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Ambulance: High Risk

Written by RSS Poster Medic Scribe

The dispatch is for an unresponsive overdose, likely fatality.  We are coming from a fair distance, but we are the only unit available.  There no updates.  No PD dispatcher asking if we are a medic unit or the message that CPR is in progress.  PD and fire have beaten us to the scene, but as we pull in, we know the story.  Friends and family members are gathered outside the triple-decker as word has no doubt gotten around the neighborhood.  The firefighter standing by the engine, nods to us.  A police officer comes out of the house and walks towards his cruiser.  I still grab my red in-house bag and cardiac monitor, and hike up the narrow stairs, and then through the open apartment door, down a hallway and into a bedroom where a man lays back against the bed like he was sitting up, and then just fell immediately backwards.  He has rigor and lividity.  Asystole in all three leads.  I announce the time.  It doesn’t take long to get the picture.  On a small table is a cardboard box, the kind glassine envelopes come in, and on top of the box is...

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Ambulance: New CDC Report: Characteristics of Fentanyl Overdoses

Written by RSS Poster Medic Scribe

Yesterday the CDC released a fascinating new report, Characteristics of Fentanyl Overdose — Massachusetts, 2014–2016.

The Massachusetts Department of Public Health, the state’s Medical Examiner’s Office and the CDC gathered 20 heroin users from three counties (Barnstable, Bristol, Plymouth) with high fentanyl overdose death rates (Two-thirds of overdose deaths were attributed to fentanyl) and interviewed them about their thoughts and experiences with opioid overdoses.

While the fact that the respondents were recruited by local harm reduction coalitions, suggesting they were knowledgeable about overdoses and naloxone training, likely skewed the results, the results are still informative.

Respondents

95% had witnessed an overdose in the previous 6 months

42% had overdosed themselves in the previous six months.

88% attributed the rising death toll to fentanyl.

They often did not know if they had purchased fentanyl or heroin.  While some wanted fentanyl and others wanted to avoid it, the presence of...

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Ambulance: Hard Time

Written by RSS Poster Medic Scribe

Let’s examine punishment for drug dealers who sell heroin to patients who subsequently die.

A new legal strategy is to charge dealers with homicide when one of their customers fatally overdoses and it can be proven the customer bought the fatal drug from the dealer.

In Rhode Island recently a 25-year-old dealer was convicted of selling $40 worth of “Diesel” to to a 29-year-old customer who died 4 hours later.  The dealer was sentenced to 20 years in jail.   One way to look at this is it sends a message to the dealers that they better think twice before they sell illegal drugs in Rhode Island.  They are tough and bad ass on crime there.  They do not tolerate drug dealing.

You can read more about it here:

Drug Dealer Sentenced To 20 Years For Murder After Customer’s Fatal Overdose

In the story the dealer expresses regret.   “The actions that I did that day, I never meant to hurt nobody,” he said.  He apologizes both to the mother of the victim and his own mother.

The story mentions that the victim had just been discharged from drug treatment...

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Ambulance: Fountain

Written by RSS Poster Medic Scribe

In Connecticut we are in the midst of hospital wars.  It is a very competitive market and all of the hospitals fight to attract patients.  You can see it on the billboards that line Interstates 91 and 84 with hospitals proclaiming themselves the best at heart care, stroke, trauma care or declaring they are the safest or provide the shortest wait times.  It can be seen even in EMS CMEs where medics and EMTs were recently treated to a lavish meal at one of the city’s finest restaurants complete with free valet parking to hear a specialist tout a hospital’s latest capabilities. (The event was subsidized by a vendor).  But nowhere is the battle more evident than in the TV commercials where hospitals tout their state of the art technology, their beautiful grounds and rooms, and the attractiveness (and wisdom) of their staffs.  It can make going to the hospital look almost like a trip to the Bellagio or some fine hotel with lavish fountains that go off at regular intervals.

Last Tuesday, my last call of a three day tour (I work three consecutive 12-hour...

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Ambulance: Narrative

Written by RSS Poster Medic Scribe

 

Upon arrival found a 22 Y/O female unresponsive lying on the floor of her bedroom with her father performing CPR on her.

He states that he last saw her alive a hour ago and then found her on the floor unconscious before calling 911.

He states she has a history of heroin abuse and there is a used needle sitting next to her.

She is unresponsive, with no palpable pulse, and she is apneic.

 

52,404 Americans died of overdoses in American last year.  Some died in their homes and were found by family, others were found by strangers in places like public restrooms, parked cars and motels that rent by the hour.  We in EMS bear witness.

143 more Americans will die this way tomorrow.

 



Ambulance: 3 EMS Models of Opiate Intervention

Written by RSS Poster Medic Scribe

Opiate users who suffer a non-fatal overdose are at the highest risk for having a fatal overdose.

Many of these people are hard to reach by traditional substance use and health care professionals.  EMS can make a difference with this population.

Whether the patient refuses further care and transport at the scene after being resuscitated or whether they go to the ED and then check out AMA, EMS has the opportunity to intervene.  Here are three models an EMS system should consider.

Provide Treatment Information. 

If there is a toll-free number for substance use help in your state, as there is in Connecticut, give them that number, or give the number of the local harm reduction coalition.

In Connecticut call 1-800-563-4086.

Department of Mental Health and Addiction Services Access Line for Opioid Users

Greater Hartford Harm Reduction Coalition

Give your patient information on where to obtain treatment, and/or if they are not ready for treatment, provide them with information on where they or their family members can...

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Ambulance: Don’t Use Alone

Written by RSS Poster Medic Scribe

61 people died of heroin overdoses in Hartford in 2016 (according to numbers released by the state Medical Examiner’s office on friday), up from 37 in 2015.  Based on the first six months of the year, the state estimated 888 people would die statewide, but when the final numbers came out last Friday, the number was  917.  This represents a 25% increase over last year, which was itself a 11% increase over the year before.  Of the 917 who died, 479 had Fentanyl in their system.  In 2012 there were only 14 Fentanyl deaths in Connecticut.  Here are the year by year numbers:

Fentanyl Deaths in Connecticut

2012-14

2013-37

2014-75

2015-188

2016-479

Last week I responded to an unresponsive in an area known for drug overdoses.  When I arrived in the 2nd floor apartment, I heard  a person say the man had a pacemaker.  I found a man on his side on a mattress in the living room.  His head was bluish purple, he had vomit on the side of his mouth and pillow.  He was not breathing,  I felt for a pulse on his thick neck, but felt nothing.  We...

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Ambulance: Harm Reduction

Written by RSS Poster Medic Scribe

Two words people in EMS interested in battling the opiate overdose epidemic should know are “HARM REDUCTION.”

According to the Harm Reduction Coalition, harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.

Harm reduction “accepts, for better and or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them.”

We in EMS like to respond to calls where a crisis is happening and we fix it and the person is better and can return to their normal life.   Unfortunately, EMS calls are rarely that simple.

We give someone Narcan and then we find the same person oded later that day.  Does that mean, we stop trying to save them?  Or does it mean we have to find other ways to get through to them?

If we can’t stop someone from using drugs that could kill them, we can at least try to help them mitigate the risks.

Across the country harm reduction organizations run needle exchange programs,...

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Ambulance: Novel Vagal Maneuver

Written by RSS Poster Medic Scribe

I never had great luck with vagal maneuvers.  Admittedly when I was a new medic, I didn’t particularly want them to work.  I wanted to give Adenosine, and watch the strip suddenly go asystole and then some wild funky beats before correcting to a nice sinus tack in the 120’s, way better than the 200’s I encountered.  Paramedic as savior!  I remember once how upset I was when I encountered a man in an PSVT in a doctor’s office.  As I got out my IV kit, the doctor ordered me to just take the patient to the hospital so they could see the rhythm for themselves.  Okay, I said, fully determined to work my magic in the ambulance.  Unfortunately for me, carrying the man down the stairs, caused a brief jostle and wallah, he was out of the PSVT.  Drat.

In time though I collected the experience of patients’ extreme uncomfortableness with Adenosine.  They’d clutch their chests in terror as their hearts stopped.  Two actually told me they would rather be shocked than get that drug.  Another pleaded with me not to give it to her, and even...

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Ambulance: Narcan 4mg IN

Written by RSS Poster Medic Scribe

download

I was a big initial fan of the intranasal atomizers both for pain management and opiate overdoses.  I liked them for pain management for their quick access.  I often gave an intranasal dose, and then after getting an IV, gave the rest IV.  Overtime I noticed quite a difference in response between the two methods.  IN might touch them; IV almost always worked.  Recently I have switched to IM for the quick first dose.  Sure it involves a needle stick, but the onset is quicker and it seems more effective.

I have continued to use intranasal Naloxone as my first line for opiate overdose accompanied, of course, by bag valve ventilation, but I have been having second thoughts about the IN route of late.  I have always preached patience, and when I give Narcan IN, my patience is usually always rewarded with a calm, almost placid patient.  Many of my peers have told me they prefer 1.2 mg IM as their starting dose.  That’s what I used before IN came out.  True, it does return their breathing sooner and almost always wakes them, but sometimes it...

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Latest Medic Scribe Stories

High Risk
New CDC Report: Characteristics of Fentanyl Overdoses
Hard Time
Fountain
Narrative

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