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In this video:
This video is based on the newest 2020 guidelines for narcotic poisoning and features the most uptodate recommendations for naloxone administration. This instructional video will demonstrate the steps for overdose response and emergency care.

It will start with the minimum care (CPR compressionsonly) with one rescuer and will gradually provide more advanced procedures with tworescuers. We will highlight the proper PPE and protective equipment required to ensure safety precautions to prevent crosscontamination of infectious disease and toxic chemicals.

This video will provide an emphasis on providing ventilationsonly quickly and safely for opioid poisoning. This is particularity important when the person suffering from an opioid overdose is in not breathing but maintains a pulse. This procedure known as "assisted breathing" will be demonstrated using a BagValve Mask (BVM) which will include a HEPA filter.

We will also highlight extra PPE precautions for managing aerosol generating procedures when providing "teamCPR". This video will also provide a stepbystep guide on how to administer nasal naloxone properly as well as injectable naloxone.

This video provides expert advice and safety tips from Dave Archer, Heart2Heart CPR's very own Emergency Medical Responder Instructor Trainer (EMRIT) about safeguards when using needles, and extra COVID19 precautions when providing "upfront CPR".

Directors Notes Background to Heart2Heart CPR's "Overdose Prevention Resuscitation (OPR)" program:

We had identified some time ago, the missing link to the chain of survival for overdose deaths, particularly opioid overdoses, when CPR guidelines for lay rescuers excluded important components like "pulse check", how to use a Bag Valve Mask (BVM), and the option to provide an essential lifesaving technique known as "Assisted Breathing”. This ventilationonly technique is often the critical component to preventing a persons heart from stopping if the person suffering from an overdose has stopped breathing effectively but STILL maintains a heartbeat. This condition is called Respiratory Arrest which is often the root cause of most drug overdoses. This is especially true in opioid overdoses where the opioid blocks the receptors in the brain that controls breathing.

If ventilations are not provided quickly or effectively during Respiratory Arrest, the brain begins to get damaged within 46 minutes. The heart stops beating soon after. The average 911 response time in the Toronto area is around 9 minutes. By the time EMS arrives, if there is no bystander care, the person has a lower survival rate. This scenario plays out time and time again in overdose cases.

The rescuer may be extremely reluctant to give ventilations for fear of disease transmission or crosscontamination with dangerous drugs. There are many reasons why someone would feel apprehensive about giving ventilations. Even in the best circumstances where the rescuer has access to a traditional "pocket mask" with a oneway valve, they still may be reluctant to place their mouth on the mask and provide ventilations. This is especially true now, given COVID19. For this reason, I am strongly advocating for the use of the "Bag ValveMask" (BVM) to be the primary breathing barrier device. This process is safer and will provide the person with higher levels of concentrated oxygen

The "team approach" training gives the rescuers more confidence to handle the situation with others as opposed to doing so individually (which is another negative aspect to the current recommended "CPR level A or C" training). A "team rescue" approach allows a team to manage a stressful situation while providing extra knowledge and skills to give the best care possible. It is for this reason that I recommend Worker and Peer Support Responders to work as teams when providing frontline support to highrisk communities.

Other notable delays to care is providing administration of naloxone. Naloxone can help restore breathing during an opioid overdose. Although lay rescuers are encouraged to search for an application of naloxone for a respiratory or cardiac arrest, it should not delay basic first aid measures. Additionally, many who provide naloxone will only depend on it and not provide other lifesaving measures sooner such as placing the person into the recovery position or starting CPR. Since naloxone takes several minutes to start working, without the immediate intervention of first aid and CPR, the person may experience a prolonged lack of oxygen, causing an increase to brain damage and loss of life.