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