Jaime Gallaher and Michael Lunden demonstrate advanced training offered by TRU's Simulation-Based Learning Centre on giving CPR and naloxone.
Training in the life-saving use of naloxone for people experiencing an opioid overdose has been offered at Thompson Rivers University (TRU) since the drug crisis emerged. But naloxone alone isn't always enough. In situations where the person has no pulse, cardiac arrest is common, requiring immediate CPR but the signs of cardiac arrest in an overdose situation are hard to recognize.
One of many tragic headlines in the news, an overdose death at another university campus caught the attention of faculty member Jamie Gallaher at the TRU School of Nursing's Simulation-Based Learning Centre when she recognized the student as the daughter of a former emergency room colleague in Vancouver. The 19-year-old and her roommate were found unresponsive in their dorm room by fellow residents, who called campus security and 911. Both were given naloxone to counteract the opioids, but this student was also suffering full cardiac arrest, which was missed by the responders and 911 operator.
"After reading that, I felt we had a duty to respond," says Gallaher. "Naloxone training has been done historically here and done very well through the TRU Wellness Centre. The thing I hoped we could provide was education around what does cardiac arrest look like and how to respond to it if someone has progressed to that state."
The team at the Simulation-Based Learning Centre developed a new advanced training session in CPR and naloxone specifically for non-medical participants, including how to recognize cardiac arrest in someone experiencing an overdose and how to safely administer both CPR and a naloxone injection.
Giving back to community
Using the high-fidelity simulators (computerized manikins) and other resources of the centre's simulation labs, as well as live actors, the intensive three-hour session immerses participants in a hands-on learning experience that vividly mimics real life. And it's free for members of the TRU community and the public.
Simulator manikins give participants live feedback onscreen on effective CPR technique.
"A big mandate of our simulation program is to make use of our simulation resources during any downtime, for both the university and community," says centre Director Michael Lundin. "Our doors are open to health care simulation education opportunities and really giving back to the community that supported the program being here."
The centre's manikins have computer readout displays that show the effects of CPR technique with a clear visual for hands-on practice. The manikins can demonstrate symptoms that a healthy live actor can't replicate, like signs of cardiac arrest loss of pulse, abnormal breathing or pinpoint eyes as well as recovery, including the disconcerting sounds of a reviving patient vomiting or screaming.
Participants get practice with the manikins recognizing the signs of cardiac arrest and feedback to administer CPR effectively, before naloxone is given. Gallaher says the signs of cardiac arrest that most people would expect are masked or mistaken during an overdose. Cardiac arrest in woman patients also presents differently than in men, increasing the chances it won't be recognized in time.
"In many cases, people think that they're just having a seizure, but really what's happening is that there's such a dramatic loss of oxygen to the brain that it causes seizure-like activity. People also think that abnormal breathing means that they're breathing but it's actually not adequate breathing, it's called agonal respiration, and that is a telltale sign of cardiac arrest in about 30 per cent of patients who do not have a pulse. It's something that is difficult to identify, which is why we wanted to design some education around it before jumping into simulation."
Hands-on, immersive experience
The participants also learn with a live actor as their patient. The learning team sets the scene in their simulated apartment, a furnished bachelor suite with a kitchen and bed, belongings and the potential for tight spaces. This part of the session is immersive and intense. Participants learn there can be safety concerns and need awareness of their surroundings.
"The live actor was a phenomenal piece," says Gallaher. "They woke up a little bit aggressive, and that was also a teaching point that you have to sometimes be careful when you do reverse opiates in certain people, that they can wake up quite angry. So you have to be mindful of body position and where you're situated if you're in a small room, and recognize how to speak to people who have just woken up and might be initially confused and somewhat agitated as well."
The first group to take the advanced CPR and naloxone training were student wellness ambassadors co-ordinated by the TRU Wellness Centre on Aug. 30. The students were grateful for the realness of the experience and started the academic year feeling much more prepared to assist campus or community members in a time of crisis.
Wellness ambassador Anzhelika Mostovshchikova found the training highly relevant. "I felt great impact personally, and in my work as a community advisor at North Tower residence. I felt empowered to carry this knowledge on in my professional work and life."
As a community advisor at North Tower, Mostovshchikova supervises a team of residence advisors. Following the training session, she collaborated with the School of Nursing and the Wellness Centre to bring a shorter version of the naloxone and CPR training to the North Tower. Called Safety Spells, the Oct. 22 event was attended by 107 North Tower residents and advisors. The Wellness Centre supplied kits and training on naloxone injection, while the Simulation-Based Learning Centre brought its manikins for CPR training on site. Mostovshchikova plans to run the residence event again next semester.
Free training, equipment part of opioid response
The simulation centre invites interested groups from the campus and Kamloops community to request their free training. Contact the centre at simulationteam@tru.ca.
Initiatives across TRU support the province's Overdose Prevention and Response Guidelines for BC's Post-Secondary Sector. On the Kamloops campus, all automatic external defibrillator (AED) wall cabinets now include nasal naloxone. Additionally, 21 naloxone-specific cabinets have been installed in student residences. This means nearly 50 locations on campus are equipped with emergency life-saving supplies.
In recognition of National Addictions Awareness Week, all students, staff and faculty are invited to an online lunch and learn on Nov. 27, brought to you by People and Culture - Workplace Well-Being in partnership with Interior Health: Understanding Addiction and Substance Use Services.
