On November 15th, 2018 at 12:32 pm  a 911 call went out from Camden, NJ. The caller requested help for an overdose. About a minute into the call the caller reported, "He's completely out. He's STARTING to turn purple". Cooper EMS were dispatched. Four minutes later Cooper BLS arrive and do not begin CPR or administer naloxone/Narcan. A minute and a half later Cooper ALS arrives. No naloxone/Narcan is given. Two minutes later PEA is determined. PEA stands for Pulseless Electrical Activity. It is an unshockable rhythm where the heart is producing electrical activity that should produce a pulse, but a pulse is not palpable/present according to the AED. This is due to the lack of oxygen as a result of opioid suppression. It is also possible that the patient is presenting pseudo PEA which means there is a pulse but it is so weak due to opioid suppression that it is impalpable and undetectable by an AED. Although NJ EMS Field Guide states that PEA protocol is to “search and treat reversible causes” which would have been the administration of an antidote-naloxone/ Narcan, EMS did not. The truth is, NJ does not mandate the administration of naloxone/Narcan.  This allows stigma and burnout to affect care.  MD1 (who I was told was the physician) arrived 4 and half minutes after BLS and 3 minutes after ALS. BLS and ALS had the authority to give naloxone/Narcan but did not. There is not a single report from MD1 or MD2 I am requesting that the State of New Jersey mandate that patients of a suspected opioid overdose/poisoning are given naloxone/Narcan since the benefits of administration outweigh the risks.The patient in this case was my brother, Kenneth J. Arnold Jr. who died as a result of brain death due to the lack of oxygen. He saved 4 lives through organ donation and is forever my hero. Please sign your name and support change in honor of my big brother and to save more lives! #IamNotAshamed

I have listed links below that support the use of naloxone/Narcan, edpecially during PEA in addition to excerpts that state how to treat PEA.

* People in PEA can be resuscitated if a reversible cause of PEA is identified and treated appropriately. Therefore, the primary emphasis of the PEA algorithm is to find and treat the cause of the PEA.

*Once reversible causes of pulseless electrical activity (PEA) are identified, they should be corrected immediately. 

https://www.ajemjournal.com/article/S0735-6757(08)00327-6/abstract​

https://www.sciencedirect.com/science/article/abs/pii/S0300957209004924​

https://www.annemergmed.com/article/S0196-0644(85)80439-X/abstract

Part 10.3:

https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000264​

https://www.ncbi.nlm.nih.gov/pubmed/19913979​ 

https://www.ems1.com/cardiac/articles/236985048-How-to-treat-sudden-cardiac-arrest-opioid-overdose/ #3 

https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-10-special-circumstances-of-resuscitation/highlights-introduction/highlights/​ 

https://www.annemergmed.com/article/S0196-0644(85)80439-X/abstract​ 

https://www.resuscitationjournal.com/article/S0300-9572(18)31014-1/fulltext

PEA/Psuedo PEA

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4972061/ (Diagnosing & treating primary cause)