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Ambulance: Fentanyl: A Briefing Guide for First Responders

Written by RSS Poster Medic Scribe

Carfentanil (which had previously been seen in neighboring states) has now been officially identified in Connecticut.  The discovery of this drug 100 times stronger than Fentanyl poses questions: How much danger does Carfentanil (or Fentanyl for that matter) pose to EMS?  How can we in EMS protect ourselves from exposure to these drugs? What should an EMS responder do if they believe they are exposed or one of their coworkers has been exposed?

Every EMS responder should ask these questions and seek answers from both their medical control and from their services.  Unfortunately, I have had a hard time finding a one-stop source of good information on this question.  What follows is my attempt to share what I believe based on what I have read and people I have talked to.  It should not replace the information you get from your service.

Can Fentanyl or Carfentanil kill you?  Yes, they can.  If you inhale a certain amount of powder, you can go into respiratory arrest.  If no one gives you Naloxone or breathes...

Continues, Read More...



Ambulance: Narcan Man

Written by RSS Poster Medic Scribe

In troubled times in the metropolis, the unexpected rise up and battle the evils that enslave civilizations.  Today, such a tale is playing out on the streets of Hartford.  Behold…Narcan Man!

Few of us were paying attention when it started to happen.  We get called for a overdose at the bus stop, possibly not breathing.  We arrive in minutes.  There he is!  A man sits on a bench, leaning forward, head down.  We approach.  I can see his chest is moving.  Maybe four, six times a minute.  I give him a shake.  He responds slowly.  His eyes are pinpoint.  I recognize him as a regular on Park Street. His face is very pale.  I see some beads of sweat on his forehead.

Hey are you all right?

“Yeah, yeah, I’m fine,” he says.

I give him another shake.

He is breathing better now.

“How much did you do?” I ask.

“I didn’t do anything.  I’m good.  I’m good.”  He stands and looks around the street.  “I’m just.  I’m just tired, that’s all.”

“You know what day it is?”

“Monday,” he says.

Good guess.

“Who’s...

Continues, Read More...



Ambulance: New Brands

Written by RSS Poster Medic Scribe

I called a meeting of the heroin dealers of Hartford at the pavilion in Pope Park. I had no authority to call the meeting since I am neither a heroin dealer nor affiliated with anyone who is.  I just felt like things had hit a critical point where something had to be said.  I admit I was disappointed when no dealers showed.  True about forty men and a smattering of women did come.  They were of various races and tended to dress similarly, hoodies and flat brimmed baseball hats.  But they all assured me they had nothing to do with dealing drugs.  They were opposed to it.  They just came out because they were interested in why I thought there was so much heroin dealing going on in their city.

What are you serious? I said.  Look around.  Just look at the ground.  See all those ripped bags in the grass.  Pick them up, look at them.  Kong, Amazing, Predator.  Howl.  Those are what the dealers package their heroin in.  (I’ll be talking more about those in a minute.)  And look over there, there’s a syringe not 100 feet from the baseball field....

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Ambulance: Empty Wallets

Written by RSS Poster Medic Scribe

EMS responders go through more wallets than pickpockets.  Unresponsive person in an alley.  We need to ID them.  Check for a wallet.  Dead person in a hotel.  Got a wallet.  Unresponsive in car.  Check his pockets.  You are looking for the driver’s license, but you can’t help but notice how much cash they are carrying or not.

I will tell you this.  There are a lot of people out there without any green in their wallets.  Particularly opioid users.  Some may have been rolled before we got there, but it seems the same even when we find them in locked bathrooms or cars.  Not a single bill. 

OD in an apartment stairwell.  2 mgs Narcan IN.  Bag for a few minutes.  Comes around.  Immediately goes for his wallet.  It’s not there.  A firefighter holds it.  He has been writing down the demos.  He hands the wallet back to the man, who looks frantically through it.  “Where’s my money?  There was a twenty in there!”

“You were with people when you used?”

“Yeah, my boy,”

“Your boy, here?”

He looks around.  “Where...

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Ambulance: EMS Stroke Care

Written by RSS Poster Medic Scribe

Stroke Care should follow your local medical direction and treatment guidelines.  Here’s how we do it in North Central Connecticut.

EMS Role

When Emergency Medical Services (EMS) recognizes stroke in the field, and notifies the hospital either by radio patch or transmission, the hospital stroke team can be activated prior to the patient’s arrival. With enough notification, the patient can often go directly to CT Scan on the EMS stretcher. This single intervention has led to a marked decrease in door-to-needle time and improvement in patient outcome. The patient can receive an immediate evaluation by hospital neurologists and the decision can be made whether or not the patient meets the criteria for rTPA. The American Heart Association, recognizing the role EMS can play, has established a new goal of door-to-needle time of 60 minutes.  Even if the patient does not meet the narrow criteria for rTPA, the immediate neurological evaluation will lead to swifter interventions such as blood pressure control that will lead to better outcomes.

Stroke...

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Ambulance: Hello, Kitty

Written by RSS Poster Medic Scribe

Many years ago, the R.J Reynolds tobacco company got into trouble with its Joe Camel campaign, which featured a cool cartoon camel in human clothing who like to smoke.  The ad campaign was controversial because it seemed to target kids.  The American Medical Association tried to get the company to shut down Joe Camel after a study showed as many six-year-olds knew that Joe Camel was associated with cigarettes as Mickey Mouse was associated with Disney.  Sales statistics backup up a huge increase in underage sales of cigarettes that were also disproportionately camels.  Tobacco company documents were made public that revealed they were indeed targeting kids.  Finally, in 1997, they terminated the campaign and settled to the tune of $10 million dollars to be targeted to teen smoking prevention efforts.

The heroin industry in Hartford seems to be taking a similar tack these days and it is quite disconcerting.  Among the brands to hit the streets in recent weeks are Bugs Bunny, Hello Kitty, Dino babies and Smurfs to go along with the previously...

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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...

Continues, Read More...



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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Latest Medic Scribe Stories

Fentanyl: A Briefing Guide for First Responders
Narcan Man
New Brands
Empty Wallets
EMS Stroke Care

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