Handling Emergencies

[0utrider]

Taking Immediate Action

For German speaking click here (including telephone nrs etc)

If sign/symptoms of Drug overmedication or overdose are identified
taking prompt action can be lifesaving. Patients and their close family
or friends should know when to call the MMT clinic about possible
overmedication, when to call for emergency help, and what to do while
waiting for help to arrive.

If there are possible signs/symptoms of overmedication or overdose, determine if the victim is responsive. Shout
their name, pinch their ear, rub your knuckles on their breastbone to
arouse them. If they can be fully aroused, keep them awake and call the
MMT clinic for instructions on what to do. If the victim cannot be
aroused, call for emergency help immediately. In Hamburg and the Rest, dial 112 (this may differ in other countries)



While Waiting for Help to Arrive
CAUTION:
The following life-saving procedures are provided here for
informational purposes and require training to be done properly. This
is available from Red Cross chapters around the world, and training
programs offered by the American Red Cross may be found at: http://www.redcross.org/prepare/trained/trained_2.asp
Rescue Breathing…
With the victim flat on their back, preferably on a hard surface like
the floor, determine if there is breathing. Tilt the head back to open
the airway and make sure the mouth is clear. Lean close to feel on your
cheek and hear if there are breaths. If there is no breathing, brain
damage can occur within 3-5 minutes, so immediately perform rescue
breathing.
For
mouth-to-mouth rescue breathing, first pinch the victim’s nostrils
together between your thumb and first finger. Make a good seal around
their lips with your mouth and blow steadily until the chest rises,
then take your mouth away and let the chest sink back down.
Give 2 breaths every 5 seconds. Always support the victim’s chin to keep their head tilted back and airway open.
CPR (Chest Compressions & Rescue Breathing)…
If both breathing and heartbeat stop (that is, there is no pulse), CPR
(cardiopulmonary resuscitation) is the only hope of sustaining life
until emergency help arrives.
First,
measure two fingers up from where the ribs meet the breastbone (arrow).
Just above where your fingers are, place the heel of one hand on the
breastbone and put the other hand on top of this hand, locking fingers
together.
Next, keep your shoulders above the center of
the victim’s chest, arms straight, and press down on their chest by
about 1 to 2 inches. Rapidly release the pressure, but keep your hands
where they are.
It is necessary to do 15 rapid chest
compressions every 10 seconds followed by 2 breaths of rescue breathing
– repeat this cycle until help arrives.
If the heart
starts beating, and the person’s normal color comes back, stop chest
compressions but continue rescue breathing unless the person regains
consciousness.
Recovery Position…
If the person is
breathing, with a heartbeat, the “recovery position” will help them
breath better, without choking, and prevent further harm until help
arrives.
First,
tilt the victim’s head back to open the airway and straighten the legs.
Put their arm nearest to you at right angles to their body. Pull the
arm farthest from you across victim’s chest and place the back of the
hand against the cheek nearest to you to support the head.
Next, pull up on far leg just above knee and roll the victim toward you and onto their side.


Finally,
place leg at right angles to prevent the person from rolling over
further. Be sure the back of their hand is supporting the cheek and the
head is tilted back for easier breathing. Make sure the airway is clear.
Monitor the person’s breathing and heartbeat, and do not leave them alone until help arrives.


more infos & telephone #'s would be nice

Reputation Comments on this post:

	Thanks, that's useful
	thanks for adding this, good info

[notts.pirate]

i would also add that the most important thing you can do is be calm and not lose your head

[0utrider]

well yes.. thats the german part, i just didnt translate it into english yet, its about "not so dangerous" OD's, like psychedelik ods, bad trips etc

[Alfa]

Please upload any pictures.

[pinkandfluffy]

At what point would you guys call the authorities? Swim isn't thinking of opioids here, more along the lines of MDMA, LSD, etc.

[moda00]

Originally Posted by pinkandfluffy

At what point would you guys call the authorities? Swim isn't thinking of opioids here, more along the lines of MDMA, LSD, etc.

In the case of a psychedelic like LSD- If there was any chance of physical danger, swim would call an ambulance right away- if the person was physically aggressive to self/others to point of possible injury, bleeding, etc. and if individual could not be calmed by other techniques or was unwilling or unable to try. In many cases, a benzo is what would be given in the ER anyways, so swim would try to first work with the person and offer guidance and support, and benzos if needed.

Swim always has benzos around for psychedelic emergencies, but there has never been a situation in which she or another had to utilize them. That said, if there is any danger or chance of physical injury to the individual or those around them, swim would involve EMS right away- the social or pharmaceutical interventions would only be used in the case of someone having an emotionally/psychologically rough or uncomfortable trip with no danger of harming themselves or others, since in such a case an ambulance, police, doctors, etc. would likely make things worse, both in the immediate present and in the consequences/after effects.

That said, with any unknown substance such as a research chemical, or a substance like MDMA with risks of cardiovascular side effects, swim would be quicker to ask for emergency services to intervene, whereas in the above situation, involving something like DMT, LSD, salvia, or psilocybin, she would be more likely to offer a benzo and/or try to assist on her own before involving others.

[fnord]

For OD's where users are unresponsive(not psychadelic freakouts) its always a good idea to remove contraband from your friends pokets before the ambulance arives,and also hide all illicit items becasue the cops will generally search your house. another thing to add is when talking to 911 you should say the person had a heart attack this demands the same quik responce as a OD but shouldent involve the police,in my area any time the police hear about an OD over the radio they come running also,his is the advice that we were supposed to give out at a local area needle exchange i used to work with that had heard that many people were draggin there friends outside and dumping them on the sidewalk before calling 911 to avoid potential prosicution.

Sorry about my spelling my spell check is broken.

[Panthers007]

Never knowing where one might find oneself - like out in the mountains with friends high on acid or sumthin' - and have no way to immediately contact emergency services, I highly recommend taking an Emergency Medical Technician(EMT) course. These are available at many hospitals and clinics. They cost a bit of money, but what price do you put on someone's life?

Being EMT-trained comes in handy in many situations - not just some tripper falling off a cliff and breaking their collar bone. As a qualified first-responder, you will find yourself dealing with situations you never expected: People unconscious on the street, kids getting hit by a car chasing the ball, old women falling on ice and breaking a hip, many things. It can even get you a job.

It also proves that pot-smokers aren't exactly stupid, retarded social parasites!

[0utrider]

swim highly recommends not to think too long about "if or if not" to go to ER/call doctor.. especially if its not psychedelika but stuff like opioids, benzos, alkohol etc..

would be good if somebody could post the telephon #s for UK and US (as most people are from these countries) and other countries, not only emergency (and what to say to not let the police come also) but also maybe toxicology offices or stuff like that. for germany i opened a seperate thread thats a little more detailed about everything, especially opioids and OD

[Panthers007]

For emergency medical dispatch(also connects to fire & police services) in most locations in the USA: 911

For poison-control toll-free in the USA: 1-800-222-1222

[Ididnotinhale]

Swim believes/agrees that anyone who is around a lot of drug users who could O.D. might want to get CPR certified, it takes just a couple hours and costs about 20 bucks. The time and money could save a friend. EMT would be better, but this takes far less time and swim thinks people are more likely to do it.

At a lot of clean needle places, especially in Europe they will give opiate users naxolone just incase of an O.D., so if swiys can get ahold of that do so, but if someone is ODing, even if swiy has naxolone, swiy should still call 911(or the equivalent)

Also, if someone OD's does this give the police a right to search the home if swiy doesn't give permission?

[moda00]

No, this does not give police the right to search (in USA), unless they can see/smell illegal things (edit: not necessarily true- see below and research the law before proceeding). Clean up the place, hide everything while waiting for them to come. Then either tell them you aren't sure what is going on, that they came over, and passed out, or went in bathroom and then passed out, and then take one of the EMS people aside and discreetly let them know what was/may have been taken. Ie.don't say you were using together, or you saw them use, but do make it clear that it is likely a result of _____ so the EMS can do their job without creating a bad legal situation.

In any situation involving opioids, swim recommends as stated having naloxone (does require a prescription but many needle exchanges will have a doctor write these in bulk and then fill them in when you complete a training on how to use) and also know CPR. In any case where harm/death is even a slight possibility, don't hesitate or over-think the decision to call. Opioids can often be reversed by naloxone if available, and benzos, flumazenil (but this is more difficult to come by), but anything else- cocaine, RCs, amps, benzos- one should call- better safe than sorry.

That said, if the worst case scenario is an uncomfortable experience or "bad trip," then I think in many cases it is better to leave EMS out of it- if the risk is a negative or damaging emotional/psychological experience, and the people around feel knowledgeable/comfortable enough with psychedelics to assist, then I think it's better to do it that way, as often times involving the legal system and medical system will create more stress in the immediate situation, and also possibly cause one to have a legal record, lost the trust of their family, their doctor, etc. In the case one feels comfortable enough to care for someone having a rough experience with a drug that cannot cause serious harm or death, I would say avoid calling emergency services if one feels they are comfortable handling it (ie. MAPS has a great psychedelic emergency services training and the Sanctuary program at Burning Man is run by them) But again, any substance that can possibly be harmful, or any behavior that could result in harm (delirium, aggression, etc.) no matter what substance, should be taken very seriously

[Ididnotinhale]

In the U.S. you are not required to talk to the cops unless there is a lawyer present, so never talk to the cops! and never give them permission to enter your house, even if you are 99% sure you have nothing in there. Swim has seen houses torn apart while cops look for drugs.


There is a belief that vitamin C will stop bad trips, but this is not true. It may slightly sooth out the trip(friends have told swim), but it will definetly not stop the trip or take a user out of a bad trip.

Haloperidol and benzos are often used in emergency rooms for bad trips, so if swiy is a regular user he/she might want to have some in one's pocket just in case. Unfortunately Antipsychotics are not effective against dissociatives such as: pcp, ketamine, dxm.

For benzo's the only chemical cure for overdose is flumazenil, also known as Anexate(it is a benzodiazepine antagonist). This drug is pretty much impossible to find on the street, and generally charcoal and a stomach pump is used instead. If one was an addict of benzos and this was used, do any swimmers know if this would cause immediate withdrawal and likely seizures?

Finally, here is a website where swiys can find every ambulance number. Along with police and fire.
http://www.sccfd.org/travel.html

hope that helps answer some questions

[Panthers007]

I hate to correct such an esteemed moderator as Moda - but you were partially wrong on one point: In the USA, people can be arrested, and places searched, for "Being in the presence of heroin." In other words, if heroin is found/suspected - the police can arrest everybody in the area of it. And the house can be ransacked.

So if someone is doing heroin - don't let 'em in your house. Go somewhere that you can get help, and get away from. That's why people often dump od's out of cars in front of emergency rooms. Not cool - but you-know-who created this mess.

As regards having naloxone - naloxone will reverse an opiate od, but it only lasts for a short period of time. One shot won't save the person. The naloxone wears off, and the person goes back to od-ing again. You must get medical help immediately.

[moda00]

Originally Posted by Panthers007

I hate to correct such an esteemed moderator as Moda - but you were partially wrong on one point: In the USA, people can be arrested, and places searched, for "Being in the presence of heroin." In other words, if heroin is found/suspected - the police can arrest everybody in the area of it. And the house can be ransacked.

So if someone is doing heroin - don't let 'em in your house. Go somewhere that you can get help, and get away from. That's why people often dump od's out of cars in front of emergency rooms. Not cool - but you-know-who created this mess.

As regards having naloxone - naloxone will reverse an opiate od, but it only lasts for a short period of time. One shot won't save the person. The naloxone wears off, and the person goes back to od-ing again. You must get medical help immediately.

Haha I'm not always right Panthers, and it's good to know. Thank you for the correction. Do you know exactly what the law says in regard to reasonable suspicion, just cause, whatever? The way I thought it worked, if they had reason to believe heroin was in the house they could search, but in order to have proof of that wouldn't one have to either have visible proof, or verbal? I mean, it seems obvious that if someone is OD'ing, they had to have done heroin, but I wonder if there are ways around that.. Just best to be prepared either way, and know exactly how it should be handled- look forward to learning more..

In the case of the naloxone- swim's done naloxone trainings, and you are taught to monitor them, because as you say, it will wear off in 30-60 minutes, and depending on the concentration of heroin remaining in their bloodstream it is definitely possible, although not guaranteed, that they may lapse back into it. It's recommended to have at least 4-6 doses on hand, and to use 1-2 at a time (if the first doesn't work, try a second and that will usually be effective) and then monitor them for three 30-60 minute "cycles" or until they have remained awake for 90 minutes consistently.

Also I think it is really important in the case of using opiates with other people to discuss how one would handle it- in what case should one call, who to call other than 911 (ie. friends/family to notify), make sure everyone is on the same page and has made their wishes known as well as discussed if and how to use things like CPR, naloxone, etc.

Finally, while I do think naloxone administration by trained individuals can be sufficient in an overdose, I think if there iis any question of multiple drug ingestion or existing health conditions emergency services should be involved no matter what.

Swim had a situation in which an acquaintance whom she did not know very well came over- they ran into one another at a party after not seeing one another in about a year, and she invited her over later that week. They ended up doing heroin, and said individual OD'ed. Swim had naloxone but freaked out, her hands were shaking and she couldn't prepare the injection, and she didn't feel comfortable taking it into her own hands, and she called 911. As they were on the way, the operator stayed on the line and talked her through what to check for and asked her questions about the situation. Swim didn't state it was drug related on the phone, but told the emergency personnel when they arrived that she was a heroin user, and they revived her and took her to the ER for monitoring. They also called the police, and they were not the friendliest, but didn't over involve themselves. They questioned swim but she stuck with her story and they acted like they couldn't do much more than that. After they left, swim fell asleep on her couch. An hour and a half later, there was a bang on the door that woke swim. She went and it was the police, he looked at her and condescendingly said, I wanted to make sure you weren't dying or something, and swim was like uhh I'm fine thank you and he left. So in that case she thinks naloxone would have been ideal but she was in no state to comfortably administer it.

In another situation a friend was clearly on the verge of ODing, in and out of consciousness from heroin and morphine, and swim was sober. Her friend wasn't unresponsive but she was fading in and out, couldn't remember anything or hold her body up. Swim gave naloxone, no effect, gave a second and friend snapped out of it. She monitored her for a few hours and friend was drowsy but fine from then on.

So all in all it is a great tool, but again if one is not sober, not comfortable with the situation, or is concerned of polydrug use or other health conditions- call. Use your judgment. But swim does think naloxone alone can be used in certain situations as long as the people administering it have been trained and have researched this stuff. But that's swim's opinion, of course it is always ideal to err on the side of caution, and discuss this beforehand with using friends.

Thanks for pointing that out Panthers, if anyone has more info I'd love to hear it, and apologies for any misinformation on the legal situation.. And yeah.. such situations are a big part of the reason swim no longer does heroin or allows it in her house or car..

[moda00]

Anyone interested in opioid overdose emergency protocols, there is an interesting thread posted by Paracelsus here on DF detailing a recent study of training users to recognize and treat overdose. The study, as Para points out, had a small sample size, but found that users could be trained to recognize and treat overdose just as effectively or more effectively as paramedics.

I encourage anyone who is in a situation where drugs are used, or who has family or friends who may use opioids recreationally or medically, to obtain a naloxone prescription and keep it on hand- often needle exchanges and HIV prevention efforts will offer prescriptions, the naloxone itself, and training- swim has gone through this process, her clinic actually has outfitted a big van with needle exchange materials, pamphlets, a TV, etc. and will come to you if needed, you can chill in the van and watch a 45 minute training video and then they demonstrate the equipment (obviously not doing the actual injection, but swim has done it once in an emergency andit isn't hard, you just have to use your judgment on if and when to administer, and if you aren't willing and capable of taking responsibility for someone else's life, you can and should call emergency services.)

Article: http://www.drugs-forum.com/forum/showthread.php?t=56421

[UpAllNiteOCXTC]

a lot of the time a person isnt ODing, but having a panic/anxiety attack. Most drugs like that cause swiys heartrate to increase, therefore causing the user a fair amount of anxiety. THe user thinks they're going to have a heart attack. When really, swim has found that if swiy talks themselves out of it, they will be just fine.

On the contrary, some anxiety attacks are no joke and can be fatal. Swim doesn't feel right giving medical advice here, and advises any swimmer who thinks they're ODing to seek professional attention.

UpAllNiteOCXTC added 2 Minutes and 24 Seconds later...

Also a good idea to keep on hand is benadryl. But TAKE NOTICE some people are allergic to benadryl, or any time of antihistamine, which can cause one's throat to close.

Swim has found that when someone is ODing on opiates (such as oxycontin) and are itching like CRAZY, taking a little benadryl is effective. But not too much, for too many depressants on the CNS can cause the heart to stop.

Synopsis: Swiy is taking a risk every time a drug is used. The question is, whether it is a HIGH or LOW risk.

[moda00]

Originally Posted by UpAllNiteOCXTC

a lot of the time a person isnt ODing, but having a panic/anxiety attack. Most drugs like that cause swiys heartrate to increase, therefore causing the user a fair amount of anxiety. THe user thinks they're going to have a heart attack. When really, swim has found that if swiy talks themselves out of it, they will be just fine.

On the contrary, some anxiety attacks are no joke and can be fatal. Swim doesn't feel right giving medical advice here, and advises any swimmer who thinks they're ODing to seek professional attention.

UpAllNiteOCXTC added 2 Minutes and 24 Seconds later...

Also a good idea to keep on hand is benadryl. But TAKE NOTICE some people are allergic to benadryl, or any time of antihistamine, which can cause one's throat to close.

Swim has found that when someone is ODing on opiates (such as oxycontin) and are itching like CRAZY, taking a little benadryl is effective. But not too much, for too many depressants on the CNS can cause the heart to stop.

Synopsis: Swiy is taking a risk every time a drug is used. The question is, whether it is a HIGH or LOW risk.

An overdose of heroin cause the heart rate and breathing to slow down, which is how people can die from overdoses. If you are referring to cocaine, then yes, the heart rate speeds up, but I think the common wisdom in case of cocaine overdose is to involve emergency services right away as there is no effective "antidote" (the study mentioned is on training users to identify heroin ODs vs. coke or polydrug ODs and respond accordingly, either administering naloxone in heroin ODs, or positioning the person and caring for them until paramedics arrive in the case of cocaine- that was my impression at least, as there is no DIY fix for a coke induced OD)

You refer to using benadryl, which is diphenhydramine for those not in the US, for heroin overdoses. A user overdosing on heroin should never be given any other drug except naloxone, the antagonist, and would likely not be able to swallow a pill. A person in a heroin overdose is a terrifying thing. Yes, someone can have an anxiety attack when doing stimulants. Yes, someone can have adverse or uncomfortable reactions to opioids, such as itching which can be counteracted by an antihistamine. But trying to give a person antihistamines or "talk them down" in the case of a true OD is useless.

An opioid overdose is something you would likely know if you saw, but I am all in favor of training drug users to recognize this as it does seem there are plenty of misconceptions. The first time swim saw an OD her friend fell completely unconscious and unresponsive, very shallow breathing, about a 30 seconds to a minute after injecting. Swim panicked and had to call paramedics even though she had naloxone in her house. Her hands were shaking so hard she couldn't open it, and she was using that day and didn't feel comfortable taking someone else's life in her hands. Time is of the essence in an OD, you can't hesitate, if you find unable or unwilling to act then grab the phone right away! The second time she witnessed an overdose, her friend was fading in and out of consciousness and couldn't walk or remember how to answer simple questions. Swim was sober, had naloxone, and knew she could handle the situation, even though her friend wasn't completely unconscious it was not a safe place to be, and she administered two injections of naloxone, the first of which was ineffective, and the second did the trick. Her friend snapped out of it like magic lol, and asked what happened and thanked her. Swim watched her for a couple hours then had her spend the night at her place to monitor her and she was just fine.

If that helps any, that is what an opioid overdose looks like. It is really important if swiy uses or is around people who use to be able to recognize this.
Some symptoms of a heroin overdose are:
-shallow breathing and/or difficulty breathing
-tongue discoloration
-weak pulse & slowed heart rate (learning basic skills like reading someone's pulse are important if one is to be using heroin or around those who do; learning CPR is ideal but won't revive an overdose in and of itself)
-muscle spasms-
inability to hold head or body upright
-bluish tinge to lips and/or fingernails
-disorientation
-incoherence/delirium
-memory loss
-coma/lack of consciousness

This is not when someone is overly itchy or their eyes are pinned, not necessarily even when someone is on the "nod." Avery simple way to check on someone who is still and has their eyes closed, or is slumping forward, is to address them verbally and ask them a simple question like Are you ok? Do you know where you are? If someone becomes unresponsive, or responds to a question incoherently, this is usually more than just a heroin high, that is a sign of overdose. However, if someone is moving about, itching themselves, and speaking and breathing on their own, they are simply high on heroin (unless they tell you they feel that they are going to lose consciousness or ask you to seek help, in which case listen to them and evaluate the situation carefully!)

I agree with your point that all activities and substances involve some level of risk, it is a matter of determining what is an acceptable level to each individual.

Stay safe out there!!

[UpAllNiteOCXTC]

swim lives in the US...yes diphenhydramine/antihistamine can counteract an allergic reaction...

and yes there is no DIY for cocaine OD..some would say benzo's, but that is messing with the CNS way too much...overstimulating, depressing, these flucuations cant possibly be good.

swim is hesitant on this type of advice