A pilot program will let La Crosse first responders administer naloxone as an antidote for heroin overdose.
LA CROSSE, Wis. – Firefighter Jim Hillcoat knows the signs: slow, shallow breathing, shrunken pupils, weak pulse. Occasionally, even a needle nearby. A drug overdose — and it’s becoming more common as heroin has infested this college town along the Mississippi.
But on a call with the fire department here, Hillcoat can’t give the antidote he’s sure will help: naloxone.
The drug, also known as Narcan, can quickly reverse the effects of an overdose, bringing a person from unconscious to complaining in a matter of minutes. Paramedics can, and increasingly have, used the drug. But timing is crucial, and paramedics are often not first to a scene. Officials here believe that by putting naloxone in the hands of firefighters — and perhaps police officers — they can save lives.
“Whether it’s a minute or five minutes earlier, it helps,” Hillcoat said. “The sooner you can give the antidote, the better.”
It’s been done in New York and Massachusetts, where cities have since reported decreases in overdose deaths. In Wisconsin, the La Crosse Fire Department is first in line for a yearlong pilot program to train firefighters to use naloxone. Minnesota officials are watching. Sen. Chris Eaton, DFL-Brooklyn Center, has been working with two state agencies to draft a bill that would make the drug more widely available.
In recent years, cities nationwide have been grappling with growing abuse of heroin and prescription opiates, including painkillers such as Vicodin and OxyContin. Bolstered by a key study earlier this year, experts believe that naloxone could be one inexpensive way to cut the death toll.
“This is a lifesaving measure, and having it where it’s needed is a definite plus,” said Dave Hartford, an assistant commissioner in the Minnesota Department of Human Services. Naloxone is nonaddictive, easy to administer and has few side effects, so “there isn’t much of a downside to it,” he added.
But how much training a person should have in order to administer the drug is still up for debate.
‘Pounding on the door’
Every La Crosse agency seems to have a chart. On a recent afternoon, it took Fire Chief Gregg Cleveland just seconds to pluck his from the papers on his sun-drenched desk. A thick blue line shows a dramatic climb in the number of overdose incidents. In 2012, there were 98 — a 53.1 percent increase since 2009.
So far this year, his firefighters have responded to 86 overdoses, a number highlighted in red.
“We have an overdose issue in the city,” said Cleveland, whose family snapshots sit below black-and-white photographs of mustachioed men who fought fires in the 1890s.
He has been eager to apply for a state pilot program that would allow his force, some of whom are trained as paramedics, to carry naloxone. Starting this week, he’ll be able to: The application goes live Friday. “We’ve been pounding on the door,” Cleveland said.
The pilot, set to start Jan. 1, will train and test basic EMTs, then track how often they use naloxone. If the program shows the drug is needed, the Wisconsin Emergency Medical Services Unit could expand the technicians’ official “scope of practice” to include administering the drug, said Frederick Hornby, a paramedic and the unit’s education coordinator.
National guidelines for basic EMTs, who have less medical training than paramedics, don’t include naloxone, Hornby said. “Wisconsin is going above and beyond.”
Proposed state legislation would go even further, allowing police officers and others to use the drug.
Paramedics with Tri-State Ambulance — which serves 2,200 square miles in Minnesota, Wisconsin and a small slice of Iowa — have carried the antidote for decades. But they’ve never used it more. Their chart shows paramedics being on track to give naloxone 195 times this year, compared to 124 times in 2010. Three-fourths of those uses were for heroin overdoses, Tri-State estimates.
Paramedic Nick Eastman regularly unzips a yellow bag, grabs a vial of naloxone and injects the drug either into an IV or the arm of a patient. Recently, he treated three overdoses in a single shift.