Narcan

[roundout]

Only on Spirit….



I’m all for preventative measures to emergencies (which is why I have a pretty robust trauma first aid kit and tourniquets in my cars) but damn. Like where is somebody doing enough opioids in a plane to get to the requirement for Narcan, and if they are wandering through the airport in that condition how the F are they boarding?


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This actually happened to me. College kid going from AUS to DEN. There happened to be an EMT and a nurse on the plane, and the plane we were in happened to have Narcan. Most of ours didn’t carry it at the time.

The medical people said if we hadn’t had Narcan he probably would have died. Guess it was his lucky day.

 

[BobDDuck]

I just looked in our OnBoard Manual. We have Narcan onboard. Is it controversial?

I think a certain political bent have voiced displeasure about communities spending money on something that helps "druggies" who have done this to themselves.

 

[CFI A&P]

Wait... there's politics around narcan availability?

The Biden-Harris Administration Takes Critical Action to Make Naloxone More Accessible and Prevent Fatal Overdoses from Opioids Like Fentanyl

FDA approved the first nonprescription, “over-the-counter” naloxone nasal spray, Narcan

www.hhs.gov

Since a politician's name is attached to the article, someone somewhere will take issue with it because ________ .

I have a medic / FF neighbor that is just about the gloomiest person on Earth. "Hey Steve, how was shift?" "Better than last shift, only used 7 doses of Narcan this time."

 

[derg]

I think a certain political bent have voiced displeasure about communities spending money on something that helps "druggies" who have done this to themselves.

Oh, joy.

"Where's the insulin?!"

"Oh, some dude on a news-opinion show said that Type-2 Diabetes on a corpulent person has GOT to be from overindulgence, which is a sin, so there was this boycott of the airline until we got rid of it"

Having someone die on your airplane from a situation which could have been preventable is a monkey I don't want to carry around for any circumstance.

 

[JordanD]

"Where's the insulin?!"

It's funny when people try to deflect like that and you agree with them. "Oh, did you think I was arguing in good faith?"

 

[derg]

It's funny when people try to deflect like that and you agree with them. "Oh, did you think I was arguing in good faith?"

Tater tots and players!

 

[JordanD]

Tater tots and players!

It's always big "Mitch McConnell trying to call a bluff then ending up filbustering his own bill" vibes.

 

[Autothrust Blue]

To be fair....

You'd probably still have to divert. It's an uptake inhibitor, so after it wears off (which happens pretty quickly), if the subject had enough drugs in their system they could overdose again.

The only thing that makes me pause about carrying it (not like it's even up to me) is what happens after someone is Narcan'd, though I'd assume that in the event of an OD we're going to find ourselves diverting anyway, so, whatever.

Medical decision support wins the day, etc.

 

[Autothrust Blue]

I think a certain political bent have voiced displeasure about communities spending money on something that helps "druggies" who have done this to themselves.

I think it'd be great to reduce/prevent opioid addictions in the first place, which shouldn't be controversial.

But since it apparently is, I can embrace harm reduction.

 

[derg]

The only thing that makes me pause about carrying it (not like it's even up to me) is what happens after someone is Narcan'd, though I'd assume that in the event of an OD we're going to find ourselves diverting anyway, so, whatever.

Medical decision support wins the day, etc.

Oh, something to add into your brief when you upgrade or even ask the captain about is having the cabin let the cockpit know before hitting 'send' on medlink. Because if something is declared a 'medical' while you're on break and you go into 'mandatory procedures we have during a potential medical emergency', you might find yourself taking an extended break.

 

[drunkenbeagle]

I think it'd be great to reduce/prevent opioid addictions in the first place, which shouldn't be controversial.

But since it apparently is, I can embrace harm reduction.

Unfortunately, I know of exactly zero plausible ways for how we would do that.

Until we figure that out, Narcan probably needs to become standard in first aid kits. Since the opioids are already ubiquitous.

 

[derg]

Unfortunately, I know of exactly zero plausible ways for how we would do that.

Until we figure that out, Narcan probably needs to become standard in first aid kits. Since the opioids are already ubiquitous.

Especially long haul flying. I think I aaaaaaaalmost had a leg when the purser DIDN'T call the flight deck and say "We've got someone whacked out on muscle relaxers and a 750ml bottle of vodka appeared out of nowhere so we might have an issue"

 

[Lawman]

Especially long haul flying. I think I aaaaaaaalmost had a leg when the purser DIDN'T call the flight deck and say "We've got someone whacked out on muscle relaxers and a 750ml bottle of vodka appeared out of nowhere so we might have an issue"

Narcan is only a 30-60 minute solution to a very immediate problem.

It’s not a cure-all to an overdose. It’s a stabilizing capability to where urgent transport and care can be administered.

I think this is more my issue with Narcan, people think it’s just an instant fix to a serious problem, and like he said that problem is what the hell causes a person to take enough opioid to do what Narcan is there to prevent.


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[derg]

Narcan is only a 30-60 minute solution to a very immediate problem.

It’s not a cure-all to an overdose. It’s a stabilizing capability to where urgent transport and care can be administered.

I think this is more my issue with Narcan, people think it’s just an instant fix to a serious problem, and like he said that problem is what the hell causes a person to take enough opioid to do what Narcan is there to prevent.


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I literally have no idea or opinion.

Basically, something happens in the back of the aircraft, the lead/purser starts running the procedure, someone calls me after it's already started, then places a phone call on the SAT or IP phone (acutally they have an App now), then depending on their conversation (On-staff Physician, Purser, onboard medical professional, dispatch and hopefullly the flight deck [more on this on Zoom as I have a funny story about this from last week when Kristie said something on the bus about a Medical event and all us pilots (including myself) said "Le WOT?!"),
dispatch says everything from nothing to "We need you to divert to Cold Bay, here's the performance data" but we're not given anything other than "looks good to continue" or "set up for Gander".

Odd story about that which doesn't involve liability but a good reason it's best handled through dispatch and MedLink is a story about one flight crew that had a cardiac arrest onboard, they got the passenger stabilized and flight control had notified the flight deck to divert to Gander (I'm probably going to screw up the airports) but they were over Goose Bay so the captain landed at the closest becaus "it's an emergency and I'm the captain".

Well, Goose bay is, at best 90 mins from a medical facility whereas if they went a bit further to Gander, it literally has a Hospital AT the airport.

Lets just say some attorneys got some "billable minutes"


(*Again, the airports are probably off)

 

[SurferLucas]

I literally have no idea or opinion.

Basically, something happens in the back of the aircraft, the lead/purser starts running the procedure, someone calls me after it's already started, then places a phone call on the SAT or IP phone (acutally they have an App now), then depending on their conversation (On-staff Physician, Purser, onboard medical professional, dispatch and hopefullly the flight deck [more on this on Zoom as I have a funny story about this from last week when Kristie said something on the bus about a Medical event and all us pilots (including myself) said "Le WOT?!"),
dispatch says everything from nothing to "We need you to divert to Cold Bay, here's the performance data" but we're not given anything other than "looks good to continue" or "set up for Gander".

Odd story about that which doesn't involve liability but a good reason it's best handled through dispatch and MedLink is a story about one flight crew that had a cardiac arrest onboard, they got the passenger stabilized and flight control had notified the flight deck to divert to Gander (I'm probably going to screw up the airports) but they were over Goose Bay so the captain landed at the closest becaus "it's an emergency and I'm the captain".

Well, Goose bay is, at best 90 mins from a medical facility whereas if they went a bit further to Gander, it literally has a Hospital AT the airport.

Lets just say some attorneys got some "billable minutes"


(*Again, the airports are probably off)

Oh do I have a fresh story about senior FA’s, and not doing the correct procedure…and a very frustrated Capt that was playing gopher for 20+ mins

 

[Autothrust Blue]

Oh, something to add into your brief when you upgrade or even ask the captain about is having the cabin let the cockpit know before hitting 'send' on medlink. Because if something is declared a 'medical' while you're on break and you go into 'mandatory procedures we have during a potential medical emergency', you might find yourself taking an extended break.

One of the nice things about the extra trip I got (I only needed 21 minutes, ffs…) was getting to talk about this, and other things, for an extended period. I’m not a fan of the new pilot out of the comm loop Medlink thing, even though Medlink is a great service by itself. “• ACARS” “huh, I guess there’s a medical?”

Would you believe SkyWest has (or had, when I worked there—it’s possible they fixed this) no en route medical decision support? “Act at discretion” is not what pilots should be told on these things.

Also, you’re substantially accurate on that story above. *smacks forehead* it’s in at least one or two of the 400-series briefing decks as “what not to do.”

 

[Autothrust Blue]

Unfortunately, I know of exactly zero plausible ways for how we would do that.

Until we figure that out, Narcan probably needs to become standard in first aid kits. Since the opioids are already ubiquitous.

Opioid and other deaths are often called “deaths of (from) despair,” which is what I’m generally getting at fixing. You know, that whole “just, verdant, equitable and humane world” thing I’m always on about well beyond the scope of what goes in the EEMK.

And yeah, also what @Lawman said too. 60 minutes, “then what” is a question.

 

[Lawman]

I literally have no idea or opinion.

Basically, something happens in the back of the aircraft, the lead/purser starts running the procedure, someone calls me after it's already started, then places a phone call on the SAT or IP phone (acutally they have an App now), then depending on their conversation (On-staff Physician, Purser, onboard medical professional, dispatch and hopefullly the flight deck [more on this on Zoom as I have a funny story about this from last week when Kristie said something on the bus about a Medical event and all us pilots (including myself) said "Le WOT?!"),
dispatch says everything from nothing to "We need you to divert to Cold Bay, here's the performance data" but we're not given anything other than "looks good to continue" or "set up for Gander".

Odd story about that which doesn't involve liability but a good reason it's best handled through dispatch and MedLink is a story about one flight crew that had a cardiac arrest onboard, they got the passenger stabilized and flight control had notified the flight deck to divert to Gander (I'm probably going to screw up the airports) but they were over Goose Bay so the captain landed at the closest becaus "it's an emergency and I'm the captain".

Well, Goose bay is, at best 90 mins from a medical facility whereas if they went a bit further to Gander, it literally has a Hospital AT the airport.

Lets just say some attorneys got some "billable minutes"


(*Again, the airports are probably off)

That’s what I’m getting at though, there is a severe misunderstanding with what Narcan actually does and what it more importantly can’t do.

The original question was “should this be on 121 aircraft” and while well intentioned, now the educational problem becomes where your system will break.

So the people on the other end of ACARS understand you can’t simply administer it and treat it with any less seriousness than a cardiac arrest. Do your gate agents (as was given in example) relax the criteria for allowing a symptomatic person on the plane. Ok now let’s put an aircraft over ocean and start gaming scenarios where you’re too far or too heavy to simply divert. Hopefully you’ve got somebody in the cabin area with an MD at the end of their name who can say “no seriously Captain my recommendation is this….”

Narcan will very likely save somebody in destress if used properly, but it’ll just as likely kill somebody from a chain of events that either put a person in a metal tube away from advanced care who should have never been allowed down the jetway.


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[Autothrust Blue]

So the people on the other end of ACARS understand you can’t simply administer it and treat it with any less seriousness than a cardiac arrest. Do your gate agents (as was given in example) relax the criteria for allowing a symptomatic person on the plane. Ok now let’s put an aircraft over ocean and start gaming scenarios where you’re too far or too heavy to simply divert. Hopefully you’ve got somebody in the cabin area with an MD at the end of their name who can say “no seriously Captain my recommendation is this….”

Stations have never ever kicked a problem downline like that. Ever.

 

[derg]

That’s what I’m getting at though, there is a severe misunderstanding with what Narcan actually does and what it more importantly can’t do.

The original question was “should this be on 121 aircraft” and while well intentioned, now the educational problem becomes where your system will break.

So the people on the other end of ACARS understand you can’t simply administer it and treat it with any less seriousness than a cardiac arrest. Do your gate agents (as was given in example) relax the criteria for allowing a symptomatic person on the plane. Ok now let’s put an aircraft over ocean and start gaming scenarios where you’re too far or too heavy to simply divert. Hopefully you’ve got somebody in the cabin area with an MD at the end of their name who can say “no seriously Captain my recommendation is this….”



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The FAA says "thou shalt not board" but honestly speaking, they don't have the time resources (and often the interest) so you can be zonked out on pills and board a jet and usually the flight attendants onboard are the first to notice. Trust me, they want passengers out of the gate area and onboard the jet so they can work the next flight.

ETOPS you're never too far to divert because you're always x amount of minutes from a diversionary airport and if dispatch wants you to divert to Keflavik instead of continuing on to Heathrow and you continue to Heathrow, it can get really sticky. Overweight landings honestly aren't that big of a deal in a medical emergency and we have checklists and guidance for those situations.

If something medical happens onboard a jet, at least at my airline, we have this "situation room". There'll be dispatch, a supervisor, meteorology, a fleet specialist, probably a mechanic, sometimes even a medical professional on duty, a duty pilot (basically like a pilot representative that's looking out for your interests when it comes to pilot stuff) and either a hotline to MedLink and probably some other people.

So when the call comes to divert all of the deliberations, considerations, performance considerations and medical logistics have already been discussed and, for lack of a better word... decided. The biggest role you have during a medical, if things go pear shaped is relaying information over voice to MedLink if the onboard facilities aren't working. Even flight control can refile you as "Lifeguard" without your concurrence.

I'm just the Uber driver during a medical. Target? Dennys? Strip Joint? Send me the performance figures and hope they have hotels because we're probably going to time-out.