I’ve been using fentanyl and other opioids, off and on, for the past 15 years. I’ve experienced a lot of close calls from overdose, and I’ve responded to my share of them, too. Luckily I’ve been able to revive everyone so far, the way others have been able to revive me, but I know a lot of people who died because no one was there to help them breathe again.
Naloxone, the most common opioid overdose reversal medication, has been available for free over the counter in Canada since 2016. It’s very effective at reversing respiratory depression and allowing people to breathe on their own again. But if someone’s overdosing and you don’t have naloxone, rescue breathing can keep them alive until you do.
I once experienced an overdose involving fentanyl where there was no naloxone on hand. My boss at the time kept me alive for 16 minutes until help arrived, by performing rescue breathing.
The majority of the time, you’d tilt the person’s head back and lift their chin before you begin rescue breathing. The head-tilt/chin-lift is a simple maneuver to extend someone’s neck and open up their airway, and for most people responding to most opioid overdose emergencies it should be the go-to. But what if you have reason to worry the person injured their spine, and you don’t want to risk moving their neck?
While overdose doesn’t usually involve someone falling and hitting their head, for example, it can happen, and they still need their airway opened. If you’re properly trained, there’s an alternative to the head-tilt/chin-lift that’s safer to use on someone with suspected spinal injury: The modified jaw thrust maneuver.
I learned about the modified jaw thrust maneuver (sometimes just called the jaw thrust maneuver) from Derek Bevans, a former critical care paramedic in Alberta. He’s found that, if you know what you’re doing, the technique can be very effective—even in situations where spinal injury isn’t a factor, but the head-tilt/chin-lift isn’t doing the job.
“I’ve used this technique in medical overdose and in trauma where I couldn’t get an airway and I didn’t have my trauma kit,” Bevans told Filter. “The modified jaw thrust definitely pulled me through, as a layperson and [as a] paramedic.”
Rather than kneeling next to the person, in the modified jaw thrust you’re behind them with your hands on each side of their head. Done properly, the technique lifts the jawbone upward and forward, which in turn moves the tongue away from the back of the throat—clearing their airway without having to extend their neck.
“As soon as you do that, you generally get a little bit of a gasp,” Bevans said, “but then you can lose it again. So you have to continue to exert pressure until you hear that constant breathing pattern.”
When he first told me about the technique, I was shocked. Why isn’t this more widely taught?
We should be teaching the modified jaw thrust to peer workers, and to anyone who frequently responds to opioid overdose.
There’s a lot of misinformation and improper training about how to respond to opioid overdose. For instance, many public health authorities, along with law enforcement, advise performing chest compressions. But there’s a general consensus in harm reduction that this is not necessary to reverse respiratory depression, and it can actually be quite detrimental. In a typical opioid overdose the problem is a lack of oxygen, not a stopped heartbeat. Chest compressions don’t get air in someone’s lungs, and risk needless injury.
Performed incorrectly, the modified jaw thrust could potentially cause or exacerbate a spinal injury. The technique is more complicated than the head-tilt/chin-lift, and even trained paramedics sometimes do a poor job with it, so it’s important to only attempt the maneuver when necessary and with the proper training. But unlike chest compressions, it has the potential to help someone breathe in certain situations. We should be teaching it to peer workers, and to anyone who frequently responds to opioid overdose.
Claire Zagorski, a former clinical care paramedic in Alberta, said the modified jaw thrust maneuver was a major point of discussion at the Compassionate Overdose Response Summit in Pittsburgh in May.
“Practice makes a world of difference, and good ventilation is often the difference between life and death,” Zagorski told Filter. “Having naloxone on hand is very, very important, but I also think that the more we can collectively get comfortable with opening airways and giving breaths, the better.”
Bevans used to use drugs himself—mainly methamphetamine, but when experiencing difficult times on the street he was often in a position to respond to opioid overdose. He’s used the modified jaw thrust countless times; people would even run up to him for help when someone nearby was overdosing, knowing he had this way of getting an airway open. In two instances, it allowed him to avert the overdose without administering naloxone.
Bevans, with a palpable urgency in his voice, stressed that the modified jaw thrust maneuver should be part of training for anyone who responds to overdose as part of their job. More often than not, the first responders in the overdose crisis are people who use drugs. I’m so thankful for people like Bevans who have saved so many lives, whether as a paramedic or as a layperson on the street.
Image via Mount Pleasant, Tennessee
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