The Johnston-Brais Initiative - First Aid for Opioid Poisoning Emergencies


Heart to Heart First Aid CPR Services Inc., has been in operation for 21 years, servicing Downtown Toronto East. We have provided emergency response training to thousands of healthcare providers and support workers in harm reduction, outreach, and community health centres. We have also provided extensive lay person training for staff in shelters, Toronto Community Housing, and many other community services for the vulnerable population.

A social entrepreneurship branch of my company, called The Johnston-Brais Initiative, is a task force that seeks to provide education, awareness, training, certification and best practices for the unique and challenging circumstances that harm reduction and overdose prevention services face each day. This task force is made up of industry leaders from the Canadian Red Cross, Emergency Medical Services, First Aid & CPR Training Providers, instructors, educators, healthcare providers, and harm reduction workers. Our team brings with them years of frontline experience, including experience within Indigenous communities.

Our goal is to have one reliable program that becomes accepted as the standard of care for overdose prevention resuscitation, one that empowers and develops highly skilled support staff to provide excellence in emergency response.  

Our pilot programs will fine-tune a standardized approach by incorporating the latest evidence-based guidelines, expert feedback, learner feedback, video evidence for skill competency, and other recommendations set forth by the First Aid, Resuscitation Guidelines 2020 and the CSA Z1650:21- Paramedic Response to Opioid Crisis.

We are confident that this initiative will save lives and provide a platform for offering similar standardized programs across the province, including our Indigenous communities. We must empower and prepare workers in shelters, harm reduction, overdose prevention and outreach to circumvent the current tragedy that we are faced with today – the unnecessary deaths resulting from drug overdoses, particularly opioid overdoses in our shelters and community.


Here’s some background:

I would like to share a major update on the advocacy work I’ve been doing regarding opioid overdoses in Toronto Shelters, and the urgent need for updated training, equipment, and support staff. In a national press-release published on October 22, 2020, I identified reasons for the spike in opioid overdoses and the all-time high number of deaths in Toronto shelters. This was followed by 2 letters sent on Oct. 24, 2020 and Nov. 2, 2020 to Mary-Anne Bedard (General Manager), of the Shelter, Support and Housing Administration (SSHA) division of the City of Toronto.

At its meeting on November 16, 2020, the Board of Health requested the Medical Officer of Health, in consultation with Mary-Anne Bedard, General Manager, SSHA, to work with community partners toward urgently expanding overdose prevention response and other harm reduction measures in Toronto shelters. The city will begin implementing a new strategy where almost $8 million in funding is being directed to organizations and programs providing harm reduction and overdose prevention services.

We are pleased that more advanced support and resources will be provided in our shelters, however, I strongly believe that most of my initial concerns outlined in my press release on Oct. 22, 2020 – click here to see  – will remain unresolved if the City of Toronto does not create and regulate a minimum set of standards and guidelines in training and resources for ALL shelters, outreach, family/peer support, harm reduction and overdose prevention services, to follow and comply with.The entire spectrum of services must be standardized  from low-barrier support services to community health centres.

Furthermore, unless ALL Toronto shelters receive the extra support in harm reduction and overdose prevention services, we are still left with under-trained staff, lack of PPE, improper breathing barrier equipment, no AED and a “No Breaths During COVID-19” policy, which is extremely confusing to shelter workers.  If we can’t provide ventilations, even safely with a BVM, the person’s heart can stop. Quite simply, any training that does not cover the most important skills required for opioid overdoses is insufficient whether it be shelter staff or harm reduction support.

Therefore, I strongly believe ALL shelter staff, harm reduction and overdose prevention support staff be certified at the Standard First Aid and Basic Life Support (BLS) level or higher.  If reforming BLS can not be done quickly, then an alternative to BLS training must be created as soon as possible in order to cover the additional skills required for opioid overdose response. These additional skills are not  taught in current training courses.  Perhaps a new level of CPR in needed, one that is specific for opioid overdose response?

Here is what we are proposing:

1. Overdose Prevention & Resuscitation (OPR) – also known as CPR (OPR) –*Alternative name- Basic Rescuer (OPR) or BR (OPR)

Who is it for? This training and certification course is designed around the “Low-Barrier” responder – for shelter, outreach, peer/family/community housing/neighbourhood support and any other low-barrier harm reduction support service.  

2. Advanced Overdose Prevention & Resuscitation – also known as BLS (AOPR) and comes with Airway Managment and Oxygen Therapy 

Who is it for?  This  training and certification course is designed around the healthcare providers in this field or any other first responder offering support services in high-risk environments and facilities. 

I will provide more detailed information about this 2-tiered classification of Opioid Overdose Responders in a blog coming soon.

What are the additional skills required for opioid overdose response? 

Basic Life Support (BLS) covers pulse check, assisted breathing (ventilations-only) using a bag-valve mask (BVM), Two-Rescuer CPR with BVM, Automated External Defibrillation (AED), naloxone administration in accordance with the new guidelines, overdose prevention strategies and more. Airway Managment and Oxygen Therapy oxygen management training can remain optional but is highly recommended for high-risk environments. Here is our sample video to demonstrate Basic Life Support skills, up to and including oxygen and airway management.

New Guidelines for Narcotic Poisoning

In October 2020, the new guidelines for narcotic poisoning, released in the First Aid, Resuscitation Guidelines 2020 supports my 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.”

Additionally, in February 2021, the Canadian Standards Association (CSA) released new national standards called CSA Z1650:21, Paramedic Response to Opioid Crisis. This Standard provides a framework for the paramedic service organization’s (PSO) response to the opioid crisis and addresses clinical practice, training/education, community engagement, and physical/psychosocial supports. As such, we are ready to work with all PSO’s to help fulfill any objectives they may require as part of our training program.

I am very proud to dedicate and name this social entrepreneurship strategy after two of my late closest and dearest friends.

Garth Johnston, my best friend for over 18 years, died from HIV/AIDS-related causes in 2016. He experienced homelessness several times in his life and suffered from mental illness, systemic racism and sexual abuse at a very young age. He was an advocate for the vulnerable population and activist for the LBGTQ community and paved the way for LBGTQ rights.

Natalie Brais, a long-time friend for over 25 years, succumbed to drug addiction in March 2019 and overdosed in her apartment in downtown Toronto.  Natalie experienced opioid addiction resulting from prescription medication. She represents the thousands of Canadians who have fallen through the cracks leading to an early death.Natalie Brais

We are confident that this initiative will save lives and provide a platform for offering programs across the country. It will provide a legacy that I know my friends would be proud of. One that will keep their memories alive in the form of a movement that will save countless lives.

By: Nick Rondinelli – CEO / Owner
Heart to Heart First Aid CPR Services Inc.
Canadian Red Cross Training Partner & Instructor Trainer
Lobbyist Registration Number: 46850S-1


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