Question: We have been trained on the Opioid Toxicity Medical Directive and the educators reiterated to use it as a last resort because of the potential for violence. I understand their concerns. I also appreciate these kits are out in the public for use and our skill set should continue to exceed that of the layperson(s). However, I wonder why not consider expanding the king LT insertion medical directive to include GCS = 3 for PCPs? This would allow safe and effective airway management of suspected overdose patients (or other GCS = 3 patients), even in situations of long transport times. We already preform this task in situations where a ROSC is obtained. We are familiar and proficient with the equipment and there is no additional cost to the services.

First, to clarify, PCP King LT insertion should only be attempted in a patient that is in cardiac arrest. It appears that you are referring to the exact scenario where application of the Opioid Toxicity Medical Directive is most applicable. A patient with a GCS 3, inadequate respiratory drive, difficulty to adequately ventilate and requiring airway intervention is the very patient we would recommend treating with naloxone. Utilizing naloxone in this patient population avoids the risk associated with additional airway interventions such as the King LT including airway trauma, vomiting and aspiration.

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