The Laingholm First Responder's
Review Of Alcohol And Other Drugs
First, the usual disclaimer. This document is not a guide
as to where the best drugs can be got. It is written by someone who is
not trained to give medical advice, as a training exercise for the Laingholm
Volunteer Fire Brigade's first response unit. It is only on the web because
it amuses the author to put it there. If you want real medical advice,
go to a real doctor.
Definition
The St John's literature defines a drug
as "any substance which, when taken into the body, alters its function
physically and psychologically." This covers just about everything from
a bar of chocolate to heroin, so we'll try to classify them into more convenient
categories a little later. But first, some fun stuff.
A Practical Example
At the Fire Station, two drugs are commonly
used: Nicotine and alcohol. The former illustrates very well the long-term
effects a drug can inflict upon a person. Merely watching brigade members
as they fiddle nervously with hand-rolled ciggies and slope off out the
back door for a quick smoke show us that they are as addicted to their
drug of choice as any addict on junk row. The nicotine has changed the
way their body works, the most obvious symptom being their mood when they
fail to get their fix. Without it the nicotine addicts feel down; nicotine
is a stimulant.
Alcohol beautifully illustrates the short-term
poisoning that a drug can cause. Compare the guest at the Xmas party sucking
on their fourth Stella Artois bottle with the member of the brigade's duty
crew. The duty crew member is talking quietly, drinking orange juice and
eating a chocolate fish. The other, having failed to hold onto previous
the bottle, is staggering slightly, making wild gestures which shower onlookers
with beer, and after a few more bottles, a shot or three of bourbon and
uncoordinated boogie on the dance floor will probably make a multicoloured
phonecall to Europe. The symptoms they are suffering from - confusion,
altered response, altered behaviour, aggression, loss of inhibition and
an inability to understand new information - are basically identical to
a head injury. As it happens, this is exactly what has happened to them.
The alcohol is damaging their brain and depressing its normal function.
It's a depressant.
Classifying Drugs
The three classes usually used in literature
when referring to "drugs" are limited to the ones used for recreational
purposes. These are uppers, downers, and trippers. More correctly, they
are depressants, stimulants and hallucinogenics. We can get very confused
trying to determine what a patient has taken by asking what it was. The
reply may be wildly inaccurate due to dubious advertising practices and
cutting, or the response may be ambiguous. For example (and this sparked
an interesting debate at the station one week) take the word "cone". The
person in question was referring to a small amount loaded into a bong.
Amongst French speakers, "cone" is a generic term for marijuana; a Jamaican
will tell you it is a joint shaped like (and with similar effects to) a
club, while a Pom may tell you that it's a fragment broken off a bud. None
of the others will recognise "Dak" as meaning cannabis. So we may have
to record the effects of the drug to give clues as to what it actually
was.
Users frequently mix many drugs, and
they affect each other in a 'synergistic' way; they may make each other
worse. Drugs that cancel each other out like morphine and narcan are said
to have an 'antagonistic' effect.
Depressants
These slow you down, generally by affecting
the central nervous system - they make you feel drunk, and eventually knock
the user out. If they vomit while unconscious, they will be unable to manage
their airway. Sleeping tablets are often taken in deliberate overdose,
and aside from their toxic effects will do a similar thing. It is important
to find out if drugs have been mixed, particularly with barbituates. Depressants
include:
Alcohol
Heroin
Homebake (impure morphine made from
codeine)
Morphine ('Misty')
Marijuana
Solvents and hydrocarbon propellants
GHB ('Fantasy', aka CD cleaner)
Sedatives such as Zopiclone and barbituates
Stimulants
Uppers, so beloved of truck drivers. These
speed you up, or from your perspective, slow the world down. The user will
generally be somewhat animated until they consume the drug in excess and
toxic effects take hold. Even coffee is toxic in excess, although extreme
measures need to be taken to get that much coffee into the body before
diuretic effects cause it to leave the body. Tobacco is occasionally consumed
or used rectally, in which case the amount of nicotine in a single cigarette
can cause problems, and may even kill. Ecstasy users tend to under- or
over-hydrate as well as freak out. Examples of stimulants include:
Caffeine
Nicotine
Amphetamines ('Speed', 'Dex')
MDMA ('Ecstasy')
PMA (paramethoxyamphetamine)
Cocaine ('Uncle Noriega's Favourite
Nose Candy')
Hallucinogenics
These stuff up your sense of reality. The
user may well be confused, and will frequently need calming down. They
may be experiencing a 'bum trip" - a frequent reason for calling out the
emergency services, as the user may be convinced (rightly or wrongly) that
they have poisoned themselves . They may well be somewhat paranoid and/or
incoherent. Dope won't kill them, but things they've mixed it with might.
Likewise, the toxic dose of psylocybe and agaric mushrooms is quite high
but there may have been a case of mistaken identity. Datura is occasionally
used to space out dope so it lasts longer, but is a powerful muscle relaxant
- people tend to fall or drown etc. under its influence because they are
not familiar with its effects. Examples of hallucinogenics include:
Magic Mushrooms
(psylocybin)
Datura (Angel's Trumpet)
Morning Glory
Lysergic acid diethyamide (LSD)
PMA
Marijuana in excessive amounts
Action Taken At The Site
If possible, identify the cause of the patient's
condition. Do not assume that because they've got track marks and they're
unconscious that it is a drug overdose. Likewise, do not assume that a
person who has received a blow to the head and is unconscious hasn't been
taking recreational substances. You have to keep an open mind.
Even if the person admits to having been
on the receiving end of a drug and claims to be able to positively identify
it, try to obtain a sample and/or the container if possible. Obviously,
you don't go asking aggressive bikers for a free sample, but if you can
find a nice way of asking then go for it. It will assist the doctors at
the hospital in identifying problems that the patient has; it is not for
adding zip to the next Xmas party. Try to note the quantity taken and times
taken, including any mixtures such as alcohol. If the patient has vomited,
keep the vomit.
Be careful when doing a primary/secondary
survey or searching someone with track marks or has a drug abuse history
for medical bracelets, hospital notes etc., as there may be unpleasant
sharp objects on their person that you don't want to get stuck with. Also
bear in mind that an intoxicated patient may not be aware of the full extent
of their injuries. If they have an altered state of consciousness, remember
that we cannot administer Entonox for pain.
Fortunately, the patient care aspect
for the First Responder remains the same for drug overdose and intoxication
as it does for any other patient in similar circumstances. We don't judge,
we don't diagnose, we treat what we see. We take vital signs (including
state of pupils), history, and do our SRABCS, trying not to unduly upset
the patient and keeping them under constant supervision.
In Summary
Be professional, calm, reassuring and sympathetic.
Sometimes hard at 2am, I know.
Safety is, as always, our primary consideration.
Gloves, caution with sharps, and care when encountering body fluids are
the obvious ones. A potentially unbalanced patient and friends may also
constitute a safety hazard.
Make sure inebriated bystanders do not
also become victims themselves, wandering into traffic and so forth. Move
the patient somewhere quiet if necessary. If they are having psychological
problems, this is a very good idea.
Get a history, and do a thorough exam
from head to toe, treating as necessary. Advise ambulance if the patient
is in a critical condition, or if they are deteriorating.
"Not all chemicals are
bad. Without chemicals such as hydrogen and oxygen,
for example, there would
be no way to make water, a vital ingredient in beer."
- Dave Barry