First Responder Naloxone Grant - PowerPoint Presentation

First Responder Naloxone GrantFY18 Webinar Sarah Ruiz, Program Director Dr. Alex Walley, Medical Director Brittni Reilly, Program Coordinator Monday 9/25/2017 Audio:   1-877-838-7060

Agenda Review of Current Statistics / Trends Naloxone Formulations in the Field Scene Safety in the Fentanyl Era Fatigue and Burnout Data Collection & Contract Management Technical Assistance Resources Q & A

The Opioid Overdose Crisis at a Glance http:// www.mass.gov/eohhs/gov/departments/dph/stop-addiction/current-statistics.html

Impact of IMF Main conclusion: Illicitly Manufactured Fentanyl (IMF) in the heroin market is driving the surge in opioid deaths Findings Here: http ://dx.doi.org/10.15585/mmwr.mm6614a2

Rescues / Deaths Police and Fire naloxone rescues in MA 2010-2017 Massachusetts DPH First Responder Pilot

Withdrawal symptoms after naloxone rescue (2008-2017) Other = confused, disoriented, headache, aches and chills, cold, crying, diarrhea, happy, miserable, uncomfortable

Help-seeking (calling 911 or EMS present) by people reporting rescues with MDPH naloxone

OEND program rescues: 2006-2017 Active use, in treatment, in recovery N=6,511 Non-User (family, friend, staff) N=775 911 called or public safety present 42% 68% Stayed until alert or help arrived 92% 95%

First Responder Experience with Naloxone Formulations First Responder Naloxone Grant Webinar 9/25/2017

Naloxone Formulations in the Field There are a variety of formulations in the field What has your experience been like using the different products?

Scene Safety in the Fentanyl Era First Responder Naloxone Grant Webinar 9/25/2017

In the News: 6/28/2017 7/20/2017

Managing Panic “Fentanyl and its analogs are potent opioid receptor agonists, but the risk of clinically significant exposure to emergency responders is extremely low .” 2017 position paper from the American College of Medical Toxicology (ACMT) and American Academy of Clinical Toxicology (AACT) It is extremely unlikely that fentanyl or carfentanil will cause clinically significant effects from airborne or skin exposure

Guidance Recommended guidance: Fentanyl: Preventing Occupational Exposure to Emergency Responders (CDC- NIOSH) www.cdc.gov/niosh/topics/fentanyl/risk.html Not recommended guidance: Fentanyl: A Briefing Guide (DEA )www.iaclea.org/assets/uploads/pdfs/Fentanyl_BriefingGuide_June2017.pdf

Scene Safety in the Fentanyl Era Risk Assessment In what form are the drugs? Tablet, powder, large volumes? What is the background history of the location where the drugs were found ? What other risk assessment guidelines does your department use? Has your department revised scene safety protocols?

Standard Safe Operating Procedures Do not: E at , drink, smoke, or use the bathroom while working in an area with suspected fentanyl Touch eyes , mouth, and nose after touching any surface potentially contaminated with fentanyl. Field test fentanyl or its analoguesPerform tasks that may aerosolize fentanylUse hand sanitizer, but wash hands with soap and water

Training Responders should know: How to recognize the form and determine the quantity of the suspected fentanyl and other drugs When to use PPE; what PPE is necessary; how to properly put on, use, take off, properly dispose of, and maintain PPE; and the limitations of PPE P otential exposure routes are for fentanyl How to recognize the signs and symptoms of opioid exposureWhen and how to seek medical help

Personal Protection Equipment should follow level of exposure Minimal : Response to a situation where it is suspected that fentanyl may be present but no fentanyl products are visible Example: An EMS response to a suspected fentanyl overdose or law enforcement operation where intelligence indicates fentanyl products are suspected but are not visible on scene Moderate : Response to a situation where small amounts of fentanyl products are visible Example: An EMS response to a suspected fentanyl overdose or law enforcement operation where fentanyl products are suspected and small amounts are visible on scene High : Response to a situation where liquid fentanyl or large amounts of fentanyl products are visible Example: A fentanyl storage or distribution facility, fentanyl milling operation, or fentanyl production laboratory

Working Dogs Working dogs, especially police K-9s performing detection activities, are also at risk of exposure to fentanyl and its analogues. W orking dogs should be removed from an area where suspect synthetic opioids are encountered. If exposed, residual drug powder might remain on the dog’s body; therefore, the proper precautions and procedures mentioned above should be employed by those handling the dog.

Self-Care for First RespondersFirst Responder Naloxone Grant Webinar 9/25/2017

Fatigue and Burnout in the News 6/21/17, Huffington Post 5/31/17, USA today 1/12/17, CBC News

Resources McLean Hospital’s LEADER program Critical Incident Stress Management http:// www.mass.gov/eopss/agencies/dfs/emerg-resp-invest/critical-incident-stress-management-cism.html Internal Stress Units EAP What else is your dept. doing?

Contract Management& Data Collection First Responder Naloxone Grant Webinar 9/25/2017

Contract Management70% of FY18 Grant A ward deposited into EFT account on file in September Remaining 30% will be deposited in November FY18 is FINAL YEAR where existing contracts are able to be amended MDPH will need to re-procure service for FY19 (contingent upon state appropriation) More details anticipated in October

Data Collection What systems of data collection and surveillance is your department using? Feedback on paper-based First Responder Naloxone Report has been mixed Not all departments have department issued phones / laptops Would an electronic system be feasible? Is your department using ODMAP or any other overdose tracking tools?

Resources + Q&AFirst Responder Naloxone Grant Webinar 9/25/2017

Technical Assistance Technical Assistance available here: http:// masstapp.edc.org/first-responder-naloxone-narcan-technical-assistance General Overdose/Narcan Info here: Mass.gov/ narcan  Targeted online training is available to professional first responders:www.getnaloxonenow.org Police Assisted Addiction and Recovery Initiative (PAARI)www.paariusa.org

Questions?For specific questions, you can call / e-mail : Brittni Reilly, Opioid Overdose Prevention Program Coordinator 617-624-5362 / brittni.reilly@state.ma.us