Peer Support Responder - A New Community Initiative That Provides FREE Specialized Training and Supplies to People Likely to Encounter an Opioid Overdose

TORONTO, July 27, 2021 (GLOBE NEWSWIRE) -- As of today, Heart to Heart CPR has completed Phase 1 of their Peer Support Responder program that provides free advanced overdose training and protective equipment for people most likely to encounter, witness or experience opioid poisoning. There are now seventy five (75) Peer Support Responders in Toronto who are trained and equipped to offer help.

The opioid crisis is far from over. In the first three months of 2021, Toronto paramedics responded to 93 calls involving death, a 102% increase compared to the first three months of 2020.

In 2020, out of 521 fatalities, 47% of accidental opioid overdoses involving death in Toronto occurred when the person was home alone, with no one around to help them. There was no attempt to resuscitate the deceased individual in 43% of the cases. 28% of total deaths in Toronto involved people experiencing homelessness.

Overall, in 2020, there were 2,426 opioid-related deaths in Ontario. In 3 out of 4 deaths, no one was present to intervene.

Many of these preventable deaths could have been avoided if the person using opioids was not using alone. Heart to Heart CPR is taking the initiative to destigmatize people who use drugs and establish internal support systems. They are seeking to create “peer witnessing” opportunities for those who use drugs and train allies and bystanders in managing accidental overdose.

Peer supporters can be individuals within the shelter system, residents in a high-risk apartment complex or neighbourhood, workers in outreach and harm reduction services - even friends and family members of those who use opioids. It may even be other users taking turns “spotting” each other. Without peer support interventions, we will continue to see more preventable deaths. Heart to Heart CPR wants to help save those lives.

“If peers are going to support each other, they need to be trained and have the right supplies to offer help while protecting themselves from infectious disease or toxic chemicals. They should get both of these services for free,” says Nick Rondinelli, owner of Heart to Heart CPR.  

Since June 1, 2021, Heart to Heart CPR has been conducting free 2.5-hour advanced overdose response training sessions called Peer Support Responder. It is a direct response to a gap in overdose response and resuscitation training. Rondinelli provides details to this in an educational video produced by Heart to Heart CPR featuring a real overdose.

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Rondinelli says, “This program covers critical opioid poisoning skills that are not covered in basic first aid/CPR. Peer Support Responder training uses protocols from lay rescuer CPR and Basic Life Support (BLS) guidelines.” Using a collection of evidence-based practices, the training provides learners with a toolkit of options to safely provide the person with what they need.

“We are strong supporters of empowering people with skills and training. We want to give people at risk the tools and skill sets to draw from when responding to an opioid overdose. Saving one life is worthwhile, and we want to help others save as many as possible,” says Rondinelli.  

Training scenarios incorporate pulse check, bag-valve mask, assisted breathing, two-rescuer CPR, and nasal naloxone simulators. The training also includes practicing while wearing PPE. Providing critical oxygen during COVID-19 requires responders to wear N95 masks, eye protection, gloves, and gowns. Heart to Heart CPR has produced an instructional video on these protocols called Overdose Prevention Resuscitation (CPR OPR).

“Our fundamental belief is to teach a variety of evidence-based skills starting from the easiest skill set (compression-only CPR) to more advanced procedures that include ventilations,” says Rondinelli.  

These skills save lives, especially when combined with naloxone administration and the ability to provide ventilations (oxygen) quickly and safely by way of ventilations-only or by CPR (30 compressions and 2 ventilations). Since opioid overdoses cause respiratory failure, it is important that peers be equipped and ready to respond accordingly.

Peer Support Responders that complete the training receive the equipment necessary for saving lives during the pandemic from Heart to Heart CPR. Each responder receives an emergency response backpack that includes a Bag-Valve Mask with HEPA filter, a one-way valve mask, mini-first aid kit and PPE (KN95 mask, gloves, gown, face shield, eye protection).

“Giving them more tools and options will make all the difference and is the right thing to do,” says Rondinelli.  

Toronto Public Health and the City of Toronto’s Shelter, Support and Housing Administration (SSHA) supports “Compression-only CPR - No Breaths During Covid-19” while performing CPR as a minimum level of care for community responders or “lay rescuers”.

Rondinelli says, “Compression-only CPR can be useful when the rescuer is unable or unwilling to provide breaths OR if the rescuer panics, causing them to freeze and potentially delay care. It can be a great default technique and should be used whenever possible. It should not replace the benefits of providing ventilations as part of CPR or ventilations-only as part of Basic Life Support Skills - especially for opioid overdose response where associated risks of cross infection of COVID-19 are low with the right protective equipment.”

Heart to Heart CPR is taking action through their Johnston-Brais Initiative for these reasons:

• Nick Rondinelli lost his dear friend of 22 years, Natalie Brais, to opioid poisoning in 2019, and his best friend of 18 years, Garth Johnston, to AIDS-related causes exacerbated by homelessness in 2016. These profound losses have inspired positivity and hope through action.
  
  
• The new guidelines for narcotic poisoning, released in the First Aid, Resuscitation Guidelines 2020, supports Heart to Heart CPR’s position. It states, “It is recommended that those whose job may involve responding to opioid poisoning (e.g., peer support/outreach workers) be trained in full CPR protocols to the BLS level and have access to both Naloxone and proper PPE.”
  
  
• Heart to Heart CPR warned The City of Toronto and others of the gaps in existing protocols in October and early November 2020, through a nationwide press release and subsequent letters. They are now trying to fill the deadly gap.
  
  
• Rondinelli’s longtime friend, Samuel Lopez, experienced a tragedy where his dear friend, Josh Nakogée, was brought to death on January 31st, 2021 from an accidental opioid overdose. Josh’s unexpected death took place in Sam’s apartment in downtown Toronto. He was a young Indigenous male at the age of 24. It was Josh’s death that pivoted The Johnston-Brias initiative to provide the program directly to the community and people most at risk. Samuel Lopez was the first participant in the pilot course.
  

Rondinelli says, “The problem I think is that society feels like peers and workers in shelters and outreach can not learn Basic Life Support. I think that most Peer Support Responders will be able to master these advanced skills over time. We are collecting data and measuring performance over a period. We are also comparing the success rates when additional training is provided more frequently. We hope to show the details of what it takes to get there so we can show that our solution is evidence-based and change the way we look at training in overdose response.”