Live human study well know to increase morbidity & mortality

1. Read with grave concern the article by Leece et al.1 Teaching layperson’s the signs of respiratory
emergency, then training the layperson to give chest compression’s only.
Omitted from the article the “POINT” Prevent Overdose IN Toronto, signs of opioid
overdose, from the training literature.2-4
 Can’t wake the person up
 Breathing is very slow, erratic or has stopped
 Deep snoring or gurgling sounds
 Fingernails or lips are blue or purple
 Body is very limp
 Pupils are very small
These signs would indicate a poisoned patient in coma, suffering a respiratory
emergency. Author’s reference (26) states respiratory assist.5 This would be consistent with the
medical evidence worldwide.6-8
Cardiac arrest is secondary to respiratory arrest and is associated with sever hypoxia,
prognosis is poor.8 Patient now needs Advanced Cardiac Life Support (ACLS) beyond the scope of
laypersons.9 Keep coma patient alive rescue breaths, Basic Life Support (BLS).
Authors quote “Significant numbers of opioid-related deaths involve poly substance
overdose with cardio toxic drugs.” The author’s reference (29) makes slim mention of cardio
toxic drugs. Stimulant drugs and other toxins may causeadysrhythmia (control with ACLS), drugs
of abuse cause death from acute respiratory failure.10 Cyanosis can be cardio toxic, myocardial
infarction lack of oxygen in blood stream, every tissue and all organs dying lack of oxygen.
Authors quote “Painful stimulation (such as chest compressions) may be an effective
means of increasing respiratory drive.” Needs redress (primum non nocere) complications of
chest compressions is endless.11 BLS (rescue breathing) adds oxygen to the blood stream.
Can find no consensus for chest compressions only for respiratory emergencies, including
opioid poisoning (overdose).
References
1. Leece PN, Hopkins S, Marshall C, Orkin A, Gassanov MA, Shahin RM. Development and
Implementation of an Opioid Overdose Prevention and Response Program in Toronto,

2. Ontario. Canadian Journal Public Health 2013;104(3):e200-04.
http://journal.cpha.ca/index.php/cjph/article/view/3788
2. OHRDP ‘NaloxoneTrainingVideo’Availableat: https://vimeo.com/68067103 (Accessed
September 10, 2015).
3. TorontoPublicHealth‘POINT’(PreventingOverdose IN Toronto) Available at:
https://www.cpso.on.ca/uploadedFiles/members/Meth-conf-POINT-PP.pdf (Accessed
September10,2015).
4. Toronto Harm Reduction‘NALOXONE: Saves lives, learn how, share the knowledge’
Available at: http://www.youtube.com/watch?v=zlbkU5IK5Do (AccessedSeptember10,
2015).
5. VandenHoek TL, Morrison LJ, Shuster M, Donnino M, Sinz E, Lavonas EJ.et al. Part 12
Cardiac arrest in special situations: 2010 American Heart Association Guidelines for
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation
2010;122(18 Suppl 3):S829-S861.
6. UNODC/WHO 2013 ‘Opioid Overdose: preventing and reducing opioid overdose
mortality’. Available at: https://www.unodc.org/docs/treatment/overdose.pdf
(Accessed September 10, 2015).
7. Deakin CD, Morrison LJ, Morley PT, Calloway CW, Kerber RE, Kronick SL. et al. Part 8:
Advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation
and Emergency Cardiovascular Care Science with Treatment Recommendations.
Resuscitation 2010;81S:e93-e174.
8. Soar J, Perkins GD, Abbas G, Alfonzo A, Barrelli A, Bierens JJLM. et al. Section 8: Cardiac
arrest in special circumstances: 2010 European Resuscitation Council Guidelines for
Resuscitation. Resuscitation 2010;81:1400-33.
9. Roberts JR. Dissecting the ACLS guidelines on toxic ingestions. Emergency Medicine
News 2011;33(10):16-18.
10. Wilson KC, Saukkonen JJ. Acute respiratory failure from abused substances. Journal
Intensive Care Medicine 2004;19(4):183-93.
11. Atcheson SG, Fred HL. Complications of cardiac resuscitation. American Heart Journal
1975;89(2):263-65.