Overdose of medicinal or toxic substance either accidental or intentional. Substance is usually readily available and is thus over-the-counter (pain reliever, vitamin) or prescription for the patient or other family member. Foul or unpleasant substances are unusual and more ominous. History is usually very unreliable in this setting.

1. Perform patient assessment and ABC's
2. Obtain patient history and determine if you will need assistance in getting the patient to the hospital. Law enforcement will be needed if transport against will is anticipated.
3. Administer oxygen via a device, which will insure adequate patient oxygenation. Be prepared to assist ventilations with BVM/Ventilator.
4. Monitor vital signs in accordance with S.O.B. protocol.
5. Consider field administration of Activated Charcoal in patients that are conscious and where a long transport time is anticipated. Consult with Medical Control pior to administration.
6. *IM (intramuscularly) Narcan may be administered by an EMT-Basic with On-Line Medical control ONLY. The EMT-Basic must have been trained in IM administration of Narcan.
7. All patients with any question of overdose or suicidal gesture should be transported for evaluation in the hospital.

INTERMEDIATE LIFE SUPPORT

1. If history indicates a significant OD or vitals are unstable/altered, initiate IV access using an isotonic solution. Titrate infusion to support patient vitals and/or condition.
2. Measure blood glucose using Glucometer.
3. For suspected Opiate (Narcotic) overdose (history, pinpoint pupils, etc.);
   1. Administer Naloxone (Narcan) 0.4 mg IVP. SQ is acceptable if IV access not readily available. Titrate repeat administrations to adequate respiratory effort and/or adequate patient airway control.
4. For documented hypoglycemia (BGL <80mg/dcl) with signs and symptoms of same:
   1. Administer Dextrose 50% 25 gms IVP

ADVANCED LIFE SUPPORT

1. If history indicates a significant OD or vitals are unstable/altered, attach and monitor ECG.
2. Fluctuating mental status and airway compromise are common in some overdoses (tricyclics) intubation may be attempted when patient 'down'.
3. For specific OD; (refer to ADVERSE DRUG REACTION protocol, ie. B-Blockers, Calcium channel blockers, Tricyclic antidepressants).

*Under Medical Control: "Supervision, provided by or under the direction of physicians, to providers by written protocols or on-line medical control, which is direct communications with a medical doctor."

Prior to accomplishing a new skill, technique, medication, or procedure, it shall be documented by the service medical director, or approved EMS training institution that the EMS provider has been appropriately trained to perform those new skills, techniques, medications, or procedures on the equipment provided by their local service. Additionally, each EMT-B must have a signed authorization from the service's medical director to perform semi-automatic defibrillation, administration of the patient's own Nitroglycerin, or administration of epinephrine. This authorization shall be retained on file at the EMS service's headquarters or administrative offices.

[7.27.2.15 NMAC - Rp, 1-1-97; 727.2.15 NMAC - Rn,6-29-01]