Narcan is extremely potent. While our LE and EMTs carry IN (nasal) Narcan, our Medical Director actually prefers us to gently titrate IV Narcan while providing airway management and ventilation. His perspective is that 1) that makes life a lot easier for everyone involved, because sometimes those patients "come up swinging", and 2) there's a hope that if even a few per cent of those patients are gently roused by the time they get to the ER, they may be more willing to consider addiction help.

But, funny story on what you said: a call for some teens in a park drinking, one is now unconscious. "We think he's had a heart attack!" Dispatcher: "are you sure, not just black out drunk?" (not a good thing, but still). "No, we can't find a pulse...". Dispatcher starts walking them through phone CPR while dispatching us. A few minutes later, some commotion on the phone. "What's happening?" "We're having a really hard time giving him CPR!" "Why?" "He keeps pushing us away and telling us to leave him alone but you said we cannot stop no matter what!"

And on a more serious note, you can have situations where a patient is (mildly) conscious through CPR. We had a patient who had internal bleeding that we were attempting to stabilize to get to theater. He was able to squeeze his wife's hand when she talked to him through our compressions.

> Narcan is extremely potent. While our LE and EMTs carry IN (nasal) Narcan, our Medical Director actually prefers us to gently titrate IV Narcan while providing airway management and ventilation. His perspective is that 1) that makes life a lot easier for everyone involved, because sometimes those patients "come up swinging", and 2) there's a hope that if even a few per cent of those patients are gently roused by the time they get to the ER, they may be more willing to consider addiction help.

Sorry, can you explain this a bit more? Why would a patient who wakes up more gently be more willing to consider addiction help?

Probably not because it's more gentle in itself. More that the experience isn't immediately "antagonistic" with law enforcement presence, the sudden rush of being brought out of the narcotic stupor (well, respiratory depression), in a often less-than-ideal environment.

To be very real, most people that we get to the ER and they take over bringing up the Narcan until that respiratory drive kicks back in (kinda a sleepy morning wakeup feeling), will still AMA and leave. But some may consider or talk about it a bit. And maybe there's a more positive longer term outcome.

Completely agree about the wisdom of Narcan titration when you are able to do it. If you give them too much they can wake up swinging fists because you just ruined the heroin/fentanyl/whatever high they paid $20 for. And in that moment they won't be especially receptive to platitudes like "Dude, you died and I just brought you back to life."

And then 20 minutes later the Narcan will wear off and they can crash again, and you're back to square one.

That's hilarious about the teens. Teens don't have heart attacks. And you can never count on people having common sense.

I love our dispatchers. They work as hard as we do.