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Ambulance: More Opioid Deaths?

Written by RSS Poster Medic Scribe

Is the COVID epidemic causing increased opioid overdose deaths? No one knows for certain, but the head of the White House Office of Drug Policy is speculating that it has, citing increased death statistics from a few states such as Kentucky.

Pandemic unleashes a spike in overdose deaths

Here in Connecticut we won’t have an official answer until the Connecticut Medical Examiner’s Office releases its first six months of 2020 data (likely at the end of August).

I am involved with a statewide SWORD program that tracks EMS reported opioid overdoses.  Unfortunately, this program under reports fatal overdose deaths.  There are several reasons:

  1. EMS compliance with reporting is estimated to be only 70%.
  2. EMS often cannot ascribe the cause of a death to an overdose lacking eyewitness accounts of visible paraphernalia on scene.  (Example –A fifty year old lying dead in bed with rigor mortis and dependent lividity could have died from any number of causes from a heart attack to sniffing a bag of heroin that was either flushed down the...

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Ambulance: Forced Sedation

Written by RSS Poster Medic Scribe

Interesting article on NBC news about the use of ketamine for sedating patients in police custody. 

Elijah McClain was injected with ketamine while handcuffed.  Some medical experts worry about its use during police calls.

The reporter centers the story around the tragic case of Elijah McClain, who was apparently walking down the street, wearing a face mask and listening to headphones when a 911 caller said he was acting strangely.  The police stopped him and ended up taking him down with a chokehold.  He said he couldn’t breathe and he vomited.  EMS came.  The officers told them he was on something and was exhibiting inhuman strength.  The medics gave Elijah a large dose of ketamine, and shortly after he was in cardiac arrest.  He was resuscitated, but suffered a brain injury and was unplugged.

In light of today’s awareness of cases of brutality, this case has aroused considerable attention and controversy.

The article seems to take the positions that 1) people should not be injected with a sedative during a police action and...

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Ambulance: Golden Hour of Trauma

Written by RSS Poster Medic Scribe

R. Adams Cowley, the founder of Maryland’s well-known Shock Trauma hospital in downtown Baltimore, famously said:

“There is a golden hour between life and death. If you are critically injured you have less than 60 minutes to survive. You might not die right then; it may be three days or two weeks later — but something has happened in your body that is irreparable.”

The Merriam-Webster On-Line dictionary defines “golden hour” as “the hour immediately following traumatic injury in which medical treatment to prevent irreversible internal damage and optimize the chance of survival is most effective.”

The 2nd edition of the Prehospital Trauma Life Support said “The critical trauma patient has only 60 minutes to reach definitive surgical care or the odds of a successful recovery diminish dramatically.”

(It is my guess that this is no longer in the current edition.)

The following quotes are from a 2001 Academic Emergency Medicine journal article:

“The Golden Hour: Scientific Fact or Medical Urban Legend?”

“The golden hour...

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Police: 18 IS TOO YOUNG TO BE A MAGISTRATE

Written by RSS Poster The Justice of the Peace
Amongst many unexpected effects of the Convid 19 crisis the composition of juries in the crown court has come under scrutiny owing to the enormous backlog in trials which some experts are predicting could take four years or more to clear. This has caused some angst at the Ministry of Justice which has been suffering more than many other government departments from the austerity imposed from 2011 resulting in the closure of half the nation`s courts. 

The  jury system in England can be traced back to Henry II in the 12th Century becoming formalised under Magna Carta a century later when it can be said that the magistracy also came into being.  It wasn`t until 1919/1920 in the aftermath to the Great War that women became eligible both for the magistracy and for juries. From 1825 to 1962 a juror was required to own property.  In 1972 the age requirement for jury service was lowered from 21 to 18.   In 1988 the maximum age of jurors was raised from 65 to 70 and in 2016 to 75. In 1995/96 an inquiry undertaken by...

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Ambulance: Yet to Come

Written by RSS Poster Medic Scribe

My daughter had her first softball game of the summer yesterday. It was the first time she wore a uniform since her basketball team’s playoff run was stopped in March with the first Corona cancellations.  Last night they got mercied 17-5 but it was a beautiful night and she got two hits. They were supposed to play again tonight, but a thunderstorm came up and drenched the fields. Afterward there was a gorgeous rainbow, but with more rain on the way, they called the game.

We came home and had dinner. Earlier that afternoon, I stopped at Bear’s Smokehouse and picked up our local “farm share” along with two pounds of smoked burnt ends. Every Tuesday we pick up a bag of fresh picked farm products. Tonight they had a head of butter lettuce, peapods, zucchini, mint and fresh picked strawberries, juicy berries that actually taste like strawberries not the bland flavor the fat pretty-looking grocery store ones have.

After dinner I lay down and read some news stories about COVID on my computer. Connecticut dropped under 100 hospitalized...

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Fire: Bar and restaurant owners urged to check fire safety ahead of re-opening

Written by RSS Poster Merseyside Fire & Rescue Service - Latest News
Bar and restaurant owners urged to check fire safety ahead of re-opening


Ambulance: Covid-19 and Race

Written by RSS Poster Medic Scribe

Nationwide, blacks make up 13% of the population and account for 23% of the deaths.  According to the COVID Tracking Project, through today 25,932 black lives have been lost to COVID-19.  The project says “black people are dying at a rate more than 1.5 times higher than their population share.”

The COVID Racial Data Tracker

In Connecticut blacks make up 10% of the population, but account 15% of the deaths.

State-by-State Dashboard

Why might that be?

Here are some reasons:

Blacks could more genetically susceptible to COVID-19.

Or, more likely it could be because black people in America are more likely to live in poverty, in more crowded living quarters, have higher risk of hypertension and diabetes, have poorer diets, less access to health care, and be less likely to have jobs that allow them to work from home and mitigate their risk of contact with carriers.

Certainly the reasons for the above have a lot to do with American history, politics, and long-standing discrimination and disadvantage.

We have lived too long as two...

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Police: The Tate Tragedy

Written by RSS Poster Mental Health Cop

I’m sure most people heard of the sickening attack on a young boy at the Tate Modern in 2019 – I don’t intend to cover the details as they are widely available (trigger warning for the hyperlink that follows) and this post intends to focus on nothing other than a key decision for the judge at the criminal trial of Jonty Bravery who pleaded guilty to attempted murder following the attack.  Last week, the judge heard argument from lawyers and opinion from psychiatrists about whether the defendant should be hospitalised or imprisoned, after his guilty plea.  A legal decision of this kind sits solely with the trial judge, who must consider reports from experts and hear the legal arguments, before reaching their decision.  On the one hand, the defendant has a history of mental health issues of a kind which convinced two forensic psychiatrists to provide a medical recommendation for admission to hospital which would allow the judge to consider various kinds of order under Part III of the Mental Health Act, usually a (restricted)...

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Ambulance: Penetrating Trauma

Written by RSS Poster Medic Scribe

With the onset of summer, one of our more long standing epidemics is raising its head and demanding it not be forgotten

In the north end of Hartford that means penetrating trauma — the knife and gun club.  In my earlier years in the city, I often worked nights when the trauma numbers were highest,  The last several years my shift was Sunday through Tuesday 5:30-AM-5:30 PM, not really prime hours for trauma.  Lately, I have been working Fridays from 9 AM to 7 PM in a city fly car where I respond to all 911s, often arriving before the ambulance and in many cases, before the fire department first responders.  Along about four on a Friday afternoon, people start to get riled up. 

I am slowly getting back in form.

Transport times are very short in Hartford with two level one trauma centers not two miles apart.  I find traumas challenging, but often unsatisfying.  The challenge is to accomplish as much as you can in as short a time as possible.  The lack of satisfaction is that the call is often over in minutes.

I am 100% in the...

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Ambulance: Rt Numbers

Written by RSS Poster Medic Scribe

Connecticut has the second lowest Rt number in the United States, behind only Massachusetts and the District of Columbia.  Rt number is the average number of people who become infected with COVID-19 by an infectious person. If it’s above 1.0, COVID-19 will spread quickly. If it’s below 1.0, infections will slow.

In March, Connecticut’s Rt number was above 3.  By April 1, it had fallen to .99, and is now estimated to be at .76.

In contrast Nevada has the highest Rt number in the country at 1.52.  It began March at 2.17, fell below 1 in April 1 when its shelter policies started, dipped as low at .71, but then when the state reopened, the number has climber back to 1.52.

You can check out your state here:

Rt Number COVID-19

Bottom Line:  If you practice physical distancing and wear masks in public, this germ can be beaten back, but crowd into bars or packed churches with poor ventilation, and disregard the use of masks, then the germ will have the upper hand and people will die.




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Emergency Shorts:
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