The opioid overdose epidemic continues to rage in Connecticut, although numbers again show the carnage may be plateauing.

The Connecticut Medical Examiner’s Office just released the overdose death numbers for the first six months of 2018.

Connecticut Medical Examiner’s Statistics

 515 people died in contrast to 500 and 538 in the two previous six month periods.

The numbers continue to show the rise of fentanyl as the cause behind the overdose deaths,

Source: Ct. Medical Examiner’s Office numbers.  Graphs by Canning.

Connecticut Overdose Deaths Plateau

A walk in the park to stretch the legs while on post. The medic walks past a row of port o-potties from a weekend event.

One port-o-potty is not fully closed.  A sneaker blocks the door door. On second glance the sneaker is attached to a foot.

Open the door and an unresponsive man tumbles out. A syringe and empty heroin bags lay on the ground. The man is blue and breathes only on stimulation. One shake, one breath.

The medic radios his partner who drives the ambulance across the sidewalk to the scene and bring overs the house bag. No more one shake, one breath. A proper ambu-bag is applied while the naloxone is readied.

A man sprint frantically across the park directly at EMS scene.

The running man stops and stands a few feet away, looking hard at the overdose victim, whose face is covered by a mask.

The medic lifts the mask briefly to let the man look. “You know this guy?” the medic asks.

“No,” he shakes his head. “I thought it was Doug.”

A moment later, another porto-potty door opens and a man stumbles out. He looks dazed and...

Continues, Read More...

Check out this web site to read about eleven people affected by the opioid crisis, including a paramedic who injured his back on the job.

The Opioid Chapters

The next drug to add to the EMS formulary should be water. That’s right. H20. How many times have you been on a call and the patient has asked for water only to be told by every EMS responder in the room, “No! You can’t drink anything!”

Really?

The reason we don’t let people drink water is so they don’t throw up and aspirate while the anesthesiologist is trying to intubate them at the start of surgery. This all comes from two cases in the 1950’s where pregnant woman aspirated during delivery. If you are going to have scheduled surgery, the surgeon will often tell you, no liquids after midnight. The problem with this was they were telling this to old ladies who go to bed at seven at night.  Their surgery wouldn’t be until three in the afternoon.  They were going into surgery dehydrated and hypoglycemic.  Nowadays, many progressive surgeons just say no liquids for two hours before surgery.

Research Suggest Drinking Before Surgery Helps Recovery

New Rules: Eating, Drinking, Anesthesia

Research shows people who are allowed to drink water, apple juice...

Continues, Read More...

Misinformation and inconsistent recommendations  regarding fentanyl have resulted in confusion in the first responder community.

– Fentanyl Safety Recommendations for First Responders (Revised) from the Office of National Drug Control Policy.

It seems every week responders are getting exposed to Fentanyl, being rushed to the hospital, with many getting Narcan, all often without exhibiting any symptoms or symptoms no worse than lightheadedness and tingling hands.  

I have been told at scenes to be careful that just touching a speck of powder could kill me.

No, I say, that’s not true.

I have been writing about his for over a year now, and fortunately the The American College of Medical Toxicology and the American Academy of Clinical Toxicology, and even the first edition of the above document, helped correct much of the early damage done by the DEA’s first document, Fentanyl: A Briefing Guide for First Responders.

Fentanyl: A Briefing Guide for First Responders

Fentanyl Skin Exposure: An MD’s View

Fentanyl Exposure: The Toxicologist’s...

Continues, Read More...

I wrote an op-ed this month that was published by the Hartford Courant.

Insight: I See What Heroin Does. Let People Shoot Up Safely

Included was a checklist:

5 Things to Know About Heroin Addiction

I read an article a few days later that said that when called an “overdose prevention site,” as opposed to a “safe injection site” people were much more likely to support the concept.

Support increases when opioid ‘safe consumption sites’ called ‘overdose prevention sites’

For me the bottom line is harm reduction.  We may not be able to stop people from using heroin, we can at least mitigate some of the harmful effects of it.  Safe Injection Sites/Overdose Prevention Sites have been proven to keep people alive and get some of them into treatment.  We can help prevent the spread of disease and keep our streets cleaner.

The use of epinephrine in prehospital cardiac arrest showed no difference versus placebo in determining favorable neurological outcome according to a long awaited randomized controlled study published yesterday (July 18, 2018) in the New England Medical Journal.

The trial showed epinephrine produced a higher rate of survival at 30 days than placebo, but that was accompanied by almost twice the rate of severe neurological impairment.

Over 8,000 patients were enrolled in the randomized double-blind trial conducted in the United Kingdom between December of 2014 and October 2017.

The thirty day survival rate was 3.2% in the epinephrine group versus 2.4% in the placebo group. At hospital discharge 31% of the epinephrine survivors had severe neurological impairment versus 17.8% in the placebo group.

Paramedics needed to treat 112 patients with epinephrine in order to produce one extra survivor and that survivor was much more likely to have a poor neurological outcome than a placebo survivor.

The authors of an accompanying editorial speculate...

Continues, Read More...

Kelly is as dispirited as I have seen her. “My veins are shot,” she says. “I can’t even get high.” IV users use 1 cc syringes which have a very small needle they only need to slip inside the vein. When they pull back and get blood they know they are in. They push the plunger slowly, sending the heroin directly into their vein and right into their circulation where quickly delivers its powerful payload to the brain. This is a faster and stronger route than swallowing a pill or inhaling the powder in through the nose. If however, the needle in not anchored in the vein, the drug goes into the tissue where it can cause damage and necrosis. The user still gets an effect, but it is less strong and comes at a price in damage to the tissues.

Kelly has shown me her veins before and they are challenging. I fancy myself an expert at inserting intravenous lines. I may be an average medic in some skills, but I am really good at IVs. I have been doing IVs for twenty five years on all types and ages and races of people.
There is a difference between doing an IV as...

Continues, Read More...

She finds him in the bathroom at seven in the morning and knows immediately he is using heroin again. Three weeks ago, they moved east from Seattle. She had a job offer and it also represented a chance to get him away from his junky friends. After three times in rehab, she didn’t think she could go through it with him again so she was thrilled when he agreed to move with her. They got a nice loft downtown, with plenty of light. It was close to her job, and from across the street, he could get a city bus to any job in the area he could find. If was convenient to many things – a minor league ballpark, movie theatres, riverside park with running trails, a health club within blocks. He was always in good shape, but he particularly worked out hard when he was staying clean. Her new job was going to keep her busy, but there were plenty of restaurants they could go to at night, along with a comedy club and local brewpub. They’d make friends, and in time, if he started working and got a steady position, they could get up a down...

Continues, Read More...

The man is trembling, sitting on the bed in the spare motel room down by the highway. Sometimes, these rooms are filled with the patient’s worldly belongings, but this room seems to only have the bed, a dresser, a chair and the TV. The man is in his fifties, a portly man with white hair and liver spots on his hands. The Spanish woman in the room with him is of an indeterminate age. She wears a pink tank top and grey yoga pants with flip flops, even though it is cold and blustery out. She is the one who called. When I say she is of indeterminate age, I mean she could be anywhere from 30-50. It appears she is missing a fair number of teeth and her arms lack the tone of a younger woman. While he talks to us, she walks behind him and mimics a man shooting heroin. He says he is a diabetic and hasn’t eaten or taken his insulin for a couple days. He says he got robbed last night and has no money. He is going to have some transferred up to him tomorrow. We check his sugar and it is 485. The normal range is 80-120. 485 is in the danger zone. If he doesn’t take...

Continues, Read More...