(BPT) - Every day nearly 200 people die from an overdose of drugs or from alcohol poisoning, with opioids responsible for the majority. Recognizing the signs and knowing how to respond to medical emergencies, including carrying and administering naloxone in cases of opioid overdose, can save lives, says the American Society of Anesthesiologists (ASA).

“The tragic increase in overdose deaths is an alarming and devastating issue that touches so many of us,” said ASA President Mary Dale Peterson, M.D., MSHCA, FACHE, FASA. “If you can identify an overdose or alcohol poisoning, you are more likely to react quickly, making the difference between life and death for a family member, friend or stranger.”

Physician anesthesiologists have a critical role in fighting against overdoses, starting with managing patients’ pain after surgery or chronic pain in responsible ways. During Physician Anesthesiologists Week, Jan. 26-Feb. 1, ASA is joining forces with U.S. Surgeon General VADM, Jerome Adams, M.D., M.P.H., to empower everyone to recognize the following signs of an overdose or alcohol poisoning:

• Shallow, slow or irregular breathing (less than eight breaths a minute or a gap of more than 10 seconds between breaths)
• Extreme sleepiness or unconsciousness (e.g., “passed out”)
• Inability to talk
• Blue or gray skin color, with dark lips and fingernails
• Snoring or gurgling sounds
• Confusion
• Vomiting
• Seizures
• Low body temperature

Any one of these signs should prompt a call to 911 for emergency medical care. Never leave an unconscious person alone, as they may be at risk of dying, including by choking on his or her own vomit. If an opioid overdose is suspected, naloxone should be administered immediately, if available. Naloxone is administered by injection or nasal spray and access to it is expanding on a state-by-state basis. It can be prescribed by a physician and often is carried by police officers and emergency medical responders. Additionally, it’s increasingly available over the counter at some pharmacies.

“To stem the tide of the opioid overdose epidemic, we need everyone to consider themselves a first responder. We need to encourage everyone in our communities to carry naloxone and know how to use it,” said U.S. Surgeon General, VADM, Jerome M. Adams, M.D., M.P.H., a physician anesthesiologist who issued a Surgeon’s General’s advisory in 2018 calling for increased awareness and use of the medication. “When on hand, naloxone may mean the difference between life and death, and can be a first step to getting someone onto the pathway of recovery.”

Anyone who takes opioids to manage their pain may be at-risk for an overdose. In recent years, opioids were the go-to pain reliever for everything from backaches and injuries to post-surgical and chronic pain. In 2017, more than 190 million prescriptions were written for opioids. While they can be effective for short-term pain, chronic use can lead to abuse. Every day 130 people die from opioid overdoses, according to the Centers for Disease Control and Prevention.

“ASA strongly agrees with the Surgeon General and supports policies that promote access to naloxone and safe and effective pain management care,” said Dr. Peterson. “All of our members have a significant interest in reducing misuse, abuse and diversion of opioids that have led to unintended deaths.”

To learn more about the critical role physician anesthesiologists play before, during and after surgery, visit asahq.org/WhenSecondsCount. ASA also offers an opioid overdose resuscitation guide that provides guidance on symptoms of an overdose and how to help.

Health Care Solutions for Rural Americans

(Family Features) Heart disease, cancer, unintentional injuries, chronic lower respiratory disease and stroke. These top five causes of death in the United States all have a higher incidence of death among rural residents and research points to lack of access to health care as a culprit.
Today, rural hospitals are closing at a rapid pace, expanding an already vast health care desert (defined as inhabited areas more than 60 minutes away from an acute care hospital) across the country.

According to the University of North Carolina’s Rural Health Research Program, since 2010, more than 105 of America’s 1,700 rural hospitals have closed. Additionally, a Navigant report found that 21% of rural hospitals are at high risk of closing unless their financial situations improve.

Every day, rural Americans find themselves farther from medical care.

Practical challenges facing patients

Fatal injuries and illnesses aside, rural residents face other practical concerns related to the health care in their communities.

• Doctors are more concentrated in urban areas, while there are shortages in rural communities. A shortage of doctors can mean less availability for appointments, difficulty capturing enough attention from a busy provider, longer distances to reach a physician and limited access to specialists.
• Statistically, rural residents tend to be older and need more frequent visits to their primary doctors and other specialists.
• Pregnant women have to travel even farther to deliver a baby, leading to an increased risk of complications at birth. Similarly, pre-natal and post-natal care are harder to access.
• Rural residents often enjoy more outdoor activities (such as hunting, hiking and riding ATVs) than urban residents and therefore are at a greater risk of injury that requires treatment at a trauma center.

Airborne answer

One solution to fill the gap in rural health care is air medical services, which transport patients to critical care facilities in minutes. With nearly 90% of patients transported living in rural areas, air ambulance services are an essential part of health care access in these communities.

However, just like rural hospitals, air ambulances are threatened as well. Medicare and Medicaid reimbursement rates have remained steady for decades, while operational costs required for air medical services have increased, creating a financially unsustainable situation. Some private insurers also refuse to cover air medical services or pay minimal costs, requiring patients to assume the balance.

How to take action

The challenges facing rural health care access may be significant, but rural residents can take individual actions to make a difference for themselves, their families and even their communities.

• Express support to elected officials. Rural residents can call or write letters to their senators and representatives and demand they keep local hospitals open and protect access to air medical services. Reaching members of Congress at their local offices may be more effective than contacting their federal offices.
• Support efforts to secure grants. Some universities have been given grants from the Health Resources & Services Administration, an agency of the U.S. Department of Health and Human Services, to create or expand community health initiatives and facilities in rural areas.
• Explore alternative sources of care. Many rural areas have community health workers who complete home visits to assist people with chronic diseases like diabetes and high blood pressure. Although their training is limited compared to that of a doctor or nurse, their service increases health care access and they’re able to spend more time with patients.
• Get educated about your care. One role of community health workers is teaching patients about how to manage their own medical needs. This education helps residents be proactive and preventative in their health care, which can reduce the need for hospitalizations in certain cases, such as learning how to properly manage diabetes.
• Make an emergency plan. For families who reside in a rural community, it’s a smart idea to have a plan in place for how to respond in the event a medical emergency. The plan should include information about the location of the closest hospital, emergency contact information in the community and other details necessary to gain emergency care.
• Consider remote access care. Another option for both rural and urban residents alike is telemedicine, which allows patients to connect with a doctor or nurse virtually using technology and without having to travel. The two-way communication can facilitate evaluation and treatment for minor conditions. The service is offered as a cost-saving incentive through some insurance plans, as well as private providers.

Protecting Patients Against the Unexpected

With increasing frequency, insurance companies are not covering the full cost of medical emergencies, leaving families with out-of-pocket expenses they didn’t expect.

If you need medical transport and a physician or first responder determines air evacuation is the best – or only – option to get you to care, you shouldn’t have to worry about the bill you’ll receive afterward. Many emergency service providers have support efforts in place to help you focus on recovery, not finances.

For example, many air medical companies provide patients access to their patient advocates, who work with the patient’s insurance provider to properly cover air medical transport, taking the patient out of the middle. This process can result in significantly lower costs for the patient, often amounting to just the usual copay and deductible.

Visit globalmedicalresponse.com/protect-patients to learn more about these services in your area.

Photos courtesy of Getty Images (doctor and man, woman speaking with doctor on computer)