Expiring Revive! kits

Expiring Revive! kits

Question
If you are checking off your ambulance and you notice that the naloxone (Narcan) in your Revive! kit has expired, what should you do?

Answer
Remove the expired Revive! kit from the ambulance and return it to your station officers.  It has served its purpose and is no longer needed.  Naloxone and a Mucousal Administration Device (MAD) are now available — even to BLS providers — in the  orange IV box .  If you are a BLS Provider and you are unfamiliar with how to access the  orange IV box  yourself, check with your station officers.  A Revive! kit may still be kept on the ambulance if all its assigned pieces are present and if the naloxone is still in date, otherwise it should be retired from use.

Rationale
Back when naloxone was only stocked in the  red drug box  (which is only supposed to be opened in the presence of an ALS provider), the Revive! kits were added to the ambulances as a way to make naloxone available to BLS providers.  Eventually naloxone was added to the  orange IV boxes , which BLS providers are already authorized to open.  The Revive! kits are now essentially redundant.

The Revive! kits (without the medicine) were a one-time donation to us by the Virginia Department of Health.  The Department used a one-time funding source to buy the naloxone to complete the kits.  Continuing funding was not identified, nor was it considered necessary because the Department knew that the  orange IV boxes  would be reconfigured soon.

Bonus material
If you’re thinking of giving naloxone, what else should you be doing?  Oxygenating the patient, preferably by positive pressure (bag valve mask).  Don’t forget that hypoxia is the dangerous part of opioid overdose, caused by respiratory depression.  Bagging the patient with high-flow oxygen is your way of directly addressing the hypoxia.  Naloxone counteracts the opioid in the patient’s nervous system to reverse the respiratory depression, and this should eventually allow you to stop bagging the patient.