# Ohio EMS contemplating 3 strike policy for OD response



## Ooh-Rah (Jun 28, 2017)

Not sure what to make of this.

Ohio city considers three strike policy on responding to overdoses

MIDDLETOWN, OH (WLWT) — A controversial proposal has been made in Middletown to deal with heroin overdoses.

Middletown is considering whether people with addiction should only be given two strikes before they’re out of chances at Narcan.

Middletown is struggling to deal with the heroin problem.

“We are faced with stress on our services, particularly the EMS services where we can do six to eight opioid overdose runs a day,” said Paul Lolli, fire chief of Middletown.

The number of overdoses jumped this year. Last year, there were 532 overdoses. So far, only halfway through 2017, there are already 577.

Also last year, the department spent more than $11,000 on Narcan. This year, $30,000 has been spent on it.

This is a result of more overdoses and the increasing strength of the drugs addicts are using, officials said.

The number of deaths from overdoses is on track to increase, as well. Last year, there were 74 deaths. So far this year, there are 51.

Leaders are frustrated trying to find a solution.

City council member Dan Picard is proposing a three strikes system. After the first two overdose rescues, the person would perform community service for the equivalent amount of money used on the lifesaving response.

The third strike is a bit more controversial.

“If the dispatcher determines that the person who’s overdosed is someone who’s been part of the program for two previous overdoses and has not completed the community service and has not cooperated in the program, then we wouldn’t dispatch,” said Dan Picard, Middletown city council member.

@policemedic @Muppet


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## DA SWO (Jun 28, 2017)

Disagree with not dispatching, they are setting themselves up for a lawsuit.
I think three strikes your dead isn't too extreme though.


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## policemedic (Jun 28, 2017)

I actually tweeted about this...

Long story short...it's bad public policy and to a large extent it's impractical.


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## policemedic (Jun 28, 2017)

DA SWO said:


> Disagree with not dispatching, they are setting themselves up for a lawsuit.
> I think three strikes your dead isn't too extreme though.



Yeah, I get it.  But the thing is, paramedics and police officers have an inescapable moral duty to preserve life--and they don't get to place a value on that life before saving it.


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## Kraut783 (Jun 28, 2017)

if you call, we have a duty to respond....be it Fire, Paramedics, Police....it's what we do.


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## TLDR20 (Jun 28, 2017)

Yeah my response is WTF? I get it to an extent, but remember the outcry over "death boards" during the ACA debate? Now we are giving a literal life or death decision to a flowsheet in the dispatch room? Fuck off. Think about some of the people who have turned their lives around after an OD... even in the SOF world we have a SEAL with a bestselling book who overcame addiction to be a productive member of DEV... from a first responder medical standpoint I cannot believe this even got traction. Our job is to save lives, PERIOD. Narcam isn't even that expensive...


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## Frank S. (Jun 28, 2017)

This might not be much more than "spitballing", trying to get some kind of grasp on the issue, but this bothers me:

“If the *dispatcher* determines that the person who’s overdosed is someone who’s been part of the program for two previous overdoses and has not completed the community service and has not cooperated in the program, then *we *wouldn’t dispatch.”

This is putting a hell of a burden on dispatchers to make the determination whether the person at the end of the call is too expensive to save, and that, as usual, is a little bit fucked. There is no "we" in this.


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## TLDR20 (Jun 28, 2017)

Yeah and dispatchers are minimum wage workers in many places with a high school education.


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## TLDR20 (Jun 28, 2017)

DA SWO said:


> Disagree with not dispatching, they are setting themselves up for a lawsuit.
> I think three strikes your dead isn't too extreme though.



Lol at this thinking. It doesn't apply to anything else that is deemed a medical problem. Addiction is a medical problem, whether you think so or not.

God forbid you ever have a problem and have someone without that problem say "fuck it, three strikes you're out." In our day and age it is too easy for even the strongest of folks to become addicted to opioid pain medicines, some of my best friends included.

I have a good friend who was shot in the head in Afghanistan, by a dragunov, he has horrible headaches, neck pain, and seizures related to his brain injury,he took his prescribed opioids and became addicted. He suffered horrible sieizures on withdrawal, and turned to illicit drugs to ease the transisition. Had he OD'ed a couple of times does he deserve to die due to a fucking high school diploma holding dispatcher? The answer is absolutely fucking not..

It is a slippery slope, soon it is ," well he has already had one CABG, he probably doesn't deserve a second one..." or " well he has diabetes, so he doesn't deserve that heart transplant..."


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## AWP (Jun 28, 2017)

I'm all about "big boy rules" but even this is beyond my Mongol approach to accountability.


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## Ooh-Rah (Jun 28, 2017)

Similar to what @TLDR20 was saying, I cannot even imagine the lawsuits that would be brought on but such a program; not to mention once they started breaking it down by race....forget about it.


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## Muppet (Jun 29, 2017)

Yeah, fuck no. In 18 years as a paramedic in urban/suburban settings, places with a very high rate of trauma and overdoses, the area @policemedic and I work and live, in is known for top grade heroin, so they call it. I used to work 24 hour tours, fuck that, now 12 hour tours. In any 12 hour tour, even in the slower areas now, I get 3 to 4 O.D.'s for MY medic unit, not counting surrounding medics. If it gets dispatched as a cardiac arrest, 2 medic units and a fire truck are sent, along with P.D. P.D., fire and E.M.S. a all carry narcan. Hell. My first in medic bag, that carries out I.V., cardiac / arrest drugs, intubation, CPAP and B.V.M. has an outer large pocket, lined with narcan, 8 brista-jets, normal par is 2. The back up drug box in medic unit has 6 to 8 more, option to get more from pixus at any E.R. It's bad. It gets tiring, waking em up, getting attacked and punched, getting cussed at, having knives pulled but fuck. We have a professional and legal obligation to respond, treat and transport these O.D.'s with in out paramedic SOP's. I can't tell you the answer to the problem, but this ain't it. Oh, Middletown E.M.S. I work P.A.'s version of Middletown E.M.S., just north of Philly.

M.


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## Muppet (Jun 29, 2017)

And, since when are we fucking judge and jury on some junkie dipping on the stoop of a trap house. Pissed me off that a person can even think of this. I am getting tired of E.M.S. and seeing good people die while junkies get resuscitated back to back to back but WE are not the ones to be doing this. 

M.


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## CDG (Jun 30, 2017)

I like the theory of it.  Not everyone deserves to have time and resources utilized to keep saving their worthless life over and over. There's no way to practically implement it though.  And so it goes.


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## SpitfireV (Jun 30, 2017)

It's not about deserving. Local government should not have the option to choose life or death for someone.


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## Devildoc (Jun 30, 2017)

If it wasn't for the ODs, I wouldn't have gotten all the intubations I did.  #skillslab

In all seriousness, bad policy.  I get the frustration, I do, but the end does not justify the means here.


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## Red Flag 1 (Jun 30, 2017)

My $.02.


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## pardus (Jun 30, 2017)

I've always despised junkies from afar. Now I get to work them quite often in the ER. I still can't stand the "junkie" who is there drug seeking, blatantly abusing the system, moving from one hospital to the next, and just criminal minded. 
However, I've also seen average people, (i.e. YOU AND ME) have a legitimate injury, suffered a lot of pain and became addicted to opiates, prescribed to them by a medical provider.
We have a few people that are frequent fliers with Sickle Cell Anemia. Sure they're a pain in the ass while they are there, but my attitude is, these poor bastards are dying over years from a debilitating, excruciating disease, give them as much Dilaudid as they want, when they want it.
I've talked to them and listened to them about their pain and the management of it. They know how much they need, and they don't try to get more than what they need. They are aware of the addictive nature of opiates and try extremely hard to fight that addiction. 
So I'm in two minds really...

That rambling bullshit all said, this proposed policy is utterly ridiculous. It should not and will not be enacted.


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## Devildoc (Jun 30, 2017)

pardus said:


> We have a few people that are frequent fliers with Sickle Cell Anemia. Sure they're a pain in the ass while they are there, but my attitude is, these poor bastards are dying over years from a debilitating, excruciating disease, give them as much Dilaudid as they want, when they want it.



SC is no joke, and their pain is for-reals.  The damage that occurs in vaso-occlusive crisis is significant.  On the NRS their pain is 3 when ours is 9.  Some of the people in that community are a real pain in the ass and some are junkies but for the most part they are doing the best they can.


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## policemedic (Jul 1, 2017)

Devildoc said:


> If it wasn't for the ODs, I wouldn't have gotten all the intubations I did.  #skillslab
> 
> In all seriousness, bad policy.  I get the frustration, I do, but the end does not justify the means here.



Yeah, ODs did yield a good number of oral and nasal tubes.  So did CHF, but now we know better.


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## Teufel (Jul 1, 2017)

Sure. I think that makes great economic sense and would be a great policy fit in the Philippines where selling drugs is a death sentence. There is no way we could do anything like that here though for myriad political and social reasons. 

Three strikes and you're put into mando rehab and community service? That could probably work but it would cost money to implement.


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## Diamondback 2/2 (Jul 2, 2017)

They also should issue out baseball bats, so as the EMT decides the dope heads fate, they can go all Negan on that ass. Dope heads shouldn't have open casket funerals, durrrrr, their just stupid dope heads...







And yes I'm being sarcastic.


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## amlove21 (Jul 2, 2017)

Pretty crazy. Thanks again, Ohio!


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## BloodStripe (Jul 2, 2017)

Maybe NASA could use them to be their new slaves on Mars, since the children have been outted.


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## Muppet (Jul 3, 2017)

Teufel said:


> Sure. I think that makes great economic sense and would be a great policy fit in the Philippines where selling drugs is a death sentence. There is no way we could do anything like that here though for myriad political and social reasons.
> 
> Three strikes and you're put into mando rehab and community service? That could probably work but it would cost money to implement.



I see your point on one hand sir but on the other hand, the relapse percentage is absurd for those on dope. Say we send 10 to mandatory state funded rehab, 9 will relapse, ending up right back at square one. I can't tell you how many junkies I Narcan, see them clean after a while, usually, since I live in the A.O. I work, seeing em at Wally world and shit. They come up to me, thank me, blah blah blah. A month later, working, find em in the car, on in the recovery house, dipped on dope, back to square one and I am the motherfucker again for using Narcan. 

M.


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## Teufel (Jul 3, 2017)

Muppet said:


> I see your point on one hand sir but on the other hand, the relapse percentage is absurd for those on dope. Say we send 10 to mandatory state funded rehab, 9 will relapse, ending up right back at square one. I can't tell you how many junkies I Narcan, see them clean after a while, usually, since I live in the A.O. I work, seeing em at Wally world and shit. They come up to me, thank me, blah blah blah. A month later, working, find em in the car, on in the recovery house, dipped on dope, back to square one and I am the motherfucker again for using Narcan.
> 
> M.


I don't diasagree. Our system won't let people kill themselves with their poor choices though.


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## Red Flag 1 (Jul 3, 2017)

?


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## Ooh-Rah (Jul 7, 2017)

Same state as my story in the OP:

I guess I am surprised that this is even an option to him.  (not to permit it).  If people begin dying, isn't there some type of liability?

Sheriff won't let officers use Narcan, says life-saving drug not helping heroin epidemic

An Ohio sheriff is taking a stand in the war on heroin addiction that he said will get at the root of the epidemic, and that seems to fly in the face of standard police practices.

Sheriff Richard K. Jones of Butler County, Ohio, told the Cincinnati Enquirerthat he believes the drug naloxone, a substance used to revive overdose victims that is known by its brand name Narcan, is more trouble than its worth.

"I don't do Narcan," Jones told the Enquirer, noting that his deputies "never carried it... nor will they."


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## Kraut783 (Jul 7, 2017)

It's not a common thing Police carry (at least in Texas), we let FD/EMS do that.  But in a large rural area, I could see deputies carrying it, due to response times for EMS.


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## policemedic (Jul 7, 2017)

We carry it.  In fact, just had an OD code from heroin the other day.  22 year old lost his life for no good reason.


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## AWP (Jul 7, 2017)

The OD rates must have spiked after this year's NBA Finals.


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## Muppet (Jul 10, 2017)

Earlier, I saw 2 medics, 1 I was an instructor for, in the ER. They were patients. They were on an unconscious in car on highway, next township over. Junkie was wasted on dope. Medics treated and felt ill after the job. The dope is suspected to be the new shit, "grey death", typically, heroin mixed with carfentanyl, a potent narcotic horse tranq. It can be transferred via dermal, THROUGH gloves we wear. 1 medic had a grey appearance and displays EKG changes, the other medic was refusing and I got on his shit, fucking A type rookies. He signed in.

All the while, the fucking junkie is up and drinking OJ and eating an ER turkey sandwich. Fuck these idiots. I stand by my post but can dislike these fuckers nonetheless....

M.


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## Frank S. (Jul 10, 2017)

Muppet said:


> 1 medic had a grey appearance and displays EKG changes, the other medic was refusing and I got on his shit, fucking A type rookies. He signed in.
> M.



If you don't mind, I'll be interested to know how they both turn out later.


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## TLDR20 (Jul 10, 2017)

Muppet said:


> Earlier, I saw 2 medics, 1 I was an instructor for, in the ER. They were patients. They were on an unconscious in car on highway, next township over. Junkie was wasted on dope. Medics treated and felt ill after the job. The dope is suspected to be the new shit, "grey death", typically, heroin mixed with carfentanyl, a potent narcotic horse tranq. It can be transferred via dermal, THROUGH gloves we wear. 1 medic had a grey appearance and displays EKG changes, the other medic was refusing and I got on his shit, fucking A type rookies. He signed in.
> 
> All the while, the fucking junkie is up and drinking OJ and eating an ER turkey sandwich. Fuck these idiots. I stand by my post but can dislike these fuckers nonetheless....
> 
> M.



Wait what? The drug can transfer to another person dermally? Not even through secretions? That is setting off all of my bullshit detectors.

With some research handling the drug itself can cause reactions via the dermis, but not a patients skin. Maybe I am misreading your post?


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## Muppet (Jul 10, 2017)

TLDR20 said:


> Wait what? The drug can transfer to another person dermally? Not even through secretions? That is setting off all of my bullshit detectors.
> 
> With some research handling the drug itself can cause reactions via the dermis, but not a patients skin. Maybe I am misreading your post?



No misreading bro. PA Dept. Of Health sent out warnings of dermal transfer a few months back, a couple cops in western PA got hit, now this. We are told it is a mixture of heroin, carfentanyl and something else, @policemedic may know on LE side. 

M.


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## Muppet (Jul 10, 2017)

Frank S. said:


> If you don't mind, I'll be interested to know how they both turn out later.



Will do Frank.

M.


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## Frank S. (Jul 14, 2017)

Bump.


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## Muppet (Jul 14, 2017)

Frank S. said:


> Bump.



They are ok. The one EMT spent a night in hospital. Other 2 were ok.

M.


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## Dame (Jul 15, 2017)

Wow. This stuff is is even dangerous airborne. Looks like this is a big concern for the dogs used to sniff out heroin.
This was part of a release from the Indiana state DHS:



> Gray Death, a particularly dangerous mixture of heroin, fentanyl, carfentanil and other synthetic opioids, made its way to Indiana this week, causing an overdose in central Indiana. Partners warning about the increased risk are State of Indiana Emergency Medical Services and the State Fire Marshal, part of the Indiana Department of Homeland Security; Indiana State Department of Health and the Indiana State Police.
> 
> A persistent increase in opioid overdoses tied to the synthetic drug carfentanil have been seen around the country, prompting concern. …
> 
> ...


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## Muppet (Jul 15, 2017)

Dame said:


> Wow. This stuff is is even dangerous airborne. Looks like this is a big concern for the dogs used to sniff out heroin.
> This was part of a release from the Indiana state DHS:



Yep. PA State Police sent out the update. A row home, here in Philly, was just raided for a heroin lab. Philly PD/homeland security was there, in tyvek suits. Bad juju. I'm so goddamned tired of this nonsense.

M.


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## Red Flag 1 (Jul 15, 2017)

.


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