The increase in opiate overdoses is convincing many businesses and individuals to have Narcan (naloxone) readily available. Simply spraying Narcan directly into a victim’s nostrils allows anyone to save a life in seconds, making the drug a natural addition to any first aid kit. It seems logical that it be included with any medical supplies meant to serve the public—including those on commercial airliners.
Paramedics Jared Oscarson and Pat Songer likely assumed this to be the case in October. The men were flying on Delta from New Orleans to Atlanta when a medical emergency arose. Senior vice presidents of business relations and operations, respectively, for the New Orleans-based mobile health service Ready Responders, Oscarson and Songer discovered otherwise when the emergency occurred—and Narcan was nowhere to be found.
The emergency began innocently enough. “Probably 15 minutes after a normal takeoff, a flight attendant came across the intercom and asked if any medical personnel were aboard the plane,” recalls Songer. “I looked up and said, ‘I’m a paramedic.’ and she took me and Jared back a few rows to look at a male who was apparently unconscious, with his head lolling forward.”
As the flight crew retrieved the airplane’s medical kit, Oscarson and Songer repositioned the unconscious man’s head to restore respiration and began evaluating his medical condition. “He was cool to the touch and displaying respiratory depression,” says Oscarson. “His eyes had pinpoint pupils.”
Using a glucometer they borrowed from a passenger—the first-aid kit didn’t have one—the paramedics found the patient’s blood sugar levels were within acceptable limits. This eliminated their first differential, which was that the patient was hypoglycemic.
“The concerning part for us was that he had pinpoint pupils, which meant he was now fitting the clinical pathway for an opiate-type ingestion,” Oscarson says. “This was not a medical problem that was difficult to manage, except that they didn’t have Narcan on the airplane. We had a full ALS kit, and we could have done everything but give Narcan. I mean, we had atropine and epi—just about every drug you can imagine. Just not Narcan.”
Lacking it, the two paramedics did what they could to keep the patient stable until the flight landed in Atlanta. Once on the ground, local firefighters boarded the plane, consulted with Oscarson and Songer, and administered intranasal Narcan. “This roused the patient immediately and raised his respiration rate,” says Oscarson.
Treating a possible opioid overdose without Narcan was deeply troubling to both veteran paramedics. Songer and Oscarson want to see Narcan made available wherever it might be needed—which these days means virtually everywhere. They want to get people talking about incidents such as this and what can be done to keep them from happening again.
“This is a conversation we should be having at the national level,” says Oscarson. “We are seeing an increasing number of opioid overdoses in all kinds of places, including airplanes. So we need to be prepared to treat these overdoses wherever they occur—and that means having Narcan widely available in such places.”
The Industry’s Response
EMS World reached out to Delta to get its side of the story. A spokesperson said the airline was aware of the incident and the lack of Narcan on its flight. The spokesperson added that Delta is planning to include Narcan in its aircraft first-aid kits. In fact, it started adding the drug during the third quarter of 2018 and will increase efforts “in earnest” before the end of 2018.
EMS World sent e-mails to American Airlines, JetBlue, and United Airlines, asking each of them if they would be adding Narcan to their onboard medical kits. An unnamed spokesperson at American answered, “While we currently don’t have Narcan/naxolone in our first-aid kits, we are working with our medical team and plan to add it in the near future.” JetBlue and United did not respond.
We also received a reply from Airlines for America (A4A), a U.S. airline trade and lobbying group previously known as the Air Transport Association of America. An A4A spokesperson noted that while there is no specific FAA requirement for Narcan to be included in commercial aircraft first-aid kits, many airlines are already carrying it or “actively reviewing the addition of this medicine on board.”
That American and Delta and possibly others are adding Narcan to their first-aid kits is a good start. One can only hope that this effort will be completed before another apparent opioid overdose occurs at 30,000 feet—especially if there aren’t medical personnel on board to deal with the consequences.
James Careless is a freelance writer and regular contributor to EMS World.