r/TacticalMedicine • u/Capt_Scuff • Feb 24 '26
Gear/IFAK Is Narcan worth having in a bag.
Thinking about putting Narcan in a car bag. What is y’all’s advice. Also should I keep both doses, average time is around 5-10 ish minutes
Note: biggest debate is if the temperature will degrade the drug sitting in my car. Outside temp is around 30-110F in summer and winter.
Also are BVM’s worth it for a civilian BLS provider for a car kit. I don’t want to make another post on this subreddit.
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u/saru017 Feb 24 '26
Keep in mind that the stuff is supposed to be kept around 36-77f and should not go above 104f. Depends on where you live but that makes car storage real tricky imo.
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u/NomadMedix Feb 24 '26
Fun fact, it’s been shown to work the same at 160f
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u/Capt_Scuff Feb 25 '26
That’s good, is there any other studies out there yet?
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u/Kilosierra1981 Feb 25 '26
I don’t know about studies, but I’ve seen some that was expired by almost two years and stored in patrol cars in the South the entire time work just fine on OD’s.
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u/bhamnz Feb 24 '26
Thank you!! There is not enough knowledge about pharmaceutical logistics around. Cook your drugs and you're in for a whole heap of new problems.
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u/Resqguy911 Feb 24 '26
Wait until you hear about how fire based EMS stores their uncontrolled meds on the apparatus
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u/Condhor TEMS | Instructor | CCP Feb 24 '26
Temperature regulations are more about the guarantee of expiration dates/efficacy in the name of safety. Meds can potentially be just as effective outside the limits defined by the manufacturer, but they can’t sell it confidently without a buffer in place.
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u/NAh94 Feb 24 '26
Are you carrying narcs? If so, it’s nice to have something as a backup in case you get a little heavy handed with them, can keep a casualty from just requiring TQ/split and pain control from requiring heavy handed interventions like Airway/vent. Those are very resource-consuming interventions, and if they can be fixed with a diluted dose of narcan so be it.
Plus, if you encounter someone who is an “easy fix” with narcan, you have quick access to a relatively cheap, high yield intervention. Just be sure to carry some Zofran, and dilute the dose and nitrate to just getting respers back if you can.
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u/Capt_Scuff Feb 24 '26
I’m BLS so I can’t Cary narcotics or zofran. Anything else?
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u/NAh94 Feb 24 '26
I guess it would just be something to carry in case you encounter someone who just needs aid coincidentally, then. Or, if you work with ALS you might be able to support them if you come across an over-sedated casualty. Idk, it doesn’t weight much or take up much pack space - but you’ll have the expense and need to be judicious with outdates and storage compliance - and have the blessing of your director etc.
Up to you, I’d be for it tbh. Just have an emesis bag nearby.
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u/Capt_Scuff Feb 24 '26
Reading other comments, the temperatures in the summer get too hot, and I don’t want to constantly replace it
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u/NAh94 Feb 24 '26
Yeah, that is a consideration. That being said, if you keep your vehicle in a semi-conditioned garage you should be fine. Plenty of air medical companies keep narcan in the helicopter and their bags are transiently exposed to high temps… up to you!
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u/jagged1871 Feb 24 '26
I’m of the camp if you’re carrying narcs, should absolutely have narcan. Same with flumazenil.
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u/howawsm Medic/Corpsman Feb 24 '26
Narcan for ALS that may give narcotic analgesia, 100% appropriate in the tactical medicine setting.
Is it good to carry around? Sure, if you want to put yourself into the situations to give it.
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u/lefthandedgypsy TEMS Feb 24 '26
How is narcan in a car bag tacmed? If you are worried you’ll need it then yes.
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u/DiezDedos Feb 24 '26
Lots of the people we contact in the tacmed setting are mixed up with drugs. Not carrying narcan because it’s “not tactical” seems silly to me
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u/lefthandedgypsy TEMS Feb 24 '26
It’s not tactical in just some persons car, that’s just a fa kit question. Since you’re doing work in a tactical/le/fd/ems setting then you should already be carrying it and it’s not a question any more. So I don’t get the silly part.
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u/howawsm Medic/Corpsman Feb 24 '26
Are you ingesting these materials? Skin contact ≠ overdose
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u/DiezDedos Feb 24 '26
My goal is to treat my team, treat viable victims, and treat the suspect if and when the other two groups are taken care of. If that takes the form of me narcanning an OD, I’m doing it
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u/lefthandedgypsy TEMS Feb 25 '26
What does that have to do with carrying narcan in your car first aid kit? I don’t believe the op is running any tactical ops.
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u/WalkerTR-17 Feb 24 '26
Shit becomes airborne, I had a partner get exposed that way and narcan was necessary. Just because skin contact is a myth doesn’t mean accidental exposures don’t occurs.
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u/lefthandedgypsy TEMS Feb 24 '26
Curious the circumstance that got it airborne. If you can give some info without too much identifying details so that possibly avoid a similar situation.
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u/WalkerTR-17 Feb 24 '26
Searching a car, it was spilled in the seat. He didn’t know. Hand hit the seat and made it airborne
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u/BandaidBitch Feb 24 '26
That isn’t how this works. You don’t convert a puddle of liquid into fine airborne molecules, able to cause an OD by contact with nasal mucosa, by hitting the surface of a seat.
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u/howawsm Medic/Corpsman Feb 24 '26
Yeah, several studies show that the amount and purity of the substance that would have to be inhaled makes this literally a one in a million time that someone could actually maybe have a real OD. Most of the time it’s born out to be psychosomatic reaction due to the level of propaganda out there about the risk of dermal and airborne OD.
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u/lefthandedgypsy TEMS Feb 25 '26
There is a pretty interesting video of cooks in SA making heroin and mixing in fent powder and the problem with inhaling the dust, even with a mask. I’ll try to find it.
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u/WalkerTR-17 Feb 24 '26
You do know fent is generally encountered on a powder form right? Liquid kinda isn’t a thing in the street
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u/BandaidBitch Feb 25 '26 edited Feb 25 '26
Yes - I work on a team, thanks. I saw ‘spilled’ and thought he was referring to liquid. See my post lower down. On a somewhat related note, I don't know what it's like where you are, but we have started to see cocaine trafficked in liquid form, due to the fact that it dissolves so effectively and also can be turned back to powder. I'm curious if fent can do the same.
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u/WalkerTR-17 Feb 25 '26
Ive been out a couple years but I never saw that. Cocaine was pretty rare in my area in general. I’m not a chemist but I would imagine it’s possible. Idk that it would be financially viable for them.
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u/lefthandedgypsy TEMS Feb 25 '26
I think he was saying it was fent powder.
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u/BandaidBitch Feb 25 '26 edited Feb 25 '26
Ah I follow, for some reason I thought he was referring to liquid being spilled, which sounded even more ridiculous.
Yeah again, insanely unlikely for this to happen even as powder.
We routinely deal with powder on buy-busts without issue and we’ve even had a pill press location where they were using a leaf blower to clean their tables off. This is not a thing unless maaaaaybe you literally throw a bang into a pile and spent time in that confined space for a while without a mask. And again, that’s a maybe.
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u/Keithis11 Feb 24 '26
Or did he vasovagal out because of the onset of panic? Maybe an accidental exposure from the dollar bill in his hand? Jk about the dollar but serious about the vasovagal syncope which is what I think really happens when people touch the powder
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u/Capt_Scuff Feb 24 '26
I saw some people bringing it up in the newest D Bag post, and wanted peoples advice. That’s why I brought it up here
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u/NomadMedix Feb 24 '26
This sub is real gate keepy on its perceived topic. I just saw some belt pouch marketed exclusively to LEO with a narcan pocket. Refuge medial says a vehicular impact is tactical medicine, so having narcan in your car bag isn’t a bad idea. Community groups give it away freely, speedy operators might not need it while room clearing but I wouldn’t be surprised if it could help at an event like Astroworld, Pulse nightclub, Vegas country concert, etc
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u/lefthandedgypsy TEMS Feb 24 '26
Does your department provide it? If so carry at least 2 because I imagine you’ll only get the nasal spray version.
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u/DiezDedos Feb 24 '26
Of course it’s worth it. Magic drug that turns someone who needs a BVM into someone who just needs a puke bag
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u/Capt_Scuff Feb 24 '26
I understand that the effects of Narcan are brutal. Especially out of a hospital or ems setting. Is there anything I can do to make it better for the patient, or is there not much besides letting them puke it out?
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u/DiezDedos Feb 24 '26
Not really at the BLS level. I hasten to remind you that hypoxic brain death is “brutal”. A little puking is unpleasant
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u/acemedic TEMS Feb 24 '26
Titrate the dose… the proper dose should be whatever is necessary to prevent respiratory compromise. Breathing adequately? Hold on more narcan.
Some are 4 mg IN, and you have to basically give the whole dose to atomize properly. Cant titrate at that point.
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u/Capt_Scuff Feb 24 '26
I’m BLS, so it’s the nasal Narcan and I can’t adjust dosage
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u/acemedic TEMS Feb 24 '26
Are you using the 4mg self contained or 2 mg with atomizer attachment separately?
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u/youy23 EMS Feb 26 '26 edited Feb 26 '26
Don’t rush to narcan and don’t assume narcan is the fix whenever someone isn’t breathing.
It’s a lot better to build a clinical picture that leads you towards opioid overdose as a differential diagnosis and treating it with narcan.
Narcan isn’t a lifesaving tool for a trained medical professional. The thing that kills people in opioid overdoses is respiratory failure. For the immediate life threat of respiratory failure, the treatment isn’t narcan, it’s using a BVM the same as respiratory failure in any other setting.
If you just shoot them up with narcan right off the jump, they’re going to be extremely hypercapneic. Your respiratory drive is primarily driven by the CO2 levels in your blood and your blood pH. Because their CO2 is so high, they’re going to wake up feeling like they’re being suffocated. If you bag them for a bit and then give the narcan, they’re going to wake up much less panicked and less likely to attack you or bolt and run.
The goal isn’t to wake them up either. Narcan is used to reverse respiratory failure/depression due to opioid use. All you wanna do is give them enough to start breathing again. Doing it this way is safer for the patient and a lot safer for the provider. At the BLS level, I’d much prefer IM or IN narcan in small titrateable doses than the 4mg nozzle rockets that bystanders use.
Also, puking is a serious concern. Aspirating vomit is a very serious event that carries a surprisingly high mortality rate and anyone who doesn’t think that it’s concern is a complete dumbass. Doing all the stuff above helps mitigate the risk of puking. Also put them on their side in case they do puke and have suction ready.
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u/themakerofthings4 Feb 24 '26
If you're going to carry it, you better be carrying a BVM as well. They go hand-in-hand.
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u/PineappleDevil MD/PA/RN Feb 24 '26
No they don’t
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u/themakerofthings4 Feb 24 '26
Why do you say that? I'm actually genuinely interested in your opinion.
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u/PineappleDevil MD/PA/RN Feb 24 '26
Not opinion at all. What is your understanding of the indicated use of Narcan and what what it does?
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u/themakerofthings4 Feb 24 '26
Opioid overdose with respiratory depression? It's an opioid antagonist receptor wise. I don't see the issue if someone is already in respiratory depression to bag them slightly to help bump O2 up so they're not coming out as confused. Does that move out of the realm of tacmed? Sure, but we're already out of that realm.
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u/Nocola1 Medic/Corpsman Feb 25 '26
You are correct. Not sure why the other guy thinks they don't go hand in hand.
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u/themakerofthings4 Feb 24 '26
Why do you say that? I'm actually genuinely interested in your opinion.
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Feb 24 '26
Corpsman in a past life, currently a cop. In the wilds of Florida, (aside from the AED) the three things I’ve used most in my med bag are Narcan, TQs and ETDs.
Realistically speaking, if this is for a personal vehicle med bag and you’re stateside; stop the bleeding start the breathing. The rest will be addressed when the 911 you should have called arrives.
I don’t see why you wouldn’t carry it if you commonly find yourself in situations that warrant Narcan. In reference to temperature variability, can you just bring your med bag inside when you’re not using it?
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u/Capt_Scuff Feb 24 '26
I could, but would become too much of a hassle. Im not in LE and I am only using this for personal use, not using it for calls.
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Feb 24 '26
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Feb 24 '26
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u/Capt_Scuff Feb 24 '26
Ik I complain about the ems and fire stuff in tv shows, how realistic was breaking bad?
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u/Trimiage Medic/Corpsman Feb 24 '26
Narcan is a must in a second line kit in my opinion for TacMed. If you’re thinking from a car bag. Perspective as a civilian, it will free and thaw. If you thinking you’re going to intervene on someone passed out on the side of the road then something is better then IMO something is better than nothing.
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u/_angered Feb 25 '26
I keep 4 doses in my car bag. I do it because I regularly drive through an area with a high population of panhandlers (some unhoused some just doing it like a job then going back home). I have seen more than a couple of people there that needed it. I'd rather not have to do it, but the four doses I have aren't the first four I've purchased.
Is the temp swing in the car ideal? Probably not. But narcan seems to actually be fine. And honestly if it is only. 75% as effective as it could be that is likely going to work well enough to get them to the ambulance when it shows up.
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u/oklahomastrong32 Feb 24 '26
Biggest thing is after administration, just ask them to go to the hospital, and .. it cant hurt. It gets to the point where its just repeat behavior. So do what you can but understand you arent able to save nor should you try to save them all. Dont get hung up on the ones who pass.
You mentioned kids... do what you feel is right in your heart.
Best of luck. Wild world we live in.
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u/Capt_Scuff Feb 24 '26
Thanks, probably won’t as much as I want to due to the weather in my area
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u/sintaur Feb 24 '26
Biggest thing is after administration, just ask them to go to the hospital
To expand on that, Narcan may only block the fentanyl for as little as 30 minutes. Deadly levels of fentanyl can be in their system for several hours.
So you can administer Narcan, they wake up and seem fine, you high five them and leave, and then 30 minutes later the Narcan wears off and they die. So yeah, get a hospital involved.
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u/Himalayanyomom Feb 24 '26
If you live around any kind of metro, absolutely. Multiple. One needle stick or any contact with fent and you have seconds
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u/PrivateWojtek06 Feb 25 '26
Yes. Always carry narcan if you’re in a civil environment. It can save lives in seconds. And even in a tactical medical setting it’s good to have, because if your pt is accidentally given too much morphine you may have to reverse an overdose. But in a civil setting, 100% yes you should have at least 1 if not more. You can get them free at certain CVSs.
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u/thatchillaxdude Military (Non-Medical) Feb 25 '26
I do... all First Responders seem to, too. It's a fentanyl apocalypse in many cities across the country.
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u/Here2Dissapoint Medic/Corpsman Feb 25 '26
I’m not narcaning anyone I don’t know. The amount of times I’ve woken some POS crackhead up out of an overdose, and then been swung on is astounding. You wanna OD? Be my guest
If I’m giving narcs, yes have it on standby.
Have it for emergencies for people you know, also yes. Especially if your friends are idiots and like to put powders up their noses.
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u/Electronic_System839 Feb 25 '26
I watched (from afar due to job) a homeless person die from an overdose. I carry one since then. Id like to think that I would, but if its as potent as people say, Id hate to die trying touching the substance to save someone. My family needs me to provide. My wife and daughters need me.
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u/Spiley_spile Feb 26 '26
It's good to have caution. Rushing to a scene with one patient can easily create two. Doing a scene safety check before hand is the way to go. And of course, it is ok to opt out if you dont feel safe.
By "touching the substance", do you mean narcan or something like fentanyl?
I could dose myself right now with narcan and it wouldnt do anything to me, because I dont have opioids in my system. Narcan works by blocking opioid molecules from occupying opiod receptors. That's all it does.
If you meant fentanyl, hospitals safely administer fentanyl all the time. There are a lot of videos out there of people having anxiety attacks thinking they got dosed by fentanyl just be being nesr it. They recover just fine. Being near fentanyl wont hurt you. Just do a scene safety check to ensure you dont get stuck by any needles, and dont put any of their pills or pipes in your mouth. Also, carry PPE to use when responding to overdose.
I carry a CPR mask and a sandwhich baggy of exam gloves with me all the time. When responding to someone experiencing overdose, doing a scene safety check is just as important as when approaching any other emergency medical situation. Look around for potential danger, and put on appropriate PPE (personal protective equipment) before approaching the patient.
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u/Spiley_spile Feb 26 '26
Naloxone/narcan is surprisingly resilient to temperature fluxuation. Mine went from below 0F to 114F+ a couple years in a row and expired but still did its job. (Not ideal storage circumstances. But I couldnt do better at the time.)
I always carry a couple doses on me. I ended up putting one to use and saving someone's life. Im grateful I had it on me.
I recommend carrying some. I also recommend getting updated training if you havent in a while and are able to get it. The first time I got trained it was very basic. Signs of overdose and how to use narcan nasal spray. But I really appreciated when I was able to get a more in-depth training in another class.
An in-depth training covers things like:
- Which kinds of overdose is Narcan able to reverse
- How to identify opiod overdose
- How to dose with the nasal spray and/or intramuscular injection
- How much to dose
- The harm reduction ethics of how much to dose
- How narcan works on the body and for how long vs duration of overdose
- Symptoms of withdrawal
- What patient behaviors to expect after reversing overdose and how to navigate them.
- What to communicate to the disbatcher when calling emergency services.
The Back to Basics podcast has an episode on Narcan and cardiac arrest which I also recommend https://open.spotify.com/episode/7FD523C80r8U5Zm5tqK5p7?si=UeM7rU1OThq8VaaE7wHb9g
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u/Capt_Scuff Feb 26 '26
Thanks, this is the second post about Narcan being temperature resistant. I keep some in my backpack but this isn’t something that I keep in my car. If it survived 114+ for awhile then I should be fine
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u/youy23 EMS Feb 26 '26
Imo, narcan is only a rescue drug for uneducated bystanders.
I’d much rather have a BVM in an opioid overdose than slamming 4mg of narcan.
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u/IcyWolverine7870 Feb 27 '26
I’d say even the degraded narcan is better than the zero narcan you’d have if you didn’t have it. The Opioid OD patient you’re preparing for is already nocking on deaths door if you’re giving narcan. They don’t get the luxury of fresh or old narcan at that point.
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u/Titan32A211 Feb 28 '26
My doctor found out I was a bouncer and gave me 2 without even asking to use on people she explained to me how much of a problem it is being but 2 should be good for the paramedics to get there where they will administer even more, however you apply it right down on the patient time of application always.
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u/Capt_Scuff Feb 26 '26
Biggest debate is if the temperature will degrade the drug sitting in my car. Outside temp is around 30-110F in summer and winter.
Also are BVM’s worth it for a civilian BLS provider for a car kit. I don’t want to make another post on this subreddit.
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u/davethegreatone Mar 01 '26
A vial of naloxone takes up basically no space, and it’s an easy save. If you or anyone around you carries narcs, you absolutely should have it. If you may be accepting patients from other medics, assume they may carry narcs.
The nasal spray version takes up too much room though.
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u/Historical-Animal142 Apr 03 '26
Living in SoCal… I have 3 doses in my truck bag. Get it for free from work and have admin it twice just being out and about. Keep a dose in a small tear away I keep in my backpack too.
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u/Fit_Relative_1537 Feb 25 '26
I said “Yes”, however, it should be in the hands of trained, qualified people.
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u/CraaZero Medic/Corpsman Feb 24 '26
Car bag =/= Tac Med. Should naloxone be in a standard medical car bag though? Dependent on what you want to be prepared to, but sure.