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Field Operations Directives (FODs)

17-002 Deployment of Narcan Nasal Spray (Naloxone) for Suspected Opioid Overdoses


18-001 Housing Non-Discrimination Policy
17-001 Sheriff's Online Reporting and Tracking System (SORTS)

DEPLOYMENT OF NARCAN® NASAL SPRAY (NALOXONE)

FOR SUSPECTED OPIOID OVERDOSES

PURPOSE

The purpose of this Field Operations Directive is to establish uniform procedures for the administering of naloxone, the generic name for “Narcan.”  This directive only applies to the Narcan Nasal Spray product.  The purpose of deploying Narcan Nasal Spray is to equip Department personnel with this essential tool to assist with a medical emergency when an opioid (i.e., Heroin, Fentanyl, Hydrocodone, Oxycodone, etc.) overdose is suspected.

BACKGROUND

According to the Centers for Disease Control and Prevention, “the United States is experiencing an epidemic of drug overdose (poisoning) deaths.  Since 2000, the rate of deaths from drug overdoses has increased 137%, including a 200% increase in the rate of overdose deaths involving opioids.”  Narcan Nasal Spray is an opioid antagonist designed to reverse the respiratory depression caused by an overdose of opioids.

POLICY

The County’s Emergency Medical Services (EMS) Agency oversees emergency medical treatment by personnel throughout the County.  Sheriff’s Department personnel are required to be properly trained in the use of Narcan Nasal Spray prior to administering it in the course and scope of their duties.  Training on the administration of the nasal spray shall be conducted by a current Narcan certified instructor trained in teaching the administration of Narcan Nasal Spray.

PROCEDURES

Narcan Nasal Spray can be obtained from the station/unit’s training coordinator.  Stations/units shall develop a process for ensuring personnel from their station/unit obtain training and are issued the nasal spray.  Each Department member shall ensure they have access to their Department-issued Narcan Nasal Spray during their work shifts and should regularly check to ensure their issued Narcan Nasal Spray has not expired.  An expired nasal spray shall be replaced with unexpired Narcan Nasal Spray.  It is recommended Department members keep their issued Narcan Nasal Spray stored with their Department-issued Cardiopulmonary Resuscitation (CPR)/First Aid kits.  Care should be taken to ensure the applicators are not exposed to excessive heat or light to protect the potency of the nasal spray.  Narcan Nasal Spray has a shelf life of approximately three years.

The Administration of Narcan Nasal Spray

Prior to deploying Narcan Nasal Spray, field personnel must first ensure the scene is secure and free of hazards for themselves, other first responders, and for bystanders in the immediate area.  Scene assessment should include, but is not limited to:

  • Presence or potential of any outstanding suspects in the area;           

  • Weapons or dangerous objects;

  • Containment of a crime scene as necessary;

  • Traffic hazards;

  • Fire, chemical, or electrical hazards; and

  • Environmental hazards.

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Once the scene is determined safe, personnel shall ensure fire/paramedic personnel have been requested.  While fire/paramedic personnel are responding to the scene, the handling deputy shall do a first assessment of the patient by:

  • Observing if the patient is unconscious or unresponsive;

  • If unconscious, check the patient’s airway, breathing, and pulse;

  • If indicated begin rescue breathing or CPR concurrently with administering Narcan Nasal Spray as described below; and

  • Check for signs of opioid overdose.

The signs of an opioid overdose may include, but are not limited to:

  • Loss of consciousness;

  • Constricted (pinpoint) pupils;

  • Unresponsive to outside verbal or physical stimulus;

  • Awake, but unable to speak;

  • Breathing is very slow and shallow, irregular (respiratory depression), or has stopped (respiratory arrest);

  • Choking sounds, or a snore-like gurgling noise;

  • Vomiting;

  • Body is very limp;

  • Face is very pale or clammy;

  • Fingernails and lips turn blue or purplish black;

  • Pulse (heartbeat) is slow, irregular, or not present; and/or

  • Indications from bystanders or persons who may have witnessed or know that the patient ingested opioids.

If Department personnel suspect the patient is experiencing respiratory depression or is unresponsive due to a suspected opioid overdose, administer Narcan Nasal Spray and begin rescue breathing or CPR if indicated.  If available, personal protective equipment (CPR mask, gloves, face shield, etc.) should be utilized when administering CPR.

Administer Narcan Nasal Spray by doing the following:

  • Gently tilt the person’s head back and make sure the nasal cavity is clear;

  • Hold the Narcan spray by placing your thumb on the bottom of the plunger and your first and middle fingers on either side of the nozzle;

  • Insert the device nozzle into one nostril until your fingers on either side of the nozzle are against the bottom of the patient’s nose;

  • Press the plunger firmly to administer the full dose of Narcan into the nostril;

  • Remove the device from the person’s nostril after administering the dose;

  • Initiate rescue breathing as needed until the person can adequately breathe on their own;

  • Once the patient is adequately breathing, you may need to move the patient on their side to prevent aspiration; and

  • Continue constant observation until fire/paramedic personnel arrive.

The Narcan Nasal Spray may take a few minutes for the patient’s body to absorb and react to the medication.  If the person does not respond to the nasal spray within three to five minutes, a secondary dose of nasal spray may be required.  Prior to administering a second dose of Narcan Nasal Spray, Department personnel shall ensure fire/paramedic personnel are responding to the scene.  Each nasal spray applicator contains one full dose.

Administering of Narcan Nasal Spray may result in immediate opioid withdrawal in patients who are opioid dependent.  Symptoms of withdrawal may include nausea/vomiting, cardiac arrest, nosebleed or, in rare cases, aggressive behavior.

Narcan Nasal Spray shall be administered to people of any age.  The nasal spray will only work on persons who have overdosed on opioid-related drugs.  The nasal spray does not have any significant side effects if the cause of unconsciousness is not opioid-related.

Sheriff’s Department personnel shall defer the authority for medical treatment and transportation to paramedic and ambulance personnel once they arrive on-scene.

State law exempts properly trained Department personnel from liability when administering Narcan Nasal Spray during the course and scope of their duties.  

Department personnel should ensure the used Narcan Nasal Spray device is properly disposed of by surrendering it to on-scene fire/paramedic/ambulance personnel, or by placing it in the station’s public contraband mailbox or other suitable secure disposal container.

Reporting an Incident

After Narcan Nasal Spray has been administered to a patient, whether successful or not, Department personnel shall:

  • Verbally advise fire/paramedic personnel what time Narcan Nasal Spray was administered and any change in the patient’s condition;

  • Enter and submit a Narcan deployment report into the Patrol Division NARCAN Tracking System (PDNATS);

  • In the event PDNATS is down, complete the LASD Narcan Use Report form (SH-R-630) and email the completed form to narcan@lasd.org.  When using the paper form, ALL boxes MUST be completed to allow proper tracking of all deployments.  If a completed form cannot be emailed, send a printed copy to the Department’s Narcan Nasal Spray Program coordinator at the Special Operations Division headquarters; and

  • If necessary, such as in cases of death, attempted suicide, suspect in a crime, reportable force used, etc., complete an Incident Report (SH-AD-49) or appropriate documentation in addition to the Narcan Use Report form.

 

Additional Information

Narcan Nasal Spray can be purchased from a pharmacy without a prescription by family, friends, or anyone in a position to assist a person suffering from an opioid overdose.

In addition, Narcan Nasal Spray can be used on Department personnel who come in contact with an opioid-related drug in the course and scope of their duties and suffer the effects of an overdose while awaiting paramedics/fire to respond. 

SEB/ESD was consulted for the content of this Field Operations Directive.  Questions regarding the content of this Field Operations Directive may be directed to Special Enforcement Bureau’s Emergency Services Detail, Narcan Group at narcan@lasd.org or Field Operations Support Services at (323) 890-5411 or FOSS@lasd.org.

 

Attachments

LASD NARCAN Use Report form SH-R-630

References

County of Los Angeles Department of Public Health, Health Officer Standing Order

NARCAN Nasal Spray Quick Start Guide

NARCAN website (www.narcan.com)