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From: Helen Tolvais <[email protected] May 21, 2015 12:03PM wroteTo: Gary ThompsonMichelle Maron Board of Health Barbara Yaffe Councillor Burnside Councillor Carmichael Greb Councillor Cressy Councillor Doucette Councillor Mihevc Councillor Nunziata Jann Houston Jennifer Veenboer Rita Shahin Shaun Hopkins
Dear Mr. Thompson:
Your email dated May 11, 2015, addressed to the members of the City of Toronto Board of Health, was forwarded to me for response.
As previously communicated to you by Dr. Rita Shahin and myself, the naloxone program protocol regarding chest compressions has been approved by Toronto Public Health (TPH) after an extensive literature review, consultations with expert medical personnel and opiate users. The protocol to perform chest compressions, in conjunction to calling 911, is to maintain cardiac output until naloxone has time to reverse the overdose and until emergency medical personnel arrive. Toronto Public Health will continue with the current protocol until there is new medical evidence and best practices regarding chest compression.
Sincerely, [Cite some literature Mr. McKeown. They can’t because chest compression’s only is the worst thing you could do as per all medicine, for any respiratory emergency]Dr. David McKeownMedical Officer of Health
Board of Health May 11 at 12:05 PMTo: Gary Thompson
Good afternoon Gary,Please note that we have received your email and have forwarded a copy of it to Toronto Public Health at [email protected] . Regards, Antoinette CrichlowCity Clerk's Office tel: 416-397-4579 email: [email protected]
Councillor Mihevc May 11 at 11:39AMTo: Gary Thompson Good morning Mr. Thompson We are in receipt of your email addressed to the Board of Health and a response will be forthcoming from the Board.
Sincerely Michelle Maron Executive AssistantOffice of Councillor Joe MihevcWard 21, St. Paul's West T: 416-392-0208 F: 416-392-7466 From: James Thompson [mailto:[email protected]] Sent: May-11-15 10:35 AMTo: Councillor Mihevc; Board of Health; Councillor Burnside; Councillor Carmichael Greb; Councillor Cressy; Councillor Doucette; Councillor NunziataSubject: Toronto Public Health CONTRAINDICATED teaching Dear BOH Committee Members: Was just posted, moderated comments Forbes Magazine about Public Health Naloxone protocols
Forbes April 23 Physicians Polled on Mark Cuban Debate http://www.forbes.com/sites/danmunro/2015/04/23/physicians-polled-on-mark-cuban-debate/
Forbes April 26 Prescription Pain Pill Overuse Is Leading To Thousands Of Hospitalized Newborns http://www.forbes.com/sites/matthewherper/2015/04/26/the-pain-pill-epidemic-is-hurting-newborn-babies/ Only took three days to stop Saskatchewan from teaching this life threatening intervention. Attached letter from Chief Medical Officer of Saskatchewan Dr. S. Shahab Basic first aid knowledge chest compression's only is the worst thing you could do for any respiratory emergency patient. Attached Letter H & S Foundation and Canadian Red Cross info. My deputation BOH Aug 18, 2014 https://youtu.be/jSEEZe5Vr2o Still waiting for a reply??Deputation BOH Chairperson “Just trying to save your life” http://issuu.com/garythompson81/docs/an_open_letter.docx Best WishesGary Thompson
Attachement Dr. S. Shahab CMO of Sask.
On Tuesday, April 21, 2015 7:46 PM, "Shahab, Saqib HE0" <[email protected]> wrote:
Dear Mr Thompson
Thank you for your voicemail, e mail and links. At present SK does not have a THN (Take Home Naloxone) program and if SK was to develop one, training materials related to that would use the best information and evidence regarding that including
when and how to administer Naloxone and additional appropriate interventions as required to support airway, breathing and circulation.
Thank you once again for flagging your concernsSincerely
Dr Saqib Shahab FRCPCGovernment of SaskatchewanChief Medical Health OfficerMinistry of Health, Population Health Branch3475 Albert St, Regina SK S4S 6X6E mail: [email protected]: 306 787 3220 From: Gary Thompson [mailto:[email protected]] Sent: Tuesday, April 21, 2015 2:43 PMTo: Shahab, Saqib HE0 Subject: Re: News article April 18
Dr. Shahab:
Read with grave concern your quote of April 18
"A key feature of the take home program is training users' family or peers to recognize signs of overdose so they know when and how to administer the antidote, perform CPR compression's and call 911" http://www.thestarphoenix.com/health/Opiate+antidote+kits+possible+Sask/10983748/story.html I hope this does not mean chest compression's only? Contraindicated for any respiratory emergency patient. Read all moderated comments AHA & ILCOR Opioid overdose response education https://volunteer.heart.org/apps/pico/Pages/PublicComment.aspx?q=891
Response to Emily Oliver (awaiting AHA moderator)"....use of naloxone into their education programs. More research is needed regarding educational effectiveness..."
Do we need more research on opioid poisoning resuscitation protocols? Clinicians see opioid poisoning daily in a clinical situation. Terminally ill are kept "comfortable" to wit OD narcotics. Cause of death acute respiratory failure. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8.b Poisoninghttp://resuscitation-guidelines.articleinmotion.com/article/S0300-9572(10)00441-7/aim/ Opioids“Opioid poisoning causes respiratory depression followed by respiratory insufficiency or respiratory arrest. The respiratory effects of opioids are reversed rapidly by the opiate antagonist naloxone.” Modifications for Advanced Life Support“There are no studies supporting the use of naloxone once cardiac arrest associated with opioid toxicity has occurred. Cardiac arrest is usually secondary to a respiratory arrest and associated with severe brain hypoxia. Prognosis is poor.”
Agnotology is the study of culturally induced ignorance or doubt, particularly the publication of inaccurate or misleading scientific [medical] data. Agnotology focuses on the deliberate fomenting of ignorance or doubt in society.http://issuu.com/garythompson81/docs/agnotologynote.docx Not placing blame, change this protocol of Public Health Ontario. Have talked with all these clinicians many times in person, they live in a state of pure guilt. Please reply Best WishesGary Thompson718-77 Finch Ave EastToronto ONM2N 6H8647-864-6609@GaryCPR
From: Rita Shahin [email protected] Sent: Tuesday, April 17, 2012 1:57:53 PM
To: gary thompson <[email protected]>; tphfeedback <[email protected]> Subject: Re: naloxone training
Hi Gary, thank you for your email regarding the Naloxone training. The protocols regarding chest compressions have been approved by Toronto Public Health after extensive consultation with medical personnel both inside and outside of Toronto Public Health. As you know, the recommendation to perform chest compressions is part of the larger protocol developed by The Works Toronto Public Health to respond to an opiod overdose. The protocol also includes administering Naloxone and calling 911. Naloxone is an extremely effective medical intervention for opiod overdose, including reversal of respiratory depression. Please be assured that we are very committed to providing the most effective response possible to people who are experiencing opiod overdose. We believe that the approach we have taken is based in good medical and scientific evidence. Regards,Rita Rita Shahin, MD, FRCPC Associate Medical Officer of Health Toronto Public Health Phone: (416) 338-7924 E-Mail: [email protected]
From: Rita Shahin Sent: Tuesday, April 09, 2013 4:14 PMTo: Gary Thompson [email protected]: Re: Your letter of April 24, 2012 to Gary Thompson File No. 2012-CDC-01
Dear Mr Thompson,
I write in response to your emails regarding Toronto Public Health's ("TPH") naloxone program at The Works.
After reviewing relevant research and consultation with various experts in the field (including RESCU -- the resuscitation science and pre-hospital Medicine research centre at St. Michael's Hospital in Toronto), TPH decided to exclude rescue breathing from its naloxone training protocol for the program that we launched in August 2011 (please note it was not "dropped" from our protocols as it was never included). While respiratory depression can be an important component of opioid overdose treatment, experts also suggest that there are various reasons why it can be counter-productive if not administered correctly.
Those receiving TPH's naxolone training, are lay citizens. They are not professional emergency medical responders or care-givers. It is important that these lay citizens not be trained in a procedure that may be too complex or difficult to administer properly.
Medical experts have reported that even trained first responders may have difficulty reliably identifying that unresponsive patients have no heartbeat , that mouth-to-mouth ventilations may not be an effective educational or resuscitative intervention, that mouth-to-mouth ventilations could put the health of the lay citizen at risk, and that a significant numbers of opioid-related deaths involve polysubstance overdose with cardiotoxic drugs. Painful stimulation (such as chest compressions) may in and of themselves be an effective means of increasing respiratory drive. Further, naloxone administration has no role in cardiac arrest (including those due to opioid overdose).
Attempting to teach both ventilations and chest compressions could complicate the protocol without providing a demonstrable benefit. Research from the United States demonstrates that a minority of trained responders actually perform rescue breathing or chest compressions. The important component of all programs is the naloxone administration and calling 911.
TPH will continue to review new evidence as it becomes available. At the present time TPH continues to support its current program. I trust this satisfies your inquiry.
Sincerely,Rita Shahin
From: Laurie Morrison [email protected] Oct 8, 2012To James Thompson CC 'Aaron Orkin ([email protected])'
Hi James Yes I helped craft them in accordance with the guidelines and feel the approach to chest compression only is the right way to go for many reasons. Happy to discuss with you at any time. Aaron Orkin (copied here) and Toronto public Health were more involved than I was as I was just the expert brought in to help out. Cell is 4165245434 or we could set up a face to face by email if you prefer. Laurie
From: James Thompson [mailto:[email protected]] Sent: Wednesday, October 03, 2012 5:02 PMTo: Laurie Morrison [email protected]: naloxone training
Dr. Morrison: I have just found out that RESCU was part of Toronto Public Health's naloxone protocols. I think they should be changed, as there is no scientific evidence for chest compressions only in opiate overdose. See Attached ILCOR and Amer Heart Assoc. Guidelines 2010Please reply ASAP
Remember the MagicGary Thompson
Dr. Morrison was not “Happy to discuss” when told her bringing a tape recorder she phoned the police. I get a phone call “Can you come to the station?” “Sure be right there” Police constable “Gary I want to shake your hand you have been saving lives, bad news is Dr. Morrison wants no contact” “Fine by me she is a nut”
Dr. Morrison follow the guidelines you wrote and all medicine says past, present and future Give respiratory assist, then you MAY give Naloxone, continue respiratory assist (rescue breathing) until patient breaths adequately on their own.
ILCOR 2010 page 345 & 367 Dr. Morrison Co-chair http://circ.ahajournals.org/content/122/16_suppl_2/S345.full.pdf+html AHA Guidelines Part 12:7 page 840-1 Dr. Morrison Co-chair http://circ.ahajournals.org/content/122/18_suppl_3/S829.full#sec-80 World Health Organization 2013 page 7-9 https://www.unodc.org/docs/treatment/overdose.pdf Canadian Red Cross Compression’s only http://www.redcross.ca/what-we-do/first-aid-and-cpr/first-aid-at-home/first-aid-tips/compression-only-cpr
Compressions only CPR AHA Guidelines Part 4http://circ.ahajournals.org/content/122/18_suppl_3/S676.full.pdf+html Sandoz Pharmaceuticals manufactures of Naloxone Read Part 10 overdose http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ca7a8abd-9301-40f5-9300-6398f4d467b3#nlm34088-5
SANDOZ manufactures of Naloxone Compendium of Pharmaceuticals & Specialties 2014 as per all medicine past, present and future. Annotated ref and moderated comments http://roguemedic.com/?s=Naloxone
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