Coming in April 2021 from Johns Hopkins University Press.

Now available for preorder on Amazon.

Killing Season: A Paramedic’s Dispatches from the Front Lines of the Opioid Epidemic

There are to COVID tracking sites I follow every day.   They both have color coded maps that show how each state is doing according to their metrics.

Connecticut is not doing as well as it has in the past.  Our dailey cases and test positivity rate have gone up and stayed there over the last couple weeks.  Much of this is likley attributable to the influx of college students into the state as well as local grade and high school students going back to school. 

Daily coronavirus updates: Higher positivity looks like new normal as metrics flatten; Sacred Heart president says students could be sent home; U.S. reaches 200,000 coronavirus deaths.

The EMS system here hasn’t felt any real uptick yet.  I don’t know if it is just a matter of time or maybe because the increase in cases is largely attributable to younger people, we are not seeing and may not see the devastation we saw in the spring in our nursing homes, prison, and group homes.

Let’s hope so.

Keep wearing your masks.

COVID ACT Now

COVID Exit Strategy

Recent data on fatal overdoses in Connecticut shows overdoses among black and Hispanic citizens are increasing as a proportion of total overdose deaths.

To date in 2020, 29% of overdose deaths in Connecticut have been black or Hispanic people compared to 18% in 2015, 21% in 2016 and 2017, 24% in 2018, and 28% in 2019.

Source: Drug Overdose Deaths in Connecticut

Accessed September 21, 2020.  Data updated through 8/27/2020 (Chart by medicscribe)

I have had more than a few people from minority communities express bitterness to me that this country only began to care about the opioid epidemic when white sons and daughters started to die, while when it affected people of color in the inner city, the government instead of showing compassion toward the sick, invented the War on Drugs to attack black and poor people.

The disparity between treatment of white and minority is often illustrated in the heavy sentences for crack cocaine users (preferred in black community) versus the lighter sentences for cocaine...

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The Mental Capacity Act continues to consume a number of the queries I receive about policing and mental health.  The point of this post is not to repeat the content of those I’ve already written, but just to highlight the ongoing issues which form my focus when I listen to the questions coming on social media.  You can read the previous posts I’ve written in the paramedic series of blogs (which, of itself, tells you that many of these situations involve the police’s interface with the ambulance service) and of course, the Quick Guide on the MCA.  It’s worth bearing in mind also, the Mental Capacity (Amendment) Act 2019 will take effect at some point and this will provide far more words within section 4B of the Act, which you’ll see shortly, is key to many of the problems we continue to see.

I want to emphasise three things here, above what I’ve written before –

• The balance of probabilities
• The least restrictive principle
• ‘Restraint’ versus a ‘deprivation of liberty’.

THE BALANCE OF PROBABILITIES

I may,...

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In Connecticut, when EMS responds to an opioid overdose, after they have taken the patient to the hospital, accepted a refusal, or presumed a patient dead, they are required to contact the state poison control center and answer a series of questions about the overdose.

The program, known as SWORD (Statewide Opioid Reporting Directive), that went statewide on June 1, 2019, recently released the results of its first year of data collecting.

Here are the highlights:

There were 4,505 suspected overdoses including 337 fatal overdoses, reported by EMS to the SWORD program between June 1, 2019 and May 31, 2020.

Males accounted for 74% of the overdoses; females 26%.

People between the ages of 25 and 39 were most likely to overdose.

When the drug of exposure was known, 87% of the overdoses were due to heroin or fentanyl versus 11% for prescription opioid and 2% for methadone or suboxone.

Bystanders gave naloxone in 15% of the overdose cases where 911 was called.

88% of overdose victims were transported to the...

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My September challenge is to try and ensure in exceptional times West Midlands Police does not lose a year in making progress on our vision of preventing crime, protecting the public and helping those in need through the “This work matters” strategy.

Some of you may admire my optimism given the challenges we are dealing with so let us start there!

The need to dial up our work on COVID restrictions is now very pressing given the global and local upturn in infections. This time of course there is no lockdown and we are very busy with normal demand. The good news is the multi-agency team in each local area is on a better footing. We have a much better picture on where infection risk is highest, though the quality of this is reliant on testing information.

We have been very successful under Operation Reliant on dealing with large gatherings. We are now trying to focus on gatherings of six and facemasks in key areas like public transport. When you are out and about please challenge and...

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Labor day weekend I had an irregular heartbeat.  I had a funny feeling in my chest and when I took my pulse, son of a gun, I was missing a beat every now and then.  I wasn’t near any place where I could put myself on the monitor and see what was actually going on, but every time I checked, even when I wasn’t feeling anything, i couldn’t get to 30 without a dropped beat.

I am sixty-two years old, and while I feel I have been in somewhat of a physical decline over the last two years, particularly this last year with the COVID altering my normal workout eating and mental health routines, I have never questioned the strength or health of my heart before.  I admit that it scared me.

I tried to determine what might be causing the missed beat and focused on two culprits.  A medication I take for my thyroid which can cause palpitations and caffeine.  I did- against my better interests have several coca-colas that day of and the day before.  I am somewhat addicted to Coke, but often go months without it because it makes me cough quite badly...

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I attended a CME recently where I heard a term I had never heard before.

SHOCK INDEX

The shock index (SI) is heart rate divided by systolic blood pressure. The normal range is 0.5 to 0.7.

The shock index has been shown to be a predictor of increased likelihood of shock, hospital admission, and mortality.

Someone is likely at risk for shock if their SI is over 0.8.

If my systolic blood pressure is 120 and my heart rate is 60, my SI is 0.5.
If my systolic is 120 and my heart rate is 120, my SI is 1.0 –in the danger zone.

While most paramedics can just look at a patient and tell you whether or not they are in shock, the shock index can help raise concern for someone in who is at risk for decompensation.

Here’s some studies on the shock index.

A prehospital shock index for trauma correlates with measures of hospital resource use and mortality

Shock index in patients with traumatic solid organ injury as a predictor of massive blood transfusion protocol activation

Here’s a great article on shock.

Approach to Shock