5.4 Medical Emergencies, First Aid Basics, & Bloodborne Pathogens

5.4 Medical Emergencies, First Aid Basics, & Bloodborne Pathogens

Core Medical Response Rule: Personal safety takes absolute priority in any medical emergency. A security officer must never enter an unsafe environment or contact bodily fluids without appropriate Personal Protective Equipment (PPE). Under the Check-Call-Care protocol, officers assess scene safety, ensure immediate emergency medical dispatch (911), and provide basic life support within the scope of their training, protected from civil liability under the New Jersey Good Samaritan Law (N.J.S.A. 2A:62A-1).

Security officers are frequently the first responders on the scene of sudden medical crises—ranging from sudden cardiac arrests, catastrophic arterial trauma, and opioid overdoses to acute diabetic shock and grand mal seizures. The actions taken during the first three to five minutes of a medical catastrophe often dictate whether a patient survives or suffers permanent brain death. Operating effectively requires mastery of basic life support protocols, rapid bleeding control, strict biohazard management, and complete familiarity with New Jersey statutory protections.

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1. Initial Scene Assessment & The Check-Call-Care Model

When encountering an injured or collapsed person, security officers must avoid the natural impulse to rush in blindly. A structured, three-step methodology—Check, Call, Care—ensures officer safety while optimizing patient survival.

Step 1: CHECK (Scene Safety & Primary Survey)

• Scene Safety Evaluation: Before approaching the patient, pause and conduct a 360-degree scan for environmental hazards. Check for:
  • Downed live electrical lines or exposed electrical fixtures;
  • Flammable vapors, natural gas odors, or chemical spills;
  • Structural instability, falling objects, or moving warehouse equipment;
  • Continuing threats of interpersonal violence (e.g., an active assailant, assault suspect, or vicious animal);
  • Biological contamination and blood pools.

  RULE OF LIFE SAFETY: If the scene is unsafe, DO NOT ENTER. Remain at a safe distance, keep bystanders back, and immediately summon specialized emergency units (police tactical units, fire HazMat, or electric utility crews). A dead or incapacitated security officer cannot save the victim and becomes an additional casualty.

• Primary Survey of the Victim: Once the scene is confirmed safe, assess the victim:
  • Responsiveness: Tap the person firmly on both shoulders and shout loudly: "Are you okay? Can you hear me?"
  • Breathing & Pulse: Simultaneously scan the chest for normal breathing (rise and fall) and check the carotid artery pulse at the neck for at least 5 but no more than 10 seconds.
  • Agonal gasps (irregular, infrequent, snorting sounds) are NOT normal breathing and are a definitive sign of cardiac arrest.

Step 2: CALL (Summoning EMS / 911)

If the individual is unresponsive, not breathing normally, or experiencing a life-threatening medical emergency:

• Immediately summon help. In a crowded environment, avoid shouting a generic "Someone call 911!" Bystander apathy frequently causes everyone to assume someone else called. Instead, point directly at a specific individual, establish eye contact, and issue an imperative order: "You in the red jacket, call 911 immediately, tell them we have an unresponsive adult, and report back to me! You in the blue shirt, run to the lobby security desk and bring the AED and first aid kit!"

Step 3: CARE (Providing Targeted Life Support)

Provide emergency care according to your level of training and post orders until relieved by emergency medical technicians (EMTs), paramedics, or hospital personnel.

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2. 911 Emergency Communications & First Responder Coordination

When communicating with municipal 911 emergency dispatchers, concise, professional communication is vital. Security officers should provide information in a calm, structured format.

Critical Dispatch Information Checklist

1. Precise Location: The exact street address, facility name, building letter/number, floor, and specific room or corridor designation (e.g., "100 Metro Park South, Building B, 3rd Floor, West Wing Restroom").
2. Access Point / Staging Entrance: Specify which security gate, loading dock, or exterior doorway emergency vehicles must enter to access the patient.
3. Nature of Emergency: Mechanism of injury or medical event (e.g., sudden collapse, fall from 20-foot scaffold, severe arterial arm laceration, suspected narcotic overdose).
4. Patient Demographics & Status: Approximate age, gender, level of consciousness (responsive, responsive to pain, completely unresponsive), and breathing status.
5. Interventions in Progress: Inform dispatch if CPR is underway, if an AED has been applied or discharged, or if a tourniquet or Narcan has been administered.

Escorting Paramedics on Arrival

One of the most consequential roles of security during a medical crisis is first responder rendezvous:

• Detail a security officer to stand at the main facility entrance or gate with an orange vest or flashlight to flag down the arriving ambulance.
• Pre-stage and lock open key access doors.
• Capture and hold a passenger or service elevator in independent service with doors open at the ground level, ensuring paramedics do not wait 3 minutes for an elevator while carrying heavy medical monitors and trauma bags.
• Lead paramedics directly along the fastest route to the patient.

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3. Cardiopulmonary Resuscitation (CPR) & Automated External Defibrillator (AED) Operations

Sudden cardiac arrest is an electrical malfunction of the heart that causes an immediate cessation of blood flow to the brain and vital organs. Without immediate intervention, clinical death occurs in 4 to 6 minutes, followed shortly by irreversible biological brain death.

                               AHA Adult CPR Parameters
┌────────────────────────────┬────────────────────────────────────────────────────────┐
│ Dimension                  │ AHA Clinical Standard                                  │
├────────────────────────────┼────────────────────────────────────────────────────────┤
│ Compression Rate           │ 100 to 120 compressions per minute (e.g., "Stayin' Alive")│
│ Compression Depth          │ At least 2.0 inches (5 cm), not exceeding 2.4 inches   │
│ Chest Recoil               │ Allow complete chest recoil between each compression   │
│ Compression-to-Breath Ratio│ 30 compressions to 2 rescue breaths (Adult)            │
│ Cycle Duration             │ 5 cycles of 30:2 (~2 minutes), then rotate compressors  │
│ Interruptions Limit        │ Minimize all pauses to fewer than 10 seconds           │
└────────────────────────────┴────────────────────────────────────────────────────────┘

High-Quality Chest Compression Mechanics

• Positioning: Kneel beside the patient's chest. Place the heel of one hand in the center of the chest on the lower half of the sternum (breastbone). Place your second hand on top, interlacing your fingers. Keep your arms completely straight, lock your elbows, and position your shoulders directly above your hands.
• Depth and Recoil: Compress straight down into the chest at least 2 inches but no more than 2.4 inches for an adult. After each compression, allow the chest to return completely to its normal resting position. Leaning on the chest prevents the heart chambers from refilling with blood.
• Hands-Only CPR: If an officer is untrained in rescue breathing, or if the officer lacks a CPR pocket mask with a one-way filter valve, the officer should perform continuous, uninterrupted Hands-Only CPR (compressions only at 100 to 120 bpm) until an AED arrives or EMS takes over.

Automated External Defibrillator (AED) Deployment

An AED is a computerized medical device that analyzes the heart's electrical rhythm and delivers an electric shock (defibrillation) to stun a heart experiencing Ventricular Fibrillation (V-Fib) or Pulseless Ventricular Tachycardia (V-Tach), allowing the heart's natural pacemaker to re-establish an effective rhythm.

TIME SENSITIVITY OF DEFIBRILLATION: For every minute that defibrillation is delayed following sudden cardiac arrest, the victim's chance of survival drops by 7% to 10%. Applying an AED within the first 3 to 5 minutes provides survival rates exceeding 50%.

Step-by-Step AED Operational Sequence

1. Power On the AED: Press the green power button or open the lid. The unit will immediately begin issuing audible voice prompts.
2. Bare and Prepare the Chest: Remove all clothing from the patient's torso. If the chest is wet from water, sweat, or rain, quickly wipe it dry with a towel. If the victim has excessive chest hair preventing pad adhesion, use the disposable razor in the AED kit to shave the pad attachment areas.
3. Apply Electrode Pads: Peel the protective backing from the self-adhesive pads and apply firmly to bare skin in the anterior-lateral configuration:
   • Pad 1: Upper right chest, directly below the clavicle (collarbone) and to the right of the sternum.
   • Pad 2: Lower left lateral chest, several inches below the armpit.
   • Special Conditions: If an implanted pacemaker or defibrillator is visible (a hard lump under the skin below the collarbone), place the pad at least 1 inch away from the device. If a transdermal medication patch (e.g., nitroglycerin, nicotine) is on the chest, remove the patch and wipe the skin clean before placing the pad.
4. Clear the Patient for Analysis: When the AED states "Analyzing heart rhythm, do not touch the patient," the officer must step back, hold their arms out, and command loudly: "CLEAR! Nobody touch the patient!" Touching the patient during analysis introduces electrical motion artifact that can cause an incorrect reading.
5. Deliver Shock if Advised: If a shockable rhythm is detected, the AED will charge and announce "Shock advised, charging... Stand clear!" Ensure no one is contacting the patient, shout "CLEAR!", visually scan from head to toe, and press the flashing orange shock button (semi-automatic models) or stand back for the shock (fully automatic models).
6. Resume Immediate CPR: Immediately following shock delivery—or if the AED advises "No shock advised"—instantly resume chest compressions, starting with compressions. Do not pause to check for a pulse or breathing; the AED will automatically re-analyze the patient's rhythm after exactly 2 minutes (5 cycles) of CPR.

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4. Emergency Bleeding Control & Tourniquet Application

Uncontrolled arterial hemorrhage is the leading cause of preventable trauma death. A person can bleed to death from a severed femoral or brachial artery in as little as three minutes.

Recognizing Types of Bleeding

• Arterial Bleeding: Bright red, highly oxygenated blood that spurts or pulses under high pressure in sync with heartbeats. Extreme life threat requiring immediate physical intervention.
• Venous Bleeding: Dark red blood flowing steadily or heavily without spurting. Life-threatening if left unmanaged.
• Capillary Bleeding: Slow oozing of blood from superficial scratches or abrasions; easily managed with standard bandages.

The Bleeding Control Sequence (Stop the Bleed)

1. Personal Protection: Immediately put on nitrile gloves and eye protection.
2. Direct Manual Pressure: Place sterile gauze, trauma pads, or a clean cloth directly over the bleeding point. Apply firm, continuous, two-handed downward pressure using your body weight. Hold direct pressure without lifting the dressing to "peek."
3. Wound Packing (Junctional Areas): For deep wounds in the groin, armpit, or base of the neck where a tourniquet cannot be placed, tightly pack hemostatic gauze (or standard rolled gauze) directly into the wound cavity until packed tight, then apply continuous direct manual pressure for at least 3 minutes.

Tourniquet Application for Extremity Bleeding

A commercial windlass tourniquet (such as the Combat Application Tourniquet / C-A-T) is the primary life-saving device for catastrophic extremity bleeding that cannot be arrested by direct pressure.

                    Tourniquet Application Protocol (C-A-T)
┌────────────────────────────────────────────────────────────────────────┐
│ 1. POSITIONING:                                                        │
│    • Place the tourniquet band 2 to 3 inches ABOVE the bleeding wound  │
│      (between the wound and the heart / torso).                        │
│    • NEVER place a tourniquet directly over a joint (knee or elbow).   │
│    • If the exact bleeding site is concealed under clothing, place     │
│      the tourniquet "High and Tight" at the top of the limb.           │
├────────────────────────────────────────────────────────────────────────┤
│ 2. TIGHTENING THE BAND:                                                │
│    • Pull the free end of the strap as tight as physically possible    │
│      before engaging the windlass rod, securing the Velcro.            │
├────────────────────────────────────────────────────────────────────────┤
│ 3. TWISTING THE WINDLASS ROD:                                          │
│    • Twist the rigid windlass rod until bright red arterial bleeding   │
│      STOPS and the distal pulse in the extremity disappears.           │
│    • Secure the rod into the plastic windlass clip / hook.             │
├────────────────────────────────────────────────────────────────────────┤
│ 4. RECORDING THE TIME:                                                 │
│    • Pull the white time strap over the clip.                          │
│    • Write the exact time of application directly on the strap         │
│      (e.g., "T = 14:22") using a permanent marker or pen.              │
├────────────────────────────────────────────────────────────────────────┤
│ 5. STRICT PROHIBITION ON REMOVAL:                                      │
│    • NEVER loosen, adjust, or remove a tourniquet in the field!        │
│    • Only a trauma surgeon or qualified hospital physician may remove  │
│      a tourniquet once applied.                                        │
└────────────────────────────────────────────────────────────────────────┘

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5. Shock Management (Hypoperfusion)

Shock is a life-threatening medical condition in which the circulatory system fails to deliver adequate oxygenated blood to vital organs. Shock frequently accompanies severe hemorrhage, severe allergic reactions (anaphylaxis), heart failure, or extensive trauma.

Signs & Symptoms of Shock

• Skin: Pale, cold, clammy, or ashen skin with profuse perspiration;
• Pulse: Rapid, weak, or thready pulse;
• Respiration: Rapid, shallow breathing;
• Mental Status: Restlessness, anxiety, altered mental state, confusion, or loss of consciousness;
• Other: Intense thirst, nausea, vomiting, or dilated pupils.

First Aid Treatment for Shock

1. Eliminate the Underlying Cause: Control severe external bleeding immediately.
2. Positioning: Lay the patient flat on their back (supine position). If there is no suspicion of head, neck, spinal, pelvic, or leg fractures, elevate the victim's feet approximately 6 to 12 inches to encourage venous blood return to the heart and brain. If spinal injury is suspected, keep the patient completely flat and immobilized.
3. Thermal Management (Prevent Hypothermia): Hypothermia severely impairs blood clotting and accelerates shock. Cover the victim with a clean blanket, jacket, or emergency foil space blanket to preserve body heat, placing insulation underneath them if resting on cold concrete.
4. No Food or Drink: NEVER administer food, water, or medication to a patient in shock, even if they complain of severe thirst. Introducing liquids can cause fatal aspiration vomiting, and if emergency surgery is required, oral intake creates life-threatening anesthesia complications.

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6. Acute Medical Emergencies: Seizures, Diabetes, & Overdoses

Security officers frequently encounter acute non-traumatic medical emergencies requiring rapid recognition and specialized first aid protocols.

1. Seizures (Generalized Tonic-Clonic / Grand Mal)

Seizures are sudden surges of abnormal electrical activity in the brain, causing violent involuntary muscle spasms, rigid body locking, and loss of consciousness.

• First Aid Protocol:
  • Protect the victim from physical injury: gently clear away nearby hard, sharp, or hot objects (chairs, tables, wastebaskets);
  • Place a soft cushion, folded jacket, or pillow under the person's head;
  • DO NOT attempt to hold down or restrain the victim's limbs during convulsions; doing so can fracture bones or tear muscles;
  • NEVER put anything into the victim's mouth (such as fingers, spoons, or bite sticks). Swallowing one's tongue is an anatomical impossibility, and placing objects in the mouth breaks teeth or completely obstructs the airway;
  • Time the duration of the seizure. If the seizure lasts longer than 5 minutes, if multiple seizures occur back-to-back, or if the person does not regain consciousness, summon 911 immediately (Status Epilepticus);
  • Once convulsions subside, roll the person onto their side into the Recovery Position to maintain an open airway and allow saliva or vomitus to drain safely from the mouth.

2. Diabetic Emergencies (Hypoglycemia vs. Hyperglycemia)

Diabetes involves an inability to properly regulate blood glucose. Security officers most frequently encounter Hypoglycemia (low blood sugar), which can develop rapidly in minutes.

• Signs: Confusion, trembling, profuse cold sweating, slurred speech, combative or glassy-eyed behavior (often mistaken for alcohol intoxication).
• First Aid Protocol:
  • If the victim is conscious, oriented, and able to swallow safely: Administer 15 to 20 grams of rapid-acting oral carbohydrates (fruit juice, non-diet soda, glucose tablets, or honey);
  • If the victim is unconscious, confused, or unable to swallow: NEVER force fluids or solid food down their throat, as it will enter the lungs. Place the victim in the recovery position, immediately summon 911, and monitor breathing.

3. Opioid Overdoses & Naloxone (Narcan) Administration

New Jersey has been severely impacted by the synthetic opioid crisis (fentanyl, heroin, prescription opioids). Security officers at transit hubs, retail centers, and commercial facilities frequently discover overdose victims.

The Opioid Overdose Triad

1. Pinpoint Pupils (Miosis): Pupils constricted to tiny black dots;
2. Severe Respiratory Depression: Breathing is shallow, agonizingly slow (fewer than 6 breaths per minute), completely absent, or characterized by a loud "death rattle" snoring sound;
3. Unresponsiveness: Total loss of consciousness; bluish/gray tint (cyanosis) around lips, fingernails, or skin.

Naloxone (Narcan) Administration Protocol

Naloxone is an opioid receptor antagonist that rapidly displaces opioid molecules from brain receptors, reversing respiratory depression within 2 to 3 minutes without causing intoxication or harm if administered to a non-overdose patient.

• Administration: Use pre-packaged 4mg intranasal Narcan spray. Peel back the package, place the nozzle tip into one nostril until your fingers touch the base of the victim's nose, and press the plunger firmly to discharge the entire dose into the nasal mucosa.
• Follow-Up Actions: Immediately call 911, initiate rescue breathing or CPR if not breathing, and place the victim in the recovery position.
• Subsequent Dosing: If the patient does not wake up or resume normal spontaneous breathing after 2 to 3 minutes, administer a second dose of Narcan in the opposite nostril.
• Safety Warning: When an overdose victim revives from Naloxone, they experience sudden, severe opioid withdrawal. The patient may awaken abruptly, become disoriented, agitated, nausea-ridden, or combative. Step back, maintain a safe physical buffer, speak calmly, and inform them that paramedics are arriving.

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4. Choking (Foreign-Body Airway Obstruction)

A conscious adult who cannot speak, cough, or breathe, often clutching the throat, has a severe airway obstruction.

• Ask: "Are you choking? Can I help you?" If the person can cough forcefully or speak, encourage coughing and watch closely.
• Adults and children (2025 American Heart Association guidelines): Give 5 back blows between the shoulder blades, then 5 abdominal thrusts, and keep alternating until the object comes out or the person becomes unresponsive.
• Infants: 5 back blows, then 5 chest thrusts.
• If the person becomes unresponsive: Lower them to the floor, call 911 (or have someone call) and send for the AED, and start CPR, looking in the mouth for the object before giving breaths.

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7. Bloodborne Pathogens Standard (OSHA 29 CFR 1910.1030)

Security officers who provide first aid or handle biological waste face exposure risks to bloodborne pathogens—infectious microorganisms present in human blood and body fluids that can cause severe, life-threatening human disease.

Major Bloodborne Pathogens

• Hepatitis B Virus (HBV): A severe viral infection attacking the liver; can survive in dried blood on surfaces at room temperature for up to 7 days. Preventable through a 3-dose vaccine series that employers must offer free of charge to occupationally exposed staff.
• Hepatitis C Virus (HCV): A bloodborne virus leading to chronic liver cirrhosis and liver failure; no current preventive vaccine available.
• Human Immunodeficiency Virus (HIV): The virus causing Acquired Immunodeficiency Syndrome (AIDS), attacking the human immune system.

The Doctrine of Universal Precautions

Under OSHA 29 CFR 1910.1030, security officers must practice Universal Precautions (integrated into modern standard precautions):

THE CORE BIOHAZARD PRINCIPLE: Treat all human blood, bodily fluids, and potentially infectious materials (OPIM) as if they are known to be infectious for HIV, HBV, and other bloodborne pathogens, regardless of the individual's appearance, age, or background.

Mandatory Personal Protective Equipment (PPE)

• Medical Gloves: Wear single-use nitrile or latex gloves whenever there is potential for touching blood, open wounds, mucus membranes, or contaminated surfaces. Never wash or reuse disposable gloves.
• CPR Pocket Masks: Never perform mouth-to-mouth rescue breathing without a certified CPR pocket mask or bag-valve mask equipped with a one-way HEPA filter valve to block backflow of vomitus and airborne blood.
• Eye Protection & Face Shields: Wear safety glasses or face shields if there is any danger of spurting arterial blood, splashing, or coughing of bodily fluids.

Safe Glove Removal & Biohazard Disposal

• Glove-to-Glove / Skin-to-Skin Technique: Pinch the outside of one glove near the wrist, peel it down turning it inside out, and ball it up into the palm of your gloved hand. Slide two bare fingers underneath the wrist of the remaining glove, peel it downward turning it inside out over the first glove, and discard.
• Decontamination: Clean contaminated surfaces using an EPA-registered hospital disinfectant or a fresh household bleach solution mixed at a ratio of 1 part bleach to 10 parts water (1:10 dilution), allowing a 10-minute wet contact dwell time.
• Disposal: Dispose of blood-soaked materials in heavy-gauge, leak-proof Red Biohazard Bags marked with the universal biohazard symbol. Contaminated needles, syringes, or broken glass must be deposited into rigid, puncture-resistant Sharps Disposal Containers; never reach into a trash can with bare hands or attempt to bend/recap needles.

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8. New Jersey Good Samaritan Law (N.J.S.A. 2A:62A-1)

Many individuals hesitate to render life-saving first aid out of fear of civil litigation. In New Jersey, the law provides robust statutory immunity to protect individuals who act to save lives.

Statutory Provisions of N.J.S.A. 2A:62A-1

Under the New Jersey Good Samaritan Act (N.J.S.A. 2A:62A-1):

"Any individual... who in good faith renders emergency care at the scene of an accident or emergency to the victim thereof, or in transporting the victim thereof to a hospital or other facility where medical care is to be rendered, shall not be liable for any civil damages as a result of any acts or omissions by such person in rendering the emergency care..."

What the Statute Requires

The statute's own conditions are short:

1. Good Faith: The care was given with an honest intention to help.
2. Emergency Care: It was emergency care rendered at the scene of an accident or emergency, or while transporting the victim to a hospital or other treatment facility.

Subsection (a) of the statute does not add a compensation test or a gross-negligence exception. Its separate gross-negligence limit applies to physicians giving emergency care inside hospitals. The law is still not a license to exceed your training. Stay within what you were taught (CPR, AED, bleeding control, naloxone), follow your employer's policy, and hand care to EMS on arrival.

Overdose Response Protections

New Jersey's Overdose Prevention Act protects a person who, in good faith, administers an opioid antidote such as naloxone to an overdose victim from civil and criminal liability for that act (N.J.S.A. 24:6J-4). It also gives limited protection from drug-possession charges to people who seek medical help for an overdose (N.J.S.A. 2C:35-30 and 2C:35-31).

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9. Comprehensive Medical Emergencies Reference Table

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10. Practical Field Scenarios & Common Compliance Traps

Scenario 1: The Warehouse Severe Arterial Laceration

• Situation: At a distribution warehouse, a forklift blade strikes a worker's upper thigh, tearing deep into the femoral artery. Bright red blood is spurting three feet across the concrete floor. The worker is screaming, pale, and losing consciousness. Officer Kowalski arrives with a trauma kit.
• Analysis: This is a catastrophic arterial emergency; the worker will bleed to death in under two minutes without intervention. Officer Kowalski immediately dons nitrile gloves, pulls a C-A-T tourniquet from his belt, and places the band 2 to 3 inches above the wound on the upper thigh (proximal to the groin, clear of the knee joint). He pulls the strap completely tight, twists the windlass rod until the bright red spurting ceases entirely, and locks the windlass into the retaining clip. He writes "T = 09:14" on the time strap. When the worker's co-worker begs Kowalski to loosen the tourniquet 5 minutes later because "his leg hurts," Kowalski refuses, explaining that loosening a tourniquet allows fatal hemorrhage to resume. Paramedics arrive at 09:22 and take over care.

Scenario 2: The Unconscious Restroom Overdose

• Situation: While conducting a routine check of a facility public restroom, Officer Washington finds a male occupant slumped on the floor against a stall partition. The man is completely unresponsive to shoulder tapping and verbal shouting. His face is pale with a bluish tint around his lips, and his breathing consists of a shallow, agonizing gurgle every 15 seconds. His pupils are constricted to the size of pinpoints. A needle lies on the floor nearby.
• Analysis: The victim displays the classic opioid overdose triad: pinpoint pupils, severe respiratory depression, and unresponsiveness. Officer Washington immediately calls for emergency backup and 911 dispatch, stating: "Restroom 2, unresponsive male, suspected opioid overdose with severe respiratory failure." Putting on nitrile gloves and using extreme caution to avoid the discarded syringe, Washington peels open an intranasal Narcan package, inserts the nozzle into the victim's left nostril, and depresses the plunger firmly. He positions the victim on his side in the recovery position to prevent aspiration of vomit. After 2 minutes, the victim's breathing remains inadequate; Washington administers a second Narcan dose into the right nostril and performs rescue breathing using a CPR pocket mask until EMS arrives.