Patient Care

Handling Patient Death with Compassion

Issue 11 and Volume 39.

Readers weigh in on NARCAN, Handling Death & ‘Incarceritis’
This month, a reader recounts his experience with end-of-life care as it relates to the July 2014 article “End-of-Life Care: Are you prepared to care for dying patients?” by Keith Wesley, MD, FACEP and Karen Wesley, NREMT-P.

Debate also rises on about the topic of carrying naloxone as discussed in the August issue article “Armed with Naloxone: The first responders’ ultimate weapon in the war on opioid use?” by Jeffrey M. Goodloe, MD, NRP, FACEP; Michael W. Dailey, MD, FACEP and A.J. Heightman, MPA, EMT-P.

Finally, our Facebook fans share stories and sentiments about patients seeking medical care to avoid jail time as illustrated in the August 2014 article “Incarceritis: When the cuffed bluff the sick stuff” by Steve Berry.

Hospice Help
I’m an EMT-B in Allentown, Pa. When we’re dispatched to take someone from their home to either the in-hospital hospice unit or free standing, I remind my coworker we need to provide care not only to the patient, but to the family.

I did HIV/AIDS and cancer hospice work for seven years, and in that time I learned so much about life and living, but also about death and dying. Many nights after shift we would sit with the family member of a dying patient so they weren’t alone.

We will ask if a family member wants to ride in the crew compartment (not in the back) so the patient can hear a familiar voice. I agree that we need to have more training about talking with the patient about end-of-life care issues and concerns. We all want good outcomes, but as one of my coworkers says, “Sometimes the Creator has another idea.”

A local hospital has a great program called No One Dies Alone, which feels like the opposite side of the healthcare spectrum. Simply sitting with the patients, holding their hand, reading, praying with them or just being present is a great consolation to the family members who can’t be there.
William A. Aull, EMT-B
Via email

Notes on Naloxone
Why are we giving police in these areas Narcan and not glucose? Why do they have the means to save an addict but not a diabetic? I think the priorities are influenced too much by what looks best—are we giving our first responders a fancy medication? Or are we giving sugar to help a diabetic? Which one is more sensational? But which are you more likely to encounter?

Not all patients unconscious from an overdose are suffering from an opioid overdose. Narcan is useless in those cases, and in most cases it’s impossible to tell if the overdose involved an opioid or not.

What do these patients really need? Assisted respirations. As the article points out, the indication for Narcan administration is “opioid-induced respiratory depression or respiratory arrest.” If the Narcan doesn’t work, you’ve now delayed critical ventilation waiting to see if it would work.

Respiratory depression or arrest should be treated first with bag-mask ventilation, regardless of cause. Our communities would be better served and more lives would be saved by training and equipping these non-EMS first responders for proper bag-mask ventilation.

As Rogue Medic is fond of pointing out, these patients are suffering from inadequate respiration, not inadequate naloxonation.
Jacob M.

What other solutions to this problem exist? As long as the drug is still active in the patient’s system, you can assist their respirations for a very long time, whether through intubatation or a bag-valve mask. It doesn’t take long to administer Narcan.
Steve C.

Facebook: Have you ever had a patient with “incarceritis”?

In the interest of informed consent, I make sure the patient knows the police will still be with them at the hospital, and they’ll still be handcuffed and have to go to the police station after being discharged. That appears to be news to some of them, and suddenly they decide they don’t want the hassle. If they want to go, they go. Doesn’t bother me.
Brendan M.

“-itis” implies an acute complaint. I prefer incarcerosis as “-osis” infers a more chronic condition. “Patient states he had chest pain. Upon further questioning, chest pains ended after he was informed he had $12,000 in warrants and would be spending time in county jail.”
Drok F.

Yes, and had one with “sickofcell.” Butch S.

I’m a medic in a high security prison in Argentina, and it’s true that we must do a thorough job, finding or deducting what’s true and what doesn’t reflect the symptoms the patients complains of. Interesting!
Federico L.

I call it P-PISD: pissed pre-incarceration stress disorder. David F.