There are instances when a firefighter may respond to a patient who is vital signs absent (VSA) due to a suspected opioid overdose. Under the SWCPM, the administration of naloxone is NOT supported in patients who are VSA. 

The SWCPM includes an Opioid Toxicity Medical Directive, which allows authorized firefighters to administer naloxone to patients experiencing a presumed opioid overdose (if the patient meets the conditions/indications/contraindications). However, this Medical Directive applies only to patients who have a pulse. 

If a firefighter assesses a patient with a suspected opioid overdose and determines that the patient has no pulse, they should immediately initiate CPR and follow the Medical Cardiac Arrest Medical Directive. 

Naloxone is an opioid antagonist that rapidly reverses the effects of opioid toxicity, such as respiratory depression and decreased level of consciousness. However, naloxone is only effective if the patient has a pulse, as circulation is necessary to deliver the medication throughout the body. 

Patients experiencing an opioid overdose may progress from respiratory arrest to cardiac arrest due to prolonged respiratory depression. In these situations, firefighters should focus on the interventions outlined in the Medical Cardiac Arrest Medical Directive: 

• High-quality CPR 

• Effective BVM ventilations 

• Early defibrillation, if indicated by the AED 

• Note: In most cases, this patient population will not be in a shockable rhythm