This section is a work in progress but is intended to provide leaders and organizations with considerations and recommendations for emergency planning, prevention and risk mitigation.

 

In the event of suspected overdose account for and assess all members of the community in school and congregate living environments.

Implement a universal expectation to treat any potential overdose in a community living or school setting as a catalyst for immediate and emergent roll call/face-to-face assessment of every community member or student. This will almost certainly save lives. Young people rarely drink/drug alone.

 

This strategy may be met with resistance as there is an understandable tendency to want to contain emergency situations and minimize potential disruption. However, urgent and real-tim accountability and assessment for every community member can and will save lives threatened by fentanyl exposure. This includes locating, and even waking students/community members in community living settings to ensure responsiveness and thoroughly assess.

 

There are staffing design, leadership and training considerations/implications that may need to be re-evaluated in order to accomplish this. Mandated minimum standards for onsite supervision may be necessary.

 

A significant level of leadership competence, training and experience is required to accomplish this level of responsiveness in an emergency during all hours of operation. Re-evaluation of resources may be indicated in any environment where there is high turnover or low paid, entry level workers are solely responsible for oversite of certain operations, facilities, timeframes or groups.

 

Establish a protocol to rapidly deploy Narcan and support to an area in the event of a multiple overdoses. 

Multiple doses of Narcan may be required in cases where there is potential Fentanyl exposure. The possibility of multiple, simultaneous emergent cases requiring multiple doses must be considered. Again, young adults rarely drink/drug alone. Ensuring that this information is ingrained in schools and community living environments is critical for two primary reasons.

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• 1st, all stake holders must know that if the first dose doesn’t work within 2 minutes, try another, up to three. 2nd, In order to accomplish this, multiple doses of Narcan must be close at hand… there is only a short window where it can help… brain damage and death happens quickly when there is no breathing.

 

• Further… School, sites, campuses and community living settings have to be ready to manage both CPR and Narcan protocols, silmultaneously, in an emergent situation. This scenario is being covered in training only in the most cursory ways, if at all, and it becomes exponentially more challenging if there is more than one person in crisis.

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Ensure that CPR/plan for rescue breathing is inexorable from opioid response training; ensure CPR masks are available and housed with Narcan.

Much of the guidance published regarding Narcan protocols fails to mention CPR at all. In many cases, it even includes steps that end with placing the victim on their sides and waiting for first responders to arrive. This protocol assumes the victim is breathing, and the average lay person is unlikely to note the difference in protocol during a crisis without training/guidance.

 

In cases where a victim is not breathing, CPR is always the 1st response including in cases of suspected overdose. This MUST be both repeated and understood. 

 

Appropriate emergency response to a suspected overdose includes:

1. Call 911

2. Assess if the victim is breathing.

3. If the victim is not breathing:

• Immediately begin  CPR with rescue breaths.

• Administer Narcan while continuing CPR

• Continue CPR and administer a second dose of Narcan if the victim has not responded in 2 minutes

• Continue CPR and administer a 3rd dose if the victim has not responded in 2 more minutes

• Continue CPR until emergency responders arrive or the victim becomes responsive. 

4. If the victim is breathing but nonresponsive:

• Administer Narcan

• Place the victim in the rescue position on their side.

• Administer a second dose of Narcan if the victim has not responded in 2 minutes

• Administer a 3rd dose if the victim has not responded in 2 more minutes

• *monitor breathing and begin CPR with rescue breaths if the victim stops breathing at any time

• Stay with the victim until Emergency responders arrive.

      

Role play must be incorporated into training.

Training protocols and materials must note the difference in response dependent on wether or not the victim is breathing. Clarifying this is imperative.

 

Further, as soon as one victim is identified as potentially having overdosed, staff/1st responders must begin assessing all other community members to ensure there are no other victims. In the event that there are additional victims, the protocol above will need to be followed for multiple victims simultaneously.

 

Emergency responders/EMTs rarely arrive in less than 7 minutes, and in some locations response times are far greater. Crystal clear protocols, intensive training for all members of the community, re-evaluation of real-time Narcan accessibility and mandated minimum expectations for staffing levels and onsite leadership in schools, sites, campuses and community living settings will save lives.

 

Yet in some environments and organizations, responsibility for conceiving, developing, implementing and overseeing these responsive measures are siloed and left entirely to the devices of site leaders. There is no standardization; resources and time are not dedicated for this purpose, and predictably, sites and communities are left woefully underprepared. This troubling dynamic is even more prevalent when applied to preventative measures.

Role play and consistent training and practice exercises are needed to fully prepare staff for these scenarios. Standardization and assessment of training effectiveness is required.

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The scope of the problem must be met by a proportionate response. Currently there is NO standard of resonse or prevention.

Ease of distribution is perhaps the greatest driver in the rise of fentanyl in the US. It is powerful and profitable in tiny amounts. It is easy to transport and easy to hide. Through both accidental cross contamination with other drugs during packaging, deliberate manufacturing and dishonest marketing, many users are exposed to fentanyl without their knowledge or consent.

 

Fueled by these realities, opioid overdoses have surpassed all other causes of death for Americans aged 18-45. When the data for 2022 and 2023 is finalized, it’s expected to show opioid overdoses to be the #1 cause of death for people under 30… the vast majority of these deaths are related to fentanyl. Fentanyl is killing more young people than cancer, drunk driving and gun violence.

 

Fentanyl is killing exponentially more young people than those (people under 45) lost to COVID 19. Yet our national response to this crisis barely registers.

 

Policing/ monitoring will not solve this problem. Impactful steps must be taken to educate and inform young people, families and the adults that serve them. Strategies must be implemented to reach hearts and minds and include ongoing, repetitive and consistent exposure to actionable information, and clear messaging.

 

Deep examination of processes that orient and introduce new people to the community are indicated. Proactive messaging, engagement, direct/explicit teaching and other strategies must be implemented early and often.

Yet there remains  little evidence of standardization of such efforts; site, school, campus, organization and community leaders remain siloed and overwhelmed with competing priorities. Even communities that have been directly and repeatedly impacted by this crisis largely resort to bandaid solutions but struggle to embrace or even attempt to develop persistent and sustainable preventative measures.

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Beat Fentanyl's approach is to ACT; Amplify, Clarify and Team Up. Our site is designed in accord with those strategic behaviors and aims to address the critical priorities named below:

1. Resources exist. There are examples of really strong platforms and strategies readily available. Unfortunately, they are not easy to find. Deliberate, intentional and strategic collaboration and information sharing is required. Effective resources and practices must be compiled and amplified to reach all stakeholders. (See our Amplify and Clarify Sections)

2. Resources and real time must be dedicated to school, site and community leaders for the purpose of learning about and understanding this problem and collaborating to solve it. (See our Resources and Team Up Sections)

3. Universal standards must be established for developing and implementing impactful strategies and solutions. These must include minimum expectations/requirements for staffing, training and on-site leadership appropriate to each entity or organization. (Resources and Team Up)

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Join us. Together we CAN Beat Fentanyl.