08-15 Naloxone

Question 1

What is the Rationale?

Answer 1

Naloxone is a life-saving medication which can be used to temporarily counteract an opioid overdose and prevent an overdose death. In response to an increase in opioid-related overdoses within the City of Toronto, the Toronto Police Service (Service) will provide designated members with Naloxone to assist with life-saving efforts until other medical assistance is available.

Question 2

Supervision

Answer 2

 Supervisory Officer attendance mandatory when
‒ Naloxone is administered
‒ a member is critically injured
 Supervisory Officer notification mandatory when Naloxone is administered
 Officer in Charge – Toronto Police Operations Centre (TPOC) notification mandatory when SIU Mandate is or
may be invoked

Question 3

Procedure - Designated Court Services members with access to Naloxone will adhere to this

Answer 3

Procedure in conjunction with Court Services’ unit specific policies.

Question 4

Fentanyl - Fentanyl is a ______. The potency and toxicity of fentanyl varies significantly, as it is sometimes combined with _____. As it can be skin permeable, ______ of suspected fentanyl and fentanyl analogues is essential to minimizing health risks to involved members.

Answer 4

powerful synthetic opioid that is highly toxic and potentially lethal in small doses

other powdered illicit narcotics and cutting agents

proper handling

Question 5

Fentanyl - Members SHALL seek immediate medical attention, in compliance with Procedure 08–06, NIP if they feel ill and note any of the following symptoms:

Answer 5

 irregular and or shallow difficult breathing,
 confusion,
 seizures,
 dizziness,
 excessive drowsiness,
 headaches,
 pinpoint pupils, or
 nausea/vomiting.

Question 6

Naloxone Spray Kits - The Service will be providing designated members with kits containing _____. Each Naloxone nasal spray kit contains ______.

Answer 6

Narcan® brand (Naloxone) nasal spray

two (2) doses of Naloxone nasal spray (4mg/0.1ml)

Question 7

Naloxone Spray Kits - Naloxone nasal spray requires storage protection from_____. It must be stored between_____. Naloxone cannot be _____ and must be protected from ______.

Answer 7

extreme temperature changes

15 ̊C - 25 ̊C, with brief excursions permitted between 4 ̊C - 40 ̊C

frozen, direct sunlight

Question 8

Medical Oversight - Section 27 of the Regulated Health Professions Act (RHPA) states that controlled medical acts, such as administering Naloxone nasal spray to a person experiencing an opioid overdose, may only be performed by persons who are not

Answer 8

physicians if a physician has delegated that authority to them.

Question 9

Medical Oversight - The Service has obtained a medical delegation from a physician in order for designated members to be able to administer Naloxone to members of the public experiencing an overdose. This medical delegation stipulates that all members being issued Naloxone SHALL

Answer 9

maintain a current Standard First Aid certification. Failure to maintain a Standard First Aid certification SHALL result in the requirement for those members to return their Service issued Naloxone kit.

Question 10

Medical Oversight - The Naloxone Tracking Form text template SHALL be used to track Naloxone use. Any member that attends an opioid- related overdose SHALL

Answer 10

complete this text template in the related eReport forthwith, regardless of whether Naloxone was administered or not.

Question 11

Notification of the Special Investigations Unit -
In instances where police officers administer Naloxone, the Special Investigations Unit (SIU) may require notification if the SIU established injury threshold is met. This may include instances where:

Answer 11

 the police officer used force against the person prior to or after the provision of first aid;
 the person suffered serious injuries or dies while detained by police or in police custody; or
 the person suffered serious injuries or died as a result of a motor vehicle incident involving police or a police pursuit.

In cases where the SIU mandate is or may be invoked, members SHALL comply with Procedure 13–16.

Question 12

Member - Prior to being issued a Naloxone kit, members SHALL complete the

Answer 12

Naloxone training program as required by the Toronto Police College (TPC).

Question 13

Member - When issued a Naloxone kit SHALL

Answer 13

 maintain a current Standard First Aid certification
 Medical delegation under the RHPA stipulates that all members being issued Naloxone SHALL maintain a current
Standard First Aid certification. Members SHALL return their Naloxone kit to their Unit Commander in the event their
Standard First Aid certification expires.
 ensure Naloxone is stored at a temperature that is between fifteen (15) ̊C – twenty five (25) ̊C
 Naloxone cannot be frozen and must be protected from direct sunlight. Naloxone kits SHALL be replaced if exposed
to either of these elements. Brief excursions between four (4) ̊C – forty (40) ̊C are permitted.
 obtain a replacement Naloxone kit, as soon as practicable by completing a TPS 587 and emailing the form to
Fleet and Material Management (FLT) – Hanna, in the event a kit is
‒ lost
‒ damaged, including as a result of exposure to heat or cold
‒ used
‒ expired

Question 14

Member - After administering Naloxone to an overdosing subject SHALL

Answer 14

 immediately notify Supervisor
 complete an eReport, including a Naloxone Tracking Form text template
 In cases where the SIU mandate is invoked, the SIU SHALL collect all evidence. Members SHALL ensure that all Naloxone spray applicators, both used and unused, are properly protected and preserved at the scene, and released to the SIU in compliance with Procedure 13–16.

Question 15

Member - In the event that Naloxone is used on an on-duty Service member SHALL also comply with Procedure 08–03.

Answer 15

Procedure 08–03. NIP

Question 16

Supervisor - When attending the scene of an overdose where Naloxone has been administered SHALL immediately notify the

Answer 16

 Officer in Charge at their division or squad
 Officer in Charge – Toronto Police Operations Centre (TPOC)

Question 17

Supervisor - After Naloxone has been administered, SHALL ensure that a _____ is completed as a part of the related eReport.

Answer 17

Naloxone Tracking Form text template

Question 18

Supervisor - When the SIU mandate is or may be invoked SHALL comply with

Answer 18

Procedure 13–16.

 In cases where the SIU mandate is invoked, the SIU SHALL collect all evidence. Members SHALL ensure that all Naloxone spray applicators, both used and unused, are properly protected and preserved at the scene, and released to the SIU in compliance with Procedure 13–16.

Question 19

Supervisor - When notified that Naloxone has been used on a Service member who has been critically injured SHALL comply with

Answer 19

Procedure 08–03. NIP

Question 20

Officer in Charge - When the SIU mandate is or may be invoked SHALL ensure compliance with

Answer 20

Procedure 13–16.

Question 21

Officer in Charge - When notified that Naloxone has been used on a Service member who has been critically injured SHALL

Answer 21

 immediately notify the involved member’s Unit Commander and the Officer in Charge – TPOC of the particulars
of the event, including
‒the date, time and location of the event
‒the nature of the injury
‒the circumstances that caused the event
‒the injured member’s name, badge, unit
‒the whereabouts of the injured member
‒any other relevant facts
 ensure compliance with Procedure 08–03 NIP

Question 22

Officer in Charge - When directed to retrieve a member’s Naloxone kit, because their Standard First Aid Certification has expired, SHALL return the kit to the

Answer 22

FLT – Hanna.

Question 23

Officer in Charge - When in receipt of a Naloxone kit that has been damaged, used or expired SHALL

Answer 23

 mark the kit with “X”
 return the spoiled Naloxone kit to FLT – Hanna
 ensure used kits are safely and properly disposed of
 Used kits can be disposed of by returning to FLT – Hanna or can be disposed of at any local pharmacy

Question 24

Officer in Charge - TPOC - When notified that Naloxone spray has been administered by a member and the SIU mandate is or may be invoked, SHALL ensure compliance with

Answer 24

Procedure 13–16.

Question 25

Officer in Charge - TPOC - When Naloxone has been administered to on an on-duty Service member who has been critically injured SHALL

Answer 25

 immediately notify the
‒ on–call Wellness unit member
‒ on–call Director of the Toronto Police Association or the Senior Officers Organization
‒ Duty Inspector – TPOC
 ensure compliance with Procedure 08–03 NIP

Question 26

Definitions - Critical Injury (to a Member)

Answer 26

in reference to member health and safety means an illness/injury of a serious nature that:
 results in the death of a member;
 places life in significant jeopardy;
 produces unconsciousness;
 results in substantial loss of blood;
 involves the fracture of a leg or arm but not a finger or toe;
 involves the amputation of a leg, arm, hand or foot but not a finger or toe;
 consists of burns to a major portion of the body, or;
 causes the loss of sight in an eye.

Question 27

Definitions - Special Investigations Unit (SIU) Mandate

Answer 27

means that the SIU Director may cause an investigation to be conducted into any incident in which any of the following occurs, if the incident may have resulted from the criminal conduct of a Service official:
 the death of a person
 the serious injury of a person
 the discharge of a firearm at a person (regardless of causing injury or death, and including less lethal weapons); and/or
 the sexual assault of a person, as reported by the person.
The SIU Director may cause an investigation to be conducted if, at the time of the incident,
the official was on duty; or
the official was off-duty but
(a) engaged in the investigation, pursuit, detention or arrest of a person or otherwise exercised the powers of a police officer, special constable, peace officer or other prescribed person, as the case may be, whether or not the official intended to exercise such powers or identified themselves as a person who may exercise such powers, or
(b) the incident involved equipment or other property issued to the official in relation to their duties.