First Responders

An opioid overdose occurs when someone has opioids in their system. Opioids include heroin, synthetic opioids such as fentanyl, and pain relievers that are available legally by prescription.
In an overdose, a person’s breathing can be dangerously slow or stop completely, resulting in the brain not getting enough oxygen. This can happen in as little as minutes or even hours and results in brain damage or death.

Signs of an opioid overdose:

• Small, constricted “pinpoint pupils”
• Falling asleep or loss of consciousness
• Slow, shallow breathing
• Choking or gurgling sounds
• Limp body
  Pale, blue, or cold skin

What can cause an overdose?

• Using opioids after your tolerance has decreased
• Using unregulated opioids – the strength can vary
• Mixing opioids with benzos, alcohol, other opioids, methamphetamine or cocaine
• Using opioid pain medications more often or at a higher dose than prescribed
• Using someone else’s opioid pain medication
• People who have overdosed in the past are more likely to overdose again

When an opioid overdose is detected, the next step is to administer Naloxone.

Naloxone

Naloxone is a safe medication that rapidly reverses an opioid overdose. It has been used for over 40 years in emergency medicine. Naloxone can quickly restore normal breathing to a person if their breathing has slowed or stopped because of an opioid overdose. It can quickly wake someone up in just a few minutes.

Naloxone has no effect on someone who does not have opioids in their system, and there are no known side effects (e.g., no allergic reactions, no potential for abuse). It is not a controlled substance nor is it a treatment for opioid use disorder.

First Responders can complete a form to join Project FREEDOM and sign up for training to receive Free Naloxone for First Responders. 

Administering Naloxone

HOW TO GIVE NALOXONE NASAL SPRAY:

• Call 911.
• Lay the person down, tilt their head back, and put one hand under their neck.
• Insert the nasal spray in one of their nostrils with your other hand.
• Push the plunger on the device with your thumb to administer the nasal spray.

If the person is not breathing…

• Use personal protective equipment (i.e., gloves, breath barrier device) if you have them available.
• Roll the person onto their back.
• Seal your mouth over theirs and breathe in 1 breath every 5 seconds. Their chest should rise, not their stomach.
• Give another dose of naloxone if there is no response after 2–3 minutes and continue to watch them.

First Responders can access these steps and other information on opioids, overdose, treatment and help lines, by downloading the app Connect Alabama.

SAMHSA’s 5 Essential Steps for First Responders

1. Evaluate for Signs of Opioid Overdose. Using the below signs, identify if the patient may be experiencing an opioid overdose.
2. Call 911 for Help. If no emergency medical services (EMS) or other trained personnel is on the scene, call 911 immediately.
3. Administer Naloxone. Naloxone should be administered to anyone who is showing signs of an opioid overdose. Read more about how to administer in the section below and sign up for the free training offered by Project FREEDOM.
4. Support the Person’s Breathing. Ventilatory support is an important intervention and may be lifesaving on its own.
5. Monitor the Person’s Reponses. A person must be monitored for at least 4 hours after receiving naloxone. Naloxone’s effects are short, so overdose symptoms may return.

One Mind Campaign

The One Mind Campaign from the International Association of Chiefs of Police (IACP) enhances relationships between police officers, the communities they serve, and those they interact with who have a mental health condition. The campaign challenges police departments to have:

• At least 20% of their officers trained in Crisis Intervention Team (CIT) or similar 40-hour crisis training
• The remaining 80% of officers trained in Mental Health First AID (MHFA)
• A working relationship with the department’s mental health provider
• A policy around officer’s response to individuals with mental health conditions

IACP has also developed a comprehensive resource entitled Responding to Persons Experiencing a Mental Health Crisis. 

Mental Health First Aid

Mental Health First Aid (MHFA) for Public Safety is a 7-hour course that teaches participants:

• How to identify initial signs of a mental health or substance use issue
• Initial steps to respond and provide assistance to individuals in need of support
• Providing a vital link to professional help
• The importance of first responder wellness and well-being

MHFA is an evidence-based training by the National Council for Mental Well-Being, and includes discussions of national, state-wide, and local mental health and substance use resources. Learn more about MHFA here.

Crisis Intervention Team

The Crisis Intervention Team (CIT) program is a community-based initiative that aims to improve the way law enforcement officers handle encounters with individuals experiencing a mental health crisis. The program involves building a network of relationships between law enforcement, mental health providers, peers, family, and advocates to create a robust crisis system. The ultimate goal is to establish a supportive role for law enforcement in the mental health system by connecting individuals to community resources, reducing injuries and trauma, and diverting them from the criminal justice system. The successful implementation of the program requires effective collaboration among all stakeholders to produce a community-wide response.

The Crisis Intervention Team (CIT) Model is a solution-focused community response to helping people in a mental health crisis. CIT programs bring stakeholders together from law enforcement, behavioral health, and advocacy sectors, along with people with lived experience with mental illness, to develop solutions for safely re-directing people in crisis away from the judicial system and into the health care system whenever appropriate. CIT prides itself on treating individuals with dignity and respect while reducing the stigma of mental illness. Learn more about how Alabama is expanding CIT and ways to bring CIT to your community here.

Secondary Trauma is a type of trauma that is caused by indirectly experiencing a traumatic event. Secondary Trauma results from caring for, hearing about, or witnessing the intense suffering of others. Over time, the cumulative effect can result in an internalization of trauma, leading to compassion fatigue or burnout.

Secondary Trauma Symptoms and Effects

• Physical Rapid pulse/breathing, headaches, impaired immune response, fatigue, depression
• Psychological Feelings of powerlessness, numbness, anxiety, fearfulness, disillusionment
• Behavioral Irritability, sleep/appetite changes, isolation from friends/family, substance abuse
• Spiritual Loss of purpose, questioning meaning of life, feeling useless
• Cognitive Cynicism, pessimism, hopelessness, preoccupation with work, traumatic image
• Relational Inability to connect/aloneness, withdraw, mistrust, lack of interest in sex, lack of close friends

Coping with Secondary Trauma

• Have a recognition and awareness of the symptoms of compassion fatigue in yourself.
• Restore a healthy balance in your life, including good sleep, good nutrition and exercise.
• Get medical treatments for those symptoms that are interfering with your daily functioning
• Utilize your positive supportive connections with others to process your feelings.
• Implement regular mini escapes in your life, like recreation, creative therapies or other healthy outlets
• Don’t medicate yourself with drugs or alcohol
• Don’t use other self-defeating addictions! Get professional help for yourself if needed to get back on track.

Compassion Fatigue Training

This free online training course informs fire and emergency medical services (EMS) personnel about their increased risk of experiencing mental health and substance use issues and conditions. It also equips them with information and resources to address these issues in themselves or their peers.

Compassion Fatigue/Burnout Training for public safety officers

Compassion Fatigue/Burnout Training for fire and EMS workers