii. Designated Residence Life Coordinators;

iii. First Aid Kits at the reception/front desk of Humber Residence buildings;

iv. First Aid Kit of the CERT Team;

v. Department of Public Safety First Aid Kit;

vi. Humber Health Centres;

vii. Welcome Centre desk First Aid Kit located at Lakeshore campus; and

viii. Registrar Desk First Aid Kit located at North Campus.

2.3.2. The following steps should be followed when responding to an opioid overdose when administering Narcan (naloxone) nasal spray:

Step 1: Stimulation

Try to wake the individual.

Shout their name.

Shake their shoulders.

If you cannot rouse the individual, try rubbing their sternum (rub your knuckles on their chest bone for about 5-10 seconds).

Step 2: Call 911

If the individual does not respond to stimulation, call 911 immediately.

State the name and address where the overdose has occurred.

Specify location (floor, closest entrance).

Describe signs and symptoms observed, treatment administered, individual’s status.

Provide information to emergency services providers.

Step 3:  Call Department of Public Safety at ext. 4000 to request first-aid assistance

The Department of Public Safety will immediately dispatch a Security Personnel and/or Supervisor to attend the location to administer first aid and coordinate the emergency response.  When available, the CERT will also be dispatched to assist with the medical response.

Step 4: Administer Narcan (naloxone) nasal spray (Intranasal)

If physically possible, lay the individual on their back to receive a dose of Narcan (naloxone) nasal spray.\

Peel back the tab with the circle to open the Narcan (naloxone) nasal spray device.   

Tilt the individual’s head back and provide support under the neck with your hand. Gently insert the tip off the nozzle into the nostril until your fingers on either side of the nozzle are against the bottom of the individual’s nose.

While in the nostril, hold the Narcan (naloxone) nasal spray device with your thumb on the bottom of the plunger and your first and middle fingers on either side of the nozzle. Do not prime or test the device. 

While ensuring that the head remains tilted back, press the plunger firmly to give the entire dose of Narcan (naloxone) nasal spray.

Remember to remove the Narcan (naloxone) nasal spray device from the nostril after giving each dose.

Step 5: If trained, initiate CPR/Rescue breathing

Use appropriate Personal Protective Equipment (“PPE”) including non-latex gloves and rescue breathing barrier to reduce the risk of exposure to infectious disease.

Depending on your level of training and ability, administer either rescue breathing, full CPR or chest compressions-only CPR.

Continue until the next dose of Narcan (naloxone) nasal spray is needed, or until the individual starts breathing on their own, or EMS arrives.

Step 6: Reassess

If the individual does not start breathing on their own within 2-3 minutes, administer a second dose of Narcan (naloxone) nasal spray in the other nostril following the same procedure in Step 4 and continue CPR until EMS arrives.

If additional Narcan (naloxone) nasal sprays are available, Narcan (naloxone) may be administered in alternating nostrils every 2-3 minutes until the individual responds or EMS arrives.

When the Narcan (naloxone) ne starts working, the individual may:

Wake up suddenly

Wake up slowly

Be disorientated

Want to use more drugs

Be agitated and may become combative- the last thing the individual likely remembers was feeling good. Narcan (naloxone) temporarily takes this feeling away

Step 7: Recovery Position

If at any point you need to leave the individual alone, place them in the recovery position (on their side).

Placing an individual in the recovery position gives gravity assistance to the clearance of physical obstruction of the airway by the tongue, and also gives a clear route by which fluid can drain from the airway and prevent choking.

2.3.3 Upon arrival of the Department of Public Safety Security Personnel, they will be designated to oversee the incident response and are responsible for controlling the scene and overseeing the administration of first aid and/or Narcan (naloxone) nasal spray to the individual experiencing a suspected opioid overdose until Emergency Services (Paramedics/Fire Department) arrive or are relieved by a more competent/higher trained responder.

3. Responsibilities for Training Coordination

3.1. The on-boarding of new Department of Public Safety Security Personnel, Residence Life staff, CERT and regulated health professionals in the Student Wellness and Accessibility Centre will not be considered complete until opioid response training and CPR training has been facilitated.

3.2. The Associate Dean, Student Wellness & Equity will be responsible for ensuring the medical content of Designated Employees training on opioid response is appropriate.

3.3. The Manager, Public Safety, will be responsible for ensuring that Department of Public Safety Security Personnel regularly assigned to Humber campuses are trained in opioid response in addition to their regular first aid training.  A record will be maintained of all training.

3.4. At a minimum, at least one of Department of Pubic Safety’s Security Personnel on each campus will be available to respond to a suspected opioid overdose at all times. 

3.5. The Director, CERT will be responsible for ensuring that the CERT responders are trained in opioid response in addition to their routine training.  A record will be maintained of all training.

3.6. The Associate Dean, Student Wellness & Equity will be responsible for ensuring that Residence Life Staff have completed the applicable training and will provide lists of the Designated Employees who have completed the training to the Director, Public Safety and Emergency Management and the Manager, Residence Life.

3.7. The Manager, Residence Life is responsible for tracking and communicating training needs to the Associate Dean, Student Wellness & Equity.

3.8. The Associate Dean, Student Wellness & Equity, will coordinate the refreshment of training for returning Designated employees.

4. Responsibilities for the Coordination of Narcan (naloxone) nasal spray

4.1. The Manager, Residence Life will establish routine auditing systems to ensure the presence of Narcan (naloxone) nasal spray kits at the following locations:

4.1.1. First aid kits housed on each floor of residence;

4.1.2. First aid kits housed at the front desk of each residence.

4.2. The Manager, Public Safety will ensure regular inspection of the first aid kits used and maintained by Department of Public Safety Security Personnel for the availability of Narcan (naloxone) nasal spray. A sufficient re-supply of Narcan (naloxone) nasal spray kits will be maintained in secure storage in the Department of Public Safety Security Office.

4.3. The Department of Public Safety’s Security Supervisors will inspect the primary use first aid kit at the beginning of each shift to ensure adequate first aid supplies, including Narcan (naloxone) nasal kits are present. Tampered or expired Narcan (naloxone) nasal spray will be removed from the kit and replaced with a new kit. A record of each inspection is to be recorded on the appropriate log sheet.

4.4. Mobile Department of Public Safety Security Personnel will inspect the first aid kits kept in each vehicle at the beginning of each shift to ensure adequate first aid supplies, including Narcan (naloxone) nasal kits are present. Tampered or expired Narcan (naloxone) nasal spray will be removed from the kit and replaced with a new kit. A record of each inspection is to be recorded on the appropriate log sheet.

4.5. The replenishment of Narcan (naloxone) spray kits in College residence buildings and in the Health Centre due to administration, tampering or expiry will be communicated to the Associate Dean, Student Wellness & Equity who will replenish Narcan (naloxone) nasal spray to the Manager, Residence Life and/or the Manager, Public Safety as needed. 

4.6. Director, CERT will ensure regular inspection of the first aid kits ensuring the supply of Narcan (naloxone) nasal spray is maintained for use by CERT.

5. Incident Reporting Responsibilities

5.1. The Department of Public Safety’s Security Personnel will ensure that a Security Incident Report is created for all incidents involving the response to a suspected opioid overdose following existing reporting and emergency notification procedures.

5.2. Upon approval of the report, the Public Safety Coordinator will ensure that a copy of the report is forwarded to following individuals/departments for appropriate follow up:

Administrative Services Specialist

Manager, Health and Safety

Associate Dean, Student Wellness & Equity

Director, Public Safety and Emergency Management

5.3. Designated employees that have deployed Narcan (naloxone) nasal spray as a life preserving measure will communicate the incident to their direct supervisor and complete an incident report immediately and provide a copy to Department of Public Safety, who will ensure that it forms a part of the official security incident report as described above.