A rapt audience of physicians, medical students, and administrative staff sat quietly in a lecture hall at the Hospital of the University of Pennsylvania as Dr. Bonnie Milas, hobbled by knee surgery and walking with crutches, gingerly maneuvered her way to the podium.
Milas, a cardiac anesthesiologist, was there to give a talk on Narcan rescue training and to help distribute 450 Narcan nasal spray cartridges, a front line defense in the public health battle to reduce overdose deaths.
“If you get there even a few minutes too late, it may be over and done,” says Milas.
Milas has a uniquely personal — and tragic – stake in the ongoing struggle to contain opioid addiction, overdoses and death. In January 2018, her youngest son Robert, an ebullient young man who had been working toward a career in engineering, died of a Fentanyl overdose at the age of 27 after years of treatment. Then in March 2019, in an unimaginably cruel second blow to the family, Milas’s eldest son Lee, a physician, also died of a drug overdose. The pain of that loss is yet so sharp that Milas can’t bring herself to talk about him.
It has become a mission for Milas to deepen public understanding of the life- saving potential of naloxone, sold under the brand Narcan, rescue breathing and CPR. She always carries Narcan and once assisted a police officer attempting to revive an overdose victim by the side of the road.
Milas’s headline message is that about 50 percent of overdose deaths occur in the home, with the remainder in public spaces. That means family members should seek out training so that they can quickly swing into action.
“It is not ideal to take rescue instructions from the 911 dispatcher over the phone,” she says.
The time pressures attendant to a rescue are crushing. The average time it takes for EMS to arrive on site is 7 minutes; that doubles to 14 minutes in rural areas.
Meanwhile Narcan, which blocks opioids from the brain’s opioid receptors, takes two to three minutes to work and may require repeated doses.
The time pressures attendant to a rescue are crushing. The average time it takes for EMS to arrive on site is 7 minutes; that doubles to 14 minutes in rural areas.
Meanwhile Narcan, which blocks opioids from the brain’s opioid receptors, takes two to three minutes to work and may require repeated doses.
Opioids suppress the respiratory system and overdose victims typically stop breathing. Soon enough, the heart stops. Without oxygen, the brain cells start dying after six minutes.
No matter how quickly EMS responders arrive on the scene, it can be fatal to wait. After calling 911, Narcan must be administered immediately by inserting the cartridge into the victims’ nostrils and depressing the plunger.
In family settings, where the victim’s history of drug use is known, it is likely a foregone conclusion the victim has overdosed.
In cases involving strangers, Milas advises to look for telltale signs of drug use: drug paraphernalia at the scene, very slow or no breathing, blue lips, pin-point pupils. Administering Narcan has no harmful side effects and giving it to an unconscious person not suffering from a drug overdose will do no harm, Milas says.
If, after administering Narcan the victim is not breathing effectively, Milas advises that responders institute rescue breathing, tilting the victim’s head back, pinching the victim’s nose and then breathing into the victim’s mouth with breaths spaced five to six seconds apart.
If the victim has no pulse – check the carotid artery in the neck — Milas says responders should institute CPR, delivering 30 rapid succession chest compressions followed by two quick breaths, followed by further chest compressions. Milas demonstrated proper use of protective gloves and facemasks, which were also provided to the audience.
Milas advises rescuers to stay close to overdose victims but not to hover. The impact of Narcan can mimic opioid withdrawal symptoms and victims, when they revive, may be agitated or in a panic. She pointed out that after being revived, the goal is to assist the individual to accept recovery. She says anyone in need of Narcan training or the medication can obtain this through local public health departments, including the city of Philadelphia.