And why haven’t you given Narcan?

Using a pen torch the Doctor calmly checked the pupils of our patient.  Without looking back at us she spoke in both a matter-of-fact way and accusing tone.

“Hmmm, pinpoint pupils.  And why haven’t you given any Narcan*?”

pinpoint pupilsWe all glanced at each other in sudden disbelief.  There were four of us stood there in resuss.  Me, my crew mate and two MRUs (Motorcycle Response Units).  Sweat was pouring from all of us – more so from the MRUs in their leathers – and we were all fighting for breath.  Clothes were disheveled, my shirt buttons were ripped, someone had a fat lip and hair was hanging about our faces.  Bent double with my hands on my knees I threw one hand up, pointing with vagueness toward the sleeping patient.

“Um . . . **puff, pant** . . . we’d . . . **puff** . . . he’d . . . ”

Half an hour earlier and this was quite a different story . . .

We had been called to a “male, collapsed in an off-licence”.  Upon arriving we found our patient curled up in the foetus position blocking the entry and exit to going behind the counter.  He was sucking his thumb peacefully.

“Ah, bless.  Someone’s in a happy place eh”

We chuckled and looked up at the shop owner who shrugged his shoulders.

“He come in ten minute ago.  I think he off his head,”  the shop owner made the drinking sign with his hand,  “he stagger round.  Swear a lot.  Then sit down here.  Then sleep.  I don’t know what do.  I cannot wake him.”

Right then.  This seemed simple enough.  There were four of us, easy egress, simple removal.  Bish, bash, bosh, sorted!   How wrong could we be . . .

First up, response . . . “Hello?  Sir?  Can you hear me?”   Nothing.  Next stage, shake the patient . . . nothing.  Next up, pain response . . .

No sooner had we squeezed their shoulder then all hell broke loose.  With lightening speed and a wail like a psycho banshee our patient leaped on all of us.

What followed next was not so much a controlled fighting retreat as more a technical rout.  Within seconds we had spilled out into the street and were desperately fighting for a) control of our patient and b) our lives!  He was rabid with super human strength, completely void of any reasoning or logic and seemed hell bent on causing as much mayhem and destruction as humanly possible.

What followed next was not so much a controlled fighting retreat as more a technical routAll five of us were rolling about the road ducking and diving under his swinging punches, kicks, scratches, grabs, biting, spitting, head-butting, kneeing, screaming, elbowing.  He seemed to have hold of us all in some form or another and it was all we could do to just refrain from being torn apart.

And all this, right in front of a trendy Shoreditch bar – much to the amusement of the patrons.   Great.

At one point our patient simply went back to sleep giving us our first breather . . . and a chance to actually call for help.  Sadly, the Police were just “too busy” to attend, meaning – we were on our own.

So, rallying somewhat, we quickly gathered up our patient and threw him on the back of the Ambulance and shut the door.  Catching our breath we decided to do some checks and attempt to see what was going on . . . however, our patient had different ideas on that.

With a new found strength and burst of superhuman speed he leaped up from the bed and launched himself at the furthest person . . . me!  Screaming like a child I collapsed under his full weight to the back of the Ambulance.   All I could see were the patient’s teeth gnashing at my face and neck.  Oh my god, I thought, is this finally the Zombie holocaust?!  Is this how it ends?

With desperate primeval fighting and the thankful help of the others I managed to worm my way out from underneath him and jump to “safety”.  This left our patient to wrap himself tightly round the bottom of the trolley bed, gnawing on one of the wheels like a dog on a bone.  He was now “asleep” again.

This time we were able to throw him on the bed and lock him down deciding this time to just go!  En route he struggled a couple of times but we managed to stay in control.  And by the time we arrived and handed over at resuss he appeared to be remaining in a calmer sleepy state.

So, knackered and disheveled we all stood about whilst the Doctor did the checks we couldn’t.

“Hmmm, pinpoint pupils.  And why haven’t you given any Narcan*?”

“Um . . . **puff, pant** . . . we’d . . . **puff** . . . he’d . . . ”

The Doctor ignored us.  Her question was merely rhetorical and meant as nothing more than a metaphorical slap to our faces.  She looked up at her pack of waiting nurses and calmly spat some orders.

“I/V access please.  Lets start with 800mcg Nalaxone, titrated.  And a full set of obs, thank you.”  She turned to us now, theatrically placing her stethoscope over her shoulders, “It appears he’s overdosed on some form of Opiate.  Narcan should have been your first choice of action should it not?  Never mind, we’ll take it from here.  Thank you.”

We all glanced quickly at each other before rolling our eyes.  Doctors never seem to understand what happens in the pre hospital environment.

I coughed up a lung and burst out my final decree, “Coffee!”

The others agreed and we all left to get ourselves some refreshment.

Binder

*Narcan – the old word for Nalaxone, which is the first line treatment to reversing the effects of Opiate use.  Can bring an overdosing Heroin patient back to the land of living in a second . . . and because they’re no longer in their “happy place”, they often start swinging!

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11 thoughts on “And why haven’t you given Narcan?

  1. Hi buddy, based on the doctors recommendation. Had you been able to administer the Nalaxone in one of the more relaxed moments of the patient’s off licence escapade, would that have prevented the ongoing unpredictability of their behaviour?

    • Yes. Yes it would . . . in much the same way that if all the inhabitants of Hiroshima and Nagasaki had looked up in time then they would have been able to take cover and not lost their lives

  2. I think doctors should do a few shifts on a front line vehicle, they might not be up their own backsides and appreciate how perilous it can be out there, especially with opiate use and alcohol ! As long as they are breathing adequately let em sleep I say, so much safer for all concerned !!

  3. Bah, I hate it when they won’t listen to handover.
    And no way am I giving a patient narcan unless I have to. I have better things to be doing than putting up with that withdrawel if I don’t have to. An asleep patient is a compliant patient, a drug user who has just had their high taken is NOT a compliant patient.

    • Agreed. I mean, the patient would have paid (in their mind) good money for that high . . . I reckon it’s common courtesy to allow them the benefits from that purchase and only intervene when you have to

  4. Bloody arrogant doctors they need to get their heads out of there as*es they really annoy me they would never be able to do your job

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