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Saving Lives in the Stacks

Saving Lives In The Stacks

On June 1, the Philadelphia Inquirer[1] broke the news that the Free Library of Philadelphia s McPherson Square Branch had a serious problem with opioid use among patrons. By June 3, everybody from the Washington Post[2] to National Public Radio[3] (NPR) had picked up the story.

As this nation s opioid crisis has exploded, the staff at the public library have become first responders, NPR s Scott Simon told listeners. And I gather the librarians there have been obliged to become involved in a way that well, become involved in a way librarians aren t usually asked to become involved. What Simon didn t say but what librarians far and wide know is that the McPherson Square branch is just one of many American libraries struggling with opioid-related issues such as discarded, contaminated needles; drug use in the library itself; and even on-site overdoses and fatalities. Libraries from California to Colorado, Pennsylvania to Missouri, are finding themselves on the front lines of a battle they never anticipated fighting. Of course, opiate use isn t limited to libraries. Neither is anyone claiming that the problem is more severe in libraries than it is anywhere else. Still, the fact that libraries are open to all, offer relative anonymity, and generally allow patrons to stay as long as they like make them uniquely vulnerable to those seeking a place to use drugs.

It s just like: What is going on? How can we stem this tide? says Kim Fender, director of the Public Library of Cincinnati and Hamilton County (PLCH).

A life at stake

In 2015, more Americans died from drug overdose than from car accidents and gun homicides combined[4], and more than six out of 10[5] of those overdoses involved an opioid. Preliminary data for 2016 suggests that drug overdose deaths for that year rose by about 19%[6] the largest annual increase the United States has ever seen. Among the opioids used illegally are heroin; prescription pain medications such as oxycodone; fentanyl, a synthetic opioid 50-100 times more potent than morphine; and carfentanil, an elephant tranquilizer 10,000 times stronger than morphine. Kitty Yancheff doesn t know exactly which opiate caused the overdose of the patron she encountered in the Humboldt County (Calif.) Library in Eureka last year. She just knows that without her intervention, he would almost certainly have died.

After noticing a man at a table near the reference desk who seemed to be sleeping, Yancheff, the library s public service division manager, tried to rouse him, first with words and then by banging on the table and his chair. As I m doing this, I noticed that he was sweating profusely, really dripping, she tells AL. He had mucus coming out of his nose, and his breathing was kind of gurgly, and his lips were blue, so I figured he was having an overdose. (The World Health Organization states that an opiate overdose can be identified by three symptoms: pinpoint pupils, unconsciousness, and respiratory depression.)

As another staff member called 911, Yancheff grabbed a dose of Narcan, a drug that reverses the effects of opiate overdose, and administered it to the man via injection in his thigh, through his clothing. (The local public health department had recently given the library a supply of Narcan and trained staff in its use.) When he didn t respond, she followed protocol by giving him a second dose, at which point his eyelids began to flutter. A few minutes later, the paramedics arrived. The man survived, though Yancheff hasn t seen him since.

It was surreal, Yancheff says. But I think to not have the Narcan, and sit idly by and watch someone die, would have been even worse.

To stock Narcan, or not

It s not clear how many libraries have joined Humboldt County Library in making Narcan available and training staff in its use. Among those who have is Denver Public Library s Central branch, which began stocking Narcan earlier this year after a homeless patron overdosed and died in the library s bathroom from a combination of heroin, methamphetamine, and other drugs. The library bought 12 Narcan kits in February. By May, it had used seven of them.

We have 13 staff members who are trained to use it our two social workers and then 11 security staff, explains Rachel Fewell, central library administrator. The library stocks a nasal-spray form of Narcan, rather than the injectable version. It s noninvasive, and there s a clear protocol around it. It costs us $75 per kit. If you can save somebody s life for $75, let s do it. But what if Narcan is mistakenly administered to someone who hasn t actually overdosed? It s not going to have any negative impact, Fewell explains. All it does is block opioids from hitting receptors in the brain, so even if you incorrectly use it on someone, there s no negative side to it. In addition, Narcan itself is not addictive, so libraries need not worry about any potential for abuse.

To the argument that administering Narcan falls outside the library s mission, Fewell responds: This is definitely scope creep for us, but we re the de facto day shelter for Denver. If that s how the city is going to see us, I d rather my staff has tools to deal with it. Yancheff agrees. Not stocking Narcan does not mean that that s going to keep folks [who use opioids] away, she points out. Some people are concerned that if you stock it, they re going to know they can come in there and overdose and know you ll be able to revive them. Personally, I don t believe that s the case. I just see it as a resource similar to CPR, just another thing in our first-aid resource kit. While other libraries consider whether to follow Denver s and Humboldt County s example regarding Narcan, some are resorting to other strategies, many of which center on library restrooms.

Needle Safety in the Library

By Roger A. Donaldson II

Whether discarded needles are found inside or outside the library facility, staff must be aware of their dangers and dispose of them safely. Conduct walkarounds in your facility at least once per day to look for discarded needles, and do not put your hands in trash cans or other areas in which you can t see what you re touching. If your facility crushes trash to conserve trash bags, use an object to do so, rather than your hands. Consider providing a sharps container in the restrooms for proper disposal of needles. Some sources recommend using tongs or other grabbing devices to pick up a discarded needle, but this may cause the needle to flick or fall, injuring yourself or others.

If you find a discarded needle:

  • Make sure to keep other people especially children away.
  • Don thin, disposable latex gloves.
  • Bring a container to the needle (rather than the other way around). The container should be sealable, with rigid, puncture-proof walls. These containers can be purchased through Amazon and other retailers; you can also consult your county health department. Do not use glass bottles for this purpose, as they can break.
  • Put the container on a stable surface, rather than holding it in your hand.
  • Make sure that you can clearly see the needle and your hands.
  • If you see more than one needle together, use a stick or similar object to separate them, and handle only one at a time.
  • Pick up the needle from the blunt end, avoiding the sharp point. Do not attempt to re-cap it.
  • Place the needle in the container and seal it.
  • Discard the gloves and wash your hands immediately.

Sharps containers should be discarded according to your local regulations. Some cities require the sharps containers to be placed with regular trash pickup in a visible manner, so that garbage collectors can handle the container safely. Other cities require sharps containers to be dropped off at the county health department or another designated point. Call your local health department or law enforcement department for information on proper disposal. If a needle-stick injury occurs, stay calm, and wash the area with soap and water as soon as possible. Apply antiseptic and a bandage, contact your supervisor, and promptly seek medical treatment.


ROGER A. DONALDSON II, CPLS, is IT administrator and technical services supervisor at Jackson (Ohio) City Library.

Keeping restrooms safe for all

It is unavoidable that people are going to use drugs in public bathrooms, says Dr. Alex Walley, director of the Addiction Medicine Fellowship Program at Boston Medical Center and associate professor of medicine at Boston University School of Medicine. The sooner that libraries accept that and try to prepare for it, the better off they re going to be. Philadelphia s McPherson branch has certainly accepted it. In May, after the branch experienced several overdoses, it began requiring patrons who wanted to use the bathroom to show identification.

That proved to be too much for the circulation desk to keep track of, says Judi Moore, the branch s library supervisor and children s librarian. So the library partnered with a local nonprofit, which now supplies volunteer bathroom monitors who sit by the bathroom door, take identification, and time people. If a person hasn t emerged from the bathroom after five minutes, a security guard knocks on the door. Since the new rules have been implemented, no overdoses have occurred in the branch s bathrooms.

The main branch of PLCH has experienced an astonishing number of overdoses in the past year about 50, or slightly fewer than one a week. As Fender points out, that s a relatively small number compared with the million-plus visits the branch gets each year, but it s still obviously a behavior we don t want in any way to continue. Because the branch is located extremely close to a fire station, which is the first to respond to 911 calls of any nature, the library has chosen not to stock Narcan, Fender says: They can get here very, very quickly. Instead, the library has taken measures such as having its 20-member security staff patrol bathrooms more often. Just having people walking in certainly helps deter any kinds of behaviors someone might do in a bathroom that you wouldn t want, she says. We had originally proposed closing off some of the restrooms, but building code requires a certain number of male and female toilets because of our occupancy. If the tide of overdoses doesn t ebb, she adds, the library will likely consider turning to Narcan. What other strategies can libraries consider to discourage drug use in restrooms? In the past, some institutions have installed blue lights in bathrooms, with the idea that doing so makes it more difficult for users of intravenous drugs to find a vein to inject. Per Walley, the physician at Boston Medical, this strategy is unwise. The worst-case scenario is that someone tries to use despite that lighting and hits an artery, so then there s pulsing blood in the bathroom, he says.

Instead, he recommends increasing bathroom monitoring, particularly for single-user bathrooms. One strategy is to keep the bathroom locked so that patrons have to ask for the key at the front desk. If the key hasn t come back after a short period of time, a security guard or other worker can be dispatched to check the bathroom. Another is to install an intercom and require bathroom users to respond through it when checked on. Steve Albrecht, a trainer and security consultant who has taught library security workshops for nearly 20 years, and who is the author of Library Security: Better Communication, Safer Facilities[7] (ALA Editions, 2015), has another suggestion: I like camera systems. He s not talking about video cameras in the bathroom itself, of course, but rather just outside it, along with signs noting that the area is under video surveillance. Banks still get robbed even though they have cameras, but it s a good deterrent, he says. Walley also recommends installing secure needle-disposal boxes in the bathroom. Otherwise, he says people will put their needles down the toilet. Indeed, Philadelphia s McPherson branch was forced to close for a few days earlier this year after its bathroom pipes were clogged with needles. The branch has since installed sharps containers.

And if the bathroom is especially small, the library should make sure that its door opens outward rather than inward. There have been cases where people have overdosed and fallen against the door and blocked the door so it can t be opened, Walley says. I imagine most libraries are ADA-compliant, so you wouldn t have that situation, but if you do, that s relatively easy to fix.

Hope on the horizon?

When and whether the opioid crisis will end is anything but clear. Preliminary data for 2017 indicates that the tide of drug deaths has yet to turn. Still, there are some signs of hope. The Federal Drug Administration recently asked[8] drug company Endo Pharmaceuticals to take the powerful medication Opana ER off the market, a move interpreted by some[9] as a sign that the agency is ramping up its efforts against the abuse of prescription opioids. And some states, including New York[10] and Maryland[11], have passed legislation aimed at combating the crisis, such as by making Narcan more widely available, requiring physicians who prescribe opioids to prescribe the lowest effective dose, or allowing prosecutors to seek longer prison sentences for drug dealers who knowingly sell fentanyl.

But until the opioid war has been won, libraries will surely continue to find themselves on its front lines. As Fender says: We re all struggling together.


Facts About Narcan

  • Narcan is the brand name of a drug called naloxone, a medication that reverses the effects of opioid overdose by preventing the opioid from reaching the brain.
  • If Narcan is given to someone who is not experiencing overdose, nothing will happen; there is no potential for harm. In addition, it is not possible to overdose on Narcan.
  • Narcan is available both as an injection and as a nasal spray. It works within two to eight minutes.
  • Libraries that stock Narcan typically administer it in conjunction with a call to professional emergency services (911).
  • For more information on Narcan, visit naloxoneinfo.org[12] or getnaloxonenow.org[13].

References

  1. ^ Philadelphia Inquirer (www.philly.com)
  2. ^ Washington Post (www.washingtonpost.com)
  3. ^ National Public Radio (www.npr.org)
  4. ^ from car accidents and gun homicides combined (www.nytimes.com)
  5. ^ more than six out of 10 (www.cdc.gov)
  6. ^ about 19% (www.nytimes.com)
  7. ^ Library Security: Better Communication, Safer Facilities (www.alastore.ala.org)
  8. ^ recently asked (www.fda.gov)
  9. ^ interpreted by some (www.bloomberg.com)
  10. ^ New York (www.governor.ny.gov)
  11. ^ Maryland (governor.maryland.gov)
  12. ^ naloxoneinfo.org (naloxoneinfo.org)
  13. ^ getnaloxonenow.org (www.getnaloxonenow.org)

APD: Security guard shoots Ace robbery suspect » KTVA 11

A man was shot while trying to rob an Anchorage hardware store. Now, he s in custody and the store owner is crediting a loss prevention officer with saving lives. Just after 5 p.m. Saturday, police say a man walked into Andy s Ace Hardware on Muldoon and pulled out a gun.

[He] pointed it at the clerk working the cash register, demanded money from the cash register, said Sgt. Jeremy Conkling. Anchorage Police say the man, identified as 45-year-old William McCann, shot the register several times.

Owner Stephanie Van Ness was in the back of the store at the time and didn t see what was happening.

We heard a noise. We thought maybe a box had dropped out on the sales floor, she said. The sound was a gunshot. Police say after getting the cash, McCann shot the register.

We heard three more shots and we knew something was wrong, said Van Ness. When McCann ran out the front door, police say he met a loss prevention officer.

We do believe at this point the suspect fired on the security guard and then the security guard fired at least two times, striking the suspect, said Conkling.

The security guard was not shot, and no other injuries were reported. Customers and employees all evacuated safely and the wounded suspect was soon in custody.

I do strongly feel that our loss prevention officer today saved lives, said Van Ness. Officers are also looking for a vehicle involved in the crime a Ford Bronco, which police say dropped the suspect off and then fled when the security guard shot McCann.

In the store s 55 years, third generation owner Van Ness said a crime like this is a first.

Never happened, she said. We ve had shoplifting, unfortunately, more lately than there has been in the past, but this is the first time we ve had a robbery, and especially a robbery with a weapon. How her store is a crime scene. Van Ness said what happened here is happening all over town.

I feel like all of Anchorage is being hit all the time now and people probably weren t talking about it like they should be to get it fixed and people are starting to talk about it now and understand what a problem shoplifting is, she said. For Van Ness, owning her grandfather s hardware store is about helping customers. They closed for the rest of Saturday, but, she says come Sunday, their doors will open and they ll get back to business as usual.

We re a family here and everybody came together and helped make sure everybody was safe.

Upon his release from the hospital Sunday, McCann was charged with first-degree robbery, two counts of third-degree assault, misconduct involving weapons, theft and reckless endangerment.

Man executed in Alabama for killing 3 workers during robbery

by KIM CHANDLER, Associated Press

Man Executed In Alabama For Killing 3 Workers During Robbery

This undated photo released by the Alabama Department of Corrections, shows Robert Bryant Melson, in Atmore, Ala., convicted of killing three fast food restaurant employees during a 1994 robbery. (Alabama Department of Corrections via AP)

ATMORE, Ala. (AP)

A man convicted of killing three people during the 1994 robbery of an Alabama fast-food restaurant was put to death by lethal injection.

Robert Melson, 46, was pronounced dead at 10:27 p.m. CDT Thursday at a southwest Alabama prison, authorities said. The execution was the state’s second of the year[1]. State prosecutors said Melson and another man who used to work at the restaurant, robbed a Popeye’s in Gadsden, 60 miles (96 kilometers) northeast of Birmingham, and Melson opened fire on four employees in the restaurant’s freezer. Nathaniel Baker, Tamika Collins and Darrell Collier were killed. The surviving employee, Bryant Archer, crawled for help and was able to identify one of the robbers as the former worker which led police to Melson. Collins’ family members wore a badge with her photograph and the phrase “In Our Hearts Forever.” Her family issued a statement saying that three young people lost their lives for “a few hundred dollars” and criticized court filings on behalf of Melson that challenged the state’s execution procedure as inhumane. Collins’ mother and two sisters witnessed the execution.

“He has been on death row for over 21 years being supported by the state of Alabama and feels he should not suffer a little pain during the execution. What does he think those three people suffered after he shot them, leaving them in a freezer?” the statement said.

Melson shook his head no when the prison warden asked if he had a final statement. A prison chaplain knelt with him. Melson’s hands quivered at the start of the procedure and his breathing was labored, with his chest moving up and down quickly, before slowing until it was no longer perceptible. Melson’s attorneys had filed a flurry of last-minute appeals seeking to stay the execution. The filings centered on Alabama’s use of the sedative midazolam which some states have turned to as other lethal injection drugs became difficult to obtain. The U.S. Supreme Court temporarily delayed the execution to consider Melson’s stay request, but ruled after 9 p.m. that the execution could go forward.

Midazolam is supposed to prevent inmates from feeling pain before other drugs are given to stop their lungs and heart, but several executions in which inmates lurched or coughed have raised questions about its use. An inmate in Alabama coughed and heaved for the first 13 minutes of an execution held in December. Melson’s attorney argued that midazolam does not anesthetize an inmate, but they might look still, because a second drug, a paralytic, prevents them from moving.

“Alabama’s execution protocol is an illusion. It creates the illusion of a peaceful death when in truth, it is anything but,” Melson’s attorneys wrote in the filing to the Alabama Supreme Court. The Alabama attorney general’s office argued midazolam’s use has been upheld by the U.S. Supreme Court and it has allowed multiple executions to proceed using the drug, including the execution of an Alabama inmate last month.

“Robert Melson’s decades-long avoidance of justice is over. For twenty-three years, the families of the three young people whose lives he took, as well as a survivor, have waited for closure and healing. That process can finally begin tonight,” Attorney General Steve Marshall said in a statement after the execution.

References

  1. ^ second of the year (fox17.com)
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