By Abby Alten Schwartz
Imagine walking into a public restroom and finding a person unconscious on the floor, with no obvious injuries. It could be an overdose. Would you know how to respond?
First-year medical students at the University of Pennsylvania’s Perelman School of Medicine (PSOM) now do, thanks to the instruction they received during medical bootcamp, a training session held on their first day of orientation.
Cindy Christian, MD, assistant dean for Community Engagement at PSOM and leader of orientation events, explained that each year, incoming students learn and practice how to handle two different medical emergencies during their first week of medical school. This year’s first session focused on using naloxone (Narcan®), an over-the-counter nasal spray, to reverse an opioid overdose. (The second session was about Stop the Bleed techniques, including tourniquets and wound packing, with volunteers playing the role of trauma patients.)
A critical skill
Students worked long and hard to get into medical school, but Christian noted that their initial classes focus more on learning basic sciences, with limited patient experience. They will begin working with actual patients on a daily basis in their second year. Narcan training provides a confidence-boosting skill, with practical application, on their very first day of medical school.
“One of the goals we have in introducing them to the opioid crisis and how to use Narcan is to give them some simple, hands-on exposure to things that can make a difference and potentially save a life,” Christian said.
The need and opportunity to help is immense. According to the Philadelphia Department of Public Health, there were 1,276 unintentional drug overdose deaths in 2021—the highest ever reported in Philadelphia. Of those, 82% involved fentanyl, a synthetic opioid that is 50-100 times stronger than morphine. Nationally, the most recent Centers for Disease Control and Prevention (CDC) reports show that overdose deaths involving opioids increased by more than 15 percent from 2020 to 2021 and those involving synthetic opioids other than methadone, such as fentanyl, increased over 22 percent.
For student Setareh Gooshvar, of Florida, who learned to use Narcan as an undergraduate, the session served as a valuable refresher course and a way to stay informed about the state of the opioid epidemic in Philadelphia and the surrounding regions. “I appreciated the training being early on in our time in medical school, as it provided context to the importance of Narcan availability,” Gooshvar said.
Bonnie Milas, MD, a professor of Clinical Anesthesiology and Critical Care Medicine at PSOM, was the keynote speaker at this year’s event and provided the mannequins and Narcan used at the bootcamp.
Milas lost two sons to accidental opioid overdoses and devotes her personal time to educating the public and lawmakers about overdose prevention. She has advocated for expanded access to Narcan and, earlier this year, testified before the U.S. Food and Drug Administration (FDA), which helped result in a new law making the treatment available without a prescription.
She said the medical students were receptive to Narcan training as young people who are socially aware and engaged in their local communities. They are also in the age group (25-35 years) in which the overdose rate is the highest, and they could conceivably encounter someone who is overdosing.
“It could be another medical student, somebody at the Philadelphia Eagles game, or their nephew or cousin when they go home and visit for Thanksgiving,” Milas said.
Hands-on instruction
Bonnie Milas, MD
During bootcamp, the instructors talked to the students about opioid use and taught them how to recognize, assess, and respond to a drug overdose. There was a panel discussion featuring substance use and recovery specialists with lived experiences, and a Q&A opportunity. Students asked a range of questions, from what to do after giving someone Narcan to how to talk to a patient after they regain consciousness.
Gabrielle Scales, a student from North Carolina, said, “One of my biggest concerns surrounding Narcan was that I could injure someone by administering it when it may not have been necessary—but the trainers assured me the drug was of no harm to an individual if they didn’t end up needing it.
Students formed small groups and practiced their new skills on medical mannequins dressed and positioned to simulate real-life patients. After, each was given a two-dose supply of Narcan to carry with them in case of emergency.
Milas noted that physicians are often held to a higher ethical standard than the average person and that she hoped with the knowledge and medication they now had, the students would be willing to help a stranger.
“Whether they’re disheveled or a smartly dressed businessperson, that stranger is someone’s sibling or spouse or child,” she said.
Scales said, “My biggest takeaway from the training was to not be a passive bystander. Becoming equipped with the tools to help, if there is a situation that necessitates it, makes me more confident in my ability to step in.”
You can watch Milas speak about her experience via the American Society of Anesthesiologists. Philadelphia residents can order free fentanyl test strips and/or Narcan. Narcan is now also available over the counter for sale at local pharmacies.