LACONIA — Nowhere has abuse of heroin and other opiates been felt more keenly than at the emergency department of Lakes Region General Hospital, where 73 patients were treated for overdoses during the last six months of 2014 and, since the turn of the year, the pace has not slowed.
"These are very resource intensive patients," said Kendra Peaslee, director of Emergency Services at LRGH. who stressed that treating those who have overdosed places heavy demands on the medical and security personnel of the hospital, often at the expense of other patients requiring care.
An overdose of an opiate, whether from illicit heroin or prescription medication, attacks the part of the brain that regulates respiration, causing breathing to become slow and shallow. As breathing slows, levels of carbon dioxide in the body are elevated, further slowing and ultimately stopping the breathing and heart rates.
Peaslee said that when patients reach the emergency room the immediate priority is to restore their breathing. Those transported by ambulance have been administered Narcan, or naloxone, a medication that reverses the effects of the opiate, by emergency medical technicians. Others may be brought to hospital by friends, in which case Peaslee said that medical staff will administer Narcan in the parking lot.
Peaslee explained that once treated with Narcan, patients go into immediate withdrawal, which may prompt them to become restless, and violent. Dr. Fred Jones, medical director of the emergency department, recalled patients whose lives were saved turning on physicians and nurses to charge "you ruined my high" or "you just wasted my money".
Consequently, Peaslee said that at least three and sometimes four nurses are required to attend patients during the first 30 minutes after their arrival and added, "we almost always have security on hand. You can imagine," she continued, "what happens when we have a couple of trauma cases and a girl drives up with her boyfriend in the back seat barely breathing."
Bill Losefsky, chief of security, said that he has two full-time officers on duty 24 hours a day, seven days a week, at least one of whom is generally required to assist with overdose patients, especially those brought to the hospital by friends. He said that the clinical staff may order that a particularly difficult patient, who is deemed a danger to self or others, be placed on watch and confined to the hospital, requiring the presence of a security officer for "what could be hours, says or more than a week. I have half my staff watching one patient," he said.
Once a patient is breathing, clinicians take their medical history and monitor their vital signs. Peaslee explained that this process can be challenging with addicts undergoing the effects of immediate withdrawal, which may be accompanied by restlessness, nausea, vomiting, fainting and other side effects. "We're scrambling to get information," she said. "It's labor intensive and kind of a puzzle that takes more time and effort with these patients."
Peaslee said that patients usually remain in the emergency room, where their condition is monitored by a nurse, for two or three hours. Those she described as "straightforward" may be discharged home, some may be held overnight and others with complicating medical conditions may be kept longer. "The outcome varies on a case-by-case basis," Peaslee said.
At peak times, seven or eight nurses, one or two medical technicians and two physicians will be on duty in the emergency department, but Peaslee said that at 3 a.m. there may be only three or four nurses and one physician on hand. She said that patients present with overdoses at random times. "They always require a significant amount of our available resources, but they are incredibly taxing when our staff is lean," she said, adding that overdose patients often lengthen the waiting time required of other patients needing emergency care.
Before patients are discharged they are given advice about the nature of their addiction and what steps they can take to address it. "It happens every time," Peaslee said. "We always want to present the opportunity for recovery and steer them in the right direction," she said. She added that the clinical staff offers to connect patients with the appropriate social services and drug counselors and will follow-up with the patient.
Dr. Jones noted after patients' lives have been spared is an opportune moment to have a chat about the risks of substance abuse, encourage them to seek treatment and refer them to an appropriate facility. While the staff of the emergency room can spare lives for the moment, he noted, ultimate survival hinges on a successful regimen of treatment and recovery.