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Editor's Desk: Primum non Nocere? "3rd Overdose = No Response" Policy Under Consideration by Ohio City

Author: Randall D. Larson, Editor

Copyright: Copyright 9-1-1 Magazine, Feature Content

Date: 2017-06-27
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"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,” proposed Dan Picard, Middletown city council member.

[Updated June 27 2017 1734 hrs]

In a story recently posted at EMS1, based on a report posted by WLWT Cincinatti, and shared on Facebook by public safety dispatch trainer First Contact 9-1-1, a city councilman in Middletown, Ohio is considering a “three strikes, you’re out” policy for those being revived with naloxone (Narcan) by first responders, in a measure to combat the growing number of overdose calls, and the expense of keeping large amounts of Narcan on hand.

City councilman Dan Picard, who is an attorney by trade, proposed that after the first two overdose revivals, a person must perform community service that equals the amount of money spent on the response. If the community service hasn’t been completed before the third strike, a dispatch would not be made.

Who is to be put in the hot seat to make the determination to respond or not? Guess who: "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,” Picard said.

According to WLWT’s report, “Picard said this plan is not aiming to solve the drug problem; it’s an attempt to save the city’s finances.” Middletown is struggling to deal with the heroin problem, and the fire department reports that they are required by law to provide Narcan when they respond to a heroin overdose. As a result, the city is considering whether addicts who overdose should be given just two strikes before they’re denied treatment with more Narcan. “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, Middletown’s fire chief.

The WLWT article concludes, “Until legal advisers look at the plan proposed by Picard, the fire department is applying for grants and accepting donations to fund more Narcan.”

While Middletown’s economic and social problem is a reality and a sympathetic one, the fundamental wrongheadedness of this particular idea is mindboggling to many in the public safety arena, and those who commented to the news report haven’t minced their words. The posting at EMS1 resulted in plenty of outrage within the EMS community (though to be fair not all commenters were against the idea), and among the sentiments expressed in the article’s comments section were:

  • That's the silliest idea I've heard yet. Let's look at the possible headlines, "You let my son die willfully" or "dispatchers played god with my child." Just thinking of the implications [is] astounding.
  • Substance abuse is a medical problem that requires a medical response. Saying that some people do not deserve help "because it is their fault" - where does that stop?
  • You revive these idiots, who then turn around and do it again and again. When is enough, enough! The mayor's right something has to be done.
  • I strongly believe in harm reduction methods and teaching people how to reduce risky behavior. Clearly someone trying to make public policy here doesn't understand addiction and treatment.

When First Contact 9-1-1’s Facebook site shared the article, their public safety dispatch/telecommunicator readers responded with concern as well:

  • This places a great amount of liability square on the dispatcher’s shoulders. Yes, these "burden" calls are causing hardship on the EMS system but this is not the answer.
  • Not a responsibility I want as a dispatcher and how are we to know how many strikes someone had and the time delay involved in getting resources dispatched?

A Reddit reader also commented on the article when it was posted on their site:

  • That's honestly the most chilling thing I've read today. Even if you're a person who would be fine with letting people overdose unassisted, how does the dispatcher determine in a timely manner, likely over the phone, that the person in question matches someone in their records?

And one of our own readers posted to our Facebook page when we shared the First Contact 9-1-1 post:

If this is really going to be a solution to the problem facing the city of Middletown, one might ask how such an idea squares with the Hippocratic Oath and its promise “to abstain from doing harm,” or the fundamental principle of bioethics that healthcare students are taught in school, and which in its Latin form is found in the title of this editorial missive. “First do no harm.” Are we really ready to throw that out as a solution to financial constraints in emergency medical response? Let’s hope the notion of “primum non nocere” prevails in Middletown, Ohio, and a less problematic and ethically uncertain solution may be found.

Read the articles/posts and their comments here: EMS1, WLWT, Reddit.

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