Emergency Procedure

This page is a work in progress and should not yet be taken as complete or valid

Sometimes the use of drugs can lead to a situation where a person will need immediate medical attention, often as the result of an overdose. This page acts as a set of guidelines for someone who is looking after a person who is having a difficult experience whilst on drugs. If you are unsure whether medical attention is required, it is always quicker and easier to ring your local emergency number (usually either 112 or 911) immediately and explain your situation to them.

Conducting a rapid assessment at home

1) Check if they are conscious, and if not, have a pulse or are breathing

Are they conscious? If they are not, immediately check for a pulse at the carotid (neck) and radial (wrist) site and look at their chest for rise and fall indicating breathing. If they ARE breathing but you feel no pulse they have one and you just cannot feel it.

IF THERE IS NO PULSE OR THEY ARE NOT BREATHING IMMEDIATELY CALL 911/EMS AND START CPR

Here is a video to check/find a pulse and measure it. https://www.youtube.com/watch?v=m0iGwD_EEXI

When you call Emergency services they should be able to tell you how to do CPR over the phone. If you cant feel a pulse and dont see obvious breathing, just go ahead and call EMS and do CPR no matter what. even if they did have a pulse this will not hurt them and could/probably will save a life.

2) Assess their mental status

If they have a pulse, check for level on mental status. If they are Alert, ask them where they are, what their name is, what day it is, and what they were doing just prior. The number of questions they get right is their level of orientation. Answering all questions right is Alert and oriented x 4 or A&Ox 4. If they are not alert, are they only responsive to your Voice? yell out their name and look for any response. if not, how about to Pain? check this by pinching their trapezium muscle (the muscle between your shoulder and neck that you move when shrugging) or rubbing their sternum hard with your knuckles (this is the bony area straight down the middle of their chest, if they are overweight really dig in). If they react they are responsive to Pain, if they do not react they are Unresponsive, IF UNRESPONSIVE IMMEDIATELY CALL 911/Emergency services

This is an EMS mental status evaluation based on the AVPU system (alert, verbal, pain, Unresponsive). It is easier to learn and faster to assess than the glasgow coma scale.

If they are only responsive to pain immediately count their pulse rate, and assess their breathing. if they are breathing shallow, and/or their pulse is below 60 or above 100 call ems immediately

3) Assess quality of circulation

If they are responsive to voice or they are alert the assessment can continue.At this point we are going to assess the quality of circulation. This includes the pulse rate (how fast the heart is beating), how it feels, if it is regular in rhythm, and how well circulation to the skin is by checking the skin for its color, temperature (by feeling with the back of your hand), and condition (how it feels when you touch it). The pulse is considered normal between 60-100. Placing both hands on both Wrist/radial pulse point, check to see if they are both equally strong and equal in speed. irregularity, or a weak feeling pulse is a red flag, you can use your own pulse as a reference point if you are of similar health normally to the patient (as in weight age etc..). There should be no skipped beats, it should be consistant in rhythm and not speeding up or slowing down, and should be decently strong. any differences from these norms are red flags. After all that, count the pulse for 15 seconds and multiply by 4 or count for 60 seconds straight and that is your rate. remember, it should be between 60-100 with minor exceptions. anything out of that range is another red flag. The more red flags you have, the more you need to consider contacting emergency services or if they seem not that bad, then taking them to an urgent care clinic or emergency room yourself. The pulse rate is your most important factor in this part of the assessment . Now that you have assessed the pulse rate regularity and strength, assess the skin. If it is blue or if the lips or fingertips or finger toes or blue, you need to call 911 immediately. skin should be of normal color like when you see them on other days (normal of course is different for everyone), it should be dry, and it should be slightly warm. If it is cold, pale, or sweaty, these are red flags and are usually found together. If someone has all those aspects on their skin and their pulse is a bad rate, you should already at this point consider seeking medical attention.

4) Assess quality of breathing

If youve made it through assessing their circulation and are not concerned enough, Assess their breathing. Is it shallow? are they using obvious accessory muscles in their ribs to breathe? (there will be contractions of muscles around the rib cage on inhalation). accessory muscle use or shallow breathing is a red flag and should be considered. Remember, none of this matters if the patient is not responsive to pain or is unresponsive. at that point immediately call 911 count their respirations for one minute. Breathing rate should be between 12 and 20. For some people it may be on the higher end, especially if anxious, but if they are on downers, especially opiates, and have a slow respiratory rate (defined as below 12) then they need medical attention as their breathing may progressively slow down until gone.

5) Take a medical history

Now for the history taking part of an assessment. Here we will use the SAMPLE system in order to assess the patient.SAMPLE is an acronym for "Signs/symptoms-Allergies-Medications-Past medical history- Last oral intake - Events leading to onset, or S.A.M.P.L.E" In whatever order you wish to ask the patient, ask them for signs and symptoms, allergies, medications and drugs they take, past medical history of any sort (including anything from asthma to prior heart attacks, be specific and ask for certain relevant things if they are not alert and oriented completely,for example if suspecting a stimulant overdose ask if they have any heart issues or have had a heart attack), ask when the last time they ate was and what happened leading up to the event/issue. Keep in mind that not all of this info is going to end up being useful, but this method tends to uncover clues about what is wrong with the patient or if they are at worse risk than you thought prior. An examples would be if they tell you while in an altered state of mind that they take medications that you find out are for their heart, and they are on stims, now you know they have a heart condition and your level of suspicion for if this is a bad situation should be raised.

6) Assess any pain

In order to assess pain, use the OPQRST system. This is an acronym standing for Onset, Provocation, Quality, Radiation, Severity, and Time. In whatever order you want ask them: When did the pain start? (This is the Onset); What makes the pain worse? does it hurt more when you touch it, move the body area, or when you do something like breathing in or coughing? (This is Provocation , think of it as what provokes the pain?); What does the pain feel like? Is it throbbing, dull, sharp, tight? (this is Quality) ; does the pain travel anywhere? for example, chest pain shooting up the persons jaw or arm (this part is known as Radiation) ; On a scale of 1-10 how bad is the pain? Is this the worst headache or chest pain youve ever had before? (This is known as Severity) ; And lastly, Is it constant or does it come and go every few seconds or minutes etc..? (This is the final portion of the OPQRST assessment: Time). as a quick note, All chest pain, especially in relation to stim use, should be taken seriously and emergency services should be activated. along with that in the middle of the upper back for women is also something of concern as women tend to present symptoms differently.

General Emergency Symptoms

If you or someone with you is experiencing what may be a medical emergency, determine if you must contact emergency services (enter common ems numbers here) and if unsure, consult this section. If you are certain only one substance is causing the worrisome signs and symptoms, please view the tables below this section directly correlated to drugs and drug classes The surest sign that you or someone else needs immediate medical attention, regardless of the substance or dose that someone has taken, is to look at the symptoms they are currently experiencing. However, it should be noted that the anxiety caused by certain drugs can also make one experience symptoms which, at the time, can be indistinguishable from those which indicate a medical emergency. Unfortunately, it is impossible and unethical for TripSit or a tripsitter to try and diagnose this beyond obvious matters. If you are having trouble deciding whether you are having an anxiety attack or are experiencing an overdose, try reading through our Overdose and Panic Attacks guides - if you are still unsure, then you should either contact health hotline services (e.g. Poison Control or NHS Direct), or otherwise seek medical attention. This table describes some medical symptoms common to immediate emergencies, and the course of action which should be taken for such symptoms:

Symptom	Worst case scenario	Possible causes	Primary action	Secondary action
Constant Chest pain; sometimes a squeezing sensation; unrelieved by sitting or resting, pain may spread to the arms	Heart attack/AMI	Stimulant use, certain steroid usage, certain hallucinogenic research chemicals	Contact Emergency services immediately,	Aspirin (~300mg) [1]
Constant high heartrate; unrelieved by rest or relaxation (Resting heart rate over 120, or over 140 on stimulants possibly, err on the side of caution)	Heart attack	Stimulant use, certain steroids and certain research chemicals	Contact Emergency Services	Avoid excessive physical work/movement, remain calm while waiting for the ambulance to arrive, do not continue using stimulants
Extremely high heart rate (150-200 beats per minute)	PSVT	Stimulant use, any drugs that increase heart rate	Immediately contact emergency services	If a medical professional is near you they can provide a carotid massage https://www.youtube.com/watch?v=dVMCX9LuPgc
Low heartrate (under 60bpm)	Respiratory failure, Death, multiorgan system damage secondary to inadequate blood flow	Opiate overdose, digoxin toxicity	Contact Emergency services	Narcan (Naloxone) if caused by opiate overdose CPR if heart stops
Unresponsiveness to pain or voice	death, permanent brain or organ damage	alcohol, or opiate overdose, OD'ing on "downers"	Contact emergency services	Check for a pulse (carotid or radial), if you cannot find a pulse or if the victim is not breathing begin CPR
Shallow breathing	Death	Alcohol or Opiate overdose or "downers" in general	Contact emergency services	If you are trained in CPR, perform rescue breathing but DO NOT do chest compressions
Hypertensive crisis (blood pressure over 180)	Stroke;Kidney failure; Congestive Heart Failure	Stimulant use, steroid use, certain RC's, decreased intake or depletion of potassium or calcium	Contact Emergency Medical Services
Seizure, especially lasting over 10 minutes	Brain damage	Stimulant/drug use, cocaine use, tramadol usage	Contact emergency medical services	move all objects away from the person so they do not hit themselves on anything that could physically injure them

Levels of help

There are often several different levels of help available to someone who is undergoing a difficult drug-related experience. In order of priority, those are:

Emergency services

The most immediate way to get medical attention is to ring the emergency services for your country. It is important to be honest and direct about what substances you have have taken, any symptoms you are experiencing and your current location and situation. Police officers are not usually dispatched when a person is dealing with a drug overdose, and if you are honest and co-operative with paramedics there is usually no reason for police to get involved, though this varies depending on country.

How to contact emergency services

1) Call Emergency services and state the emergency/nature of call. Give your location/address, number of patient(s) needing medical attention if there are more than one, age and gender of the patient, and any potential hazards Emergency medical workers may run into. Do not be afraid to be honest, emergency workers need to know what they are dealing with to properly treat it. The more information you can give to the paramedics on scene and to dispatch the better.

2) If you are not experiencing the emergency try to write down some valuable information if you know the patient for the first responders and give the paper to them. Useful information is: drugs the patient is on and approximate dosages; medications the patient takes and have those med bottles in a bag for them if possible; any allergies the patient has; when the emergency began; and a brief description of events leading up to the emergency. If possible also include any medical conditions you are aware the victim has such as diabetes or heart defects. Alert the first responders if the patient looks different than normal as in "his face normally isnt so pale or droopy" so as to give them a better picture of what they are dealing with.

3) If asked to leave, please do so. Interference with medical intervention will not help your friend and only slow down the paramedics or EMT's working.

See Emergency Numbers for some localised emergency services numbers.

Health hotlines

Many countries have numbers you can call to get advice about your health in a non-emergency situation. The most relevant of these is poison control, which are available in many countries (including the United States, Australia, United Kingdom) and are able to give advice on toxic substances and whether a person may need medical attention.

Some countries also offer non-emergency health hotlines for more general illnesses. For example the United Kingdom have a number that can be called to receive health advice from the NHS (111).

Psychological help

If a person is experiencing psychological distress but posing no risk to their own (or anyone else's) physical health, the next best course of action is psychological help. This can often be as simple as providing support for someone and giving them a person to talk to. There are many great resources available to provide psychological help to a person:

• #tripsit - drug related psychological support
• 7 Cups Of Tea - emotional support
• Befrienders - suicide prevention

See also How To Tripsit In Real Life if you are or will soon be in the company of someone who needs support.

[1] http://www.nhs.uk/conditions/heart-attack/Pages/Introduction.aspx