This past week in Hartford, a 13-year old boy brought some bags of fentanyl to school.  He later collapsed and received CPR from a school teacher.  EMS arrived and resuscitated the child, who died two days later in the hospital.  Bags of fentanyl were recovered from the scene and the boy tested positive for fentanyl.  Two of his classmates were also transported, but media reports were unclear whether or not the boys also used fentanyl or were merely exposed to it. 

A search of the grounds with drug sniffing dogs revealed 40 other bags of fentanyl hidden in various places in the school.

It was a tragic event.  

The paper referred to the death as an overdose.

His death was a poisoning.   

Overdose implies taking more than a regular dose.

Our drug supply is poisoned.  The problem with heroin/fentanyl in Connecticut is that no one can tell the potency of any individual bag.  Fentanyl is sold on the street here in small glassine envelopes mixed with a great amount cut. Each bag goes for $3-4 A typical bag may...

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The patient has a fever, headache and cough.  He can’t smell anything and he can’t taste his food.  He feels too short of breath to even get out of his chair. He sits there with his hand over his eyes as if not seeing might make how sick he feels go away. His sister says he’s been ill for a week.  She called 911 for him.  She wants him to go to the hospital and get tested.  She is counting on them making him feel better.

I am standing there in a gown that barely reaches my knees, N95 mask, covered by a surgical mask, a plastic face shield and gloves.  In my hand I hold the state’s COVID-19 Emergency Medical Services Non-transport Guidance protocol, which has just been activated in the city of Hartford for any patients wanting to go to the hospital in the north end, which is overwhelmed with patients.

The man’s BP is 100/52.  His heart rate is 120. He is breathing at a rate of 32.  His room air SAT is 96%.  His skin feels cool not hot.

He doesn’t meet the protocol. He needs IV...

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I’m recerting PALS (Pediatric Advanced Life Support), ACLS (Advanced Life Support) and CPR today in one all-day session. After this, I’ll be good for another two years. If you are in EMS, you can measure your career by how many American Heart Association recerts you have taken.  For me this is the 15th time for PALS and ACLS, the 18th time for CPR. It’s a lot of hours rehashing the same basic material.  It is pretty much universally required.  You have to maintain these three AHA certifications if you want to stay working in EMS.

When I started ACLS and PALS were nerve racking.  Not everyone passed.  Remediation and repeating stations was common. You had to study before and then do one on one sessions with ED doctors.  Now, all you do is watch videos, push on some mannequins, and take a multiple choice test that is hard to fail.

I am fortunate that our union contract requires the company to offer us the training at no cost, but still it is a day off of work.  I’m not saying knowing the subject...

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Our ED has seen record volumes of patients in recent weeks, many with COVID.  Most of these COVID positive patients recently tested positive, and not feeling well with minor shortness of breath fever or body aches, come to the ED where they are evaluated and sent home.  Our in hospital COVID admissions are only 50% of the heights achieved during the first COVID wave of March/April 2020, and are 70% of the second lessor wave of November/December 2020, but exceed the small third and fourth waves of April 2021 and September 202.

Statewide, COVID ACT Now rates Connecticut at Severe Risk despite the fact that 74.6 % of our population is fully vaccinated with 88.6% having received at least one dose.

Many of our 911 calls are for these COVID positive patients not feeling well.  I have not seen any of the severe respiratory distress patients or the patients who appear okay, but who have oxygen saturations in the 70s like I saw during the first COVID wave.  This may be because omicron supposedly doesn’t infect...

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Overdose on the avenue — a woman in a tattered hoodie and black winter coat lays on the sidewalk next to a streetlight, with bystanders surrounding her.  The woman, who looks to be in her forties, was talking to them and then she slowly collapsed against the pole and then to the ground.  If I stimulate her, she breathes, opens her eyes and emits a high-pitched wail. Leave her be, and she stops breathing, her mouth open.  I stimulate her again, and then again.  Her pupils are pinpoint, her oxygen saturation is in the 90’s when I am stimulating her,  We are just a block away from the local harm reduction center.  Some of the staff who I know have come out to help.  They tell me her name.  She used about ten minutes ago.  Normally, they say, they just sit her up in a chair and watch her.  From her pristine veins, I surmise she snorts her heroin.  I can hear the ambulance sirens coming up the street.  I am thinking I will get her in the ambulance, and if she keeps going apneic, I will put in an IV and give...

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These are two old Christmas posts I wrote years ago, reposted now.

***
Fifteen on the Scale

It’s Christmas eve. We get called to one of the local nursing homes for rib pain. The room number sounds familiar. As we wheel our stretcher through the lobby, “Good King Wencelous” plays through the speakers.

Gently shone the moon that night, thou the frost was cruel.
When a poor man came in sight, gathering winter’s fuel.

In the East Wing, the nurse hands me the paperwork. “Mr. Ryder says he needs more Percocets. He’s requesting transport.”Mr. Ryder is a tattooed biker, an emaciated COPDer with a long white beard. Almost sixty, he can’t weigh more than a hundred pounds. He sits in his wheel chair, in his Rebels motorcycle jacket, wearing an oxygen cannula.

“I’m in real bad pain,” he tells me in his whisper of a voice. “Fifteen on the scale.” He nods as if to say it is the truth.

“Well, we’ll check you out when we get you out in the ambulance,” I say.

It seems he fell a couple weeks ago and cracked a...

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