09. p. dargan - improvement in the recognition and assessment of acute drug toxicity .... p... ·...
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Improvement in the recognition and
assessment of acute drug toxicity in
the pre-hospital environment
Dr Paul I Dargan, Dr David M Wood
Clinical Toxicologists
Guy’s and St Thomas’ NHS Foundation Trust
London, UK
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‘Classical Drugs’ Clinical Classification
Stimulants
Hallucinogens
Depressants
AmphetaminesMDMA (‘ecstasy’)
Cocaine
Heroin, opioidsBenzodiazepines
GHB
LSDPsilocybinKetamine
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NPS Clinical Classification
Stimulants
Hallucinogens
DepressantsPiperazinesCathinones
Synthetic cocainePipradrolsIndanes
Benzofurans
GBL, 1,4-BDNovel opioids
and metabolites
GlaucineKetamine analogues
TryptaminesSynthetic cannabinoids
Salvia …
Usually appropriate, some have additional or
‘crossover’ toxicity
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Pre-hospital acute drug toxicity
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Pre-hospital acute drug toxicity
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� Many individuals just need reassurance in a calm
environment
� But potential for severe toxicity and life-threatening
clinical features
– GHB: coma with aspiration risk
– Sympathomimetics: hyperpyrexia, seizures,
psychosis
– Cocaine: chest pain
� 2005: delayed transit of patients to hospital
Pre-hospital acute drug toxicity
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London Pre-Hospital Guidelines Project
� February – August 2006
– Guideline development: clinical toxicology, ambulance
service, ED; support from police
– Training programme for club ‘medics’
� September – October 2006
– Implementation and audit of the referral guidelines
� December 2006 - March 2007
– Revision & implementation of finalised guidelines
AIM:
Early identification of those at risk: simple clinical assessment
Guidelines on when to call an ambulance
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Equipment
� Quiet area
� Bed or stretcher
� Thermometer
� Clock with second hand
� Sphygmomanometer
� Cold water for drinking
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Nightclubs get NHS drugs advice
Nightclubs are being given guidance from NHS specialists on spotting the symptoms in someone who may have taken drugs and
when to summon medical help.
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Adaptation to a European Context
� Different models of pre-hospital care across Europe
� EMCDDA funded project in 2011
� Internet based review of UK guidelines
1. Guideline components
2. Facilities needed for initial assessment / care:
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17 countries responded to survey
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Next Steps
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European Drug Emergencies Network Euro-DEN
� European Commission DPIP project 2013-2015
� Workstream 1 (David Wood this afternoon …)
– Systematic collection of data on European
Emergency Room Admissions with acute
recreational drug and NPS toxicity
� Workstream 2
– Training and guidelines for staff in recreational
settings to respond to drug related incidents
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Euro-DEN pre-hospital training� Development of training package
– Interactive package for staff in recreational
settings and updated referral guidelines
– Recognition of acute drug toxicity including NPS
– Pre-hospital assessment guidelines
� Feasibility study to deliver training
– London, UK; Oslo, Norway; Mallorca, Spain;
Brno, Czech Republic
– Qualitative feedback
� Finalised training package and guideline
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Conclusions� Pre-hospital acute drug/NPS toxicity is common
� Data collection in pre-hospital environment
� Different patterns to hospital cases
– Mild-moderate: reassurance, observation
– Severe: fast-track for hospital assessment
� EMCDDA project 2011
– UK guidelines adopted to European context
� Training of staff important
– Awareness of drug toxicity and assessment
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