I’m on scene of an overdose. A fifty year old man in an unkempt apartment went unresponsive after sniffing two bags of heroin. His neighbor found him, giving him 4 mgs of Naloxone IN, and then called us. The man is alert and oriented by our arrival and does not wish to go to the hospital. The neighbor says he will watch the man. He still has another Naloxone in case the man goes out again. He says he gets his Naloxone from the local harm reduction agency.

The cop on scene shakes his head and says, “They’ll give out Naloxone for free, but kids have to pay $800 for an Epi-pen.”

This is an argument I hear quite often. “They’ll give a drug addict free Naloxone, but my wife, who is a school teacher, has to pay $1000 for her Epi-pen.”

What is the implication behind the officer’s remark. Is this man’s life less worth saving then a kindergartner who mistakenly eats a cookie with nuts in it?

Last year over 70,000 Americans died of accidental overdoses. Only about 150 people die a year from fatal food anaphylaxis.  3,000 die from any type of anaphylaxis.*...

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It has been busy at work lately and the crews have been getting pounded.  An EMT posted this video (found on the internet) on our employee Facebook page.  I laugh every time I think of it.  If you have never worked commercial EMS in a high volume system, you might not appreciate it.  I can only say, over thirty years, I have witnessed similar scenes hundreds of times with scores of partners.

Here’s a link to an interesting article about working conditions in commercial EMS:

Can EMTs, paramedics catch a break?

The official death numbers for 2018 are out from the Connecticut Medical Examiner’s office.

Connecticut Accidental Drug Intoxication Deaths

1017 people died in Connecticut of accidental overdoses, down 21 from 2017.  This is the first decline (albeit minor) after six years of escalation.

746 people died in Connecticut due to the presence of Fentanyl, up 71 from 2017.

Still  much work to go before we can rest.

***

Here’s a town by town breakdowns of deaths by residence and deaths by overdose location.  95 of the fatal overdoses occurred in Hartford.

CT Drug Overdose Deaths Town-By-Town In 2018

They have installed cameras in our ambulance just behind the rear view mirror. The camera records both the traffic in front of the ambulance and inside the front cab of the ambulance. It does not record the passenger compartment, and it (supposedly) is only a video recording.  Audio would be illegal in our state.

The camera is programmed to record in the case of an accident or sudden deceleration or swerve. It can also turn on if the driver or front seat passenger hit a button on the device. The camera will capture 10 seconds before and 10 seconds after the incident. In normal function the camera displays a green light. It will turn red when activated.

If you get in an accident and the recording shows you were texting or talking on your cell phone, much less drinking a beer, then you will have to accept your fate.

If you are driving safely and a distracted driver swerves into you, then the recording will be to your benefit.

I have only set it off once so far.

We were driving back to the base after a twelve hour day. There was a car stopped in...

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EMS has focused on trauma, stroke and STEMI in recent years with resulting improvements in outcomes.  Many health care systems are now turning attention to sepsis care and the considerable role EMS can play in early recognition and treatment.

Here in Connecticut we have Sepsis Alerts, which while rarely generating the full response of Trauma, Stroke and STEMI Alerts are important to help hospitals be able to quickly recognize sick people on entry and devote them more immediate attention than they might otherwise receive.

EMS can start the treatment soonest with aggressive fluid resuscitation for those who meet the indications.

Great material on sepsis is available at this web site:

Sepsis Alliance

Check out this excellent video:

Learn to recognize sepsis:

IDENTIFICATION OF POSSIBLE SEPTIC SHOCK

Suspected infection – YES

Evidence of sepsis criteria – YES (2 or more):

o Temperature < 96.8 °F or > 100.4 °F.

o Heart rate > 90 bpm.

o Respiratory rate > 20 bpm.

o Systolic blood pressure < 90 mmHg OR Mean Arterial Pressure (MAP) <65 mmHg.

o New onset altered...

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Saturday night saw one of the pinnacle achievements of my life.  Twelve months before, while attending a Harlem Globetrotters game with my daughter, I announced that I was going to learn how to expertly spin a basketball on my finger just like the Globetrotters do.   Ever since then, I have carried a basketball in the ambulance.  In between calls while at posting locations, I have taken the ball out and practiced.  At home I have a basketball in every room of the house.  I even found a heroin addict in Hartford who for $5 a pop would give me spinning lessons. He was an ex-basketball player, who I am pleased to say now has a handyman business and is no longer on the street. (At least that was his plan when a few months ago, he told me I wouldn’t be seeing him around anymore, and true to his word, he disappeared no longer to be seen at his regular haunts.  I can only hope he is doing well).  I practiced so much I developed tendinitis in my elbow and had to suspend all spinning for a month. The elbow is much better and I can spin again without...

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This is the third in a series of posts on common drug mistakes some EMS responders make during cardiac arrests.

You find the fifty year old man supine on the floor with the fire department doing CPR. Their AED announces, “No shock advised. Continue CPR.”

You set your monitor by the man’s head and connect the fire department’s pads to your monitor, while your paramedic student quickly places an IO in the man’s tibia. As you approach the two minute mark, you charge the monitor, and then order stop CPR. The patient is in asystole. “Continue CPR,” you say, as you harmlessly dump the charge by hitting the joule button.

Just then the man’s wife announces, “Oh, my God! He was using heroin.” She holds the empty bags she has just found in the trash can. “He used to use. He’s been clean for five years.”

What drug do you give?

***

Epinephrine.

According to the 2010 AHA Guidelines

There is no data to support the use of specific antidotes in the setting of cardiac arrest due to opioid overdose.

Resuscitation...

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This is the second of three posts about common cardiac arrest drug mistakes some EMS personnel make on a routine basis.

You have been working a cardiac arrest for a 54-year-old male with no prior medical history who collapsed after grabbing his chest.  You shocked him twice for fine vfib, but now he is in a PEA. It’s been 20 minutes since you started ALS interventions and another medic suggests you try sodium bicarb.  What do you do?

Remember it 2019, not 1979, 1989, 1999 or 2009.

Unless the patient has preexisting metabolic acidosis, hyperkalemia, or tricyclic antidepressenat overdose, (which this patient clearly does not) sodium bicarb is not recommended by the AHA.  In 2010 sodium bicarb was made a Level 3 Recommendation.  Level 3 means it is not helpful and may be harmful. In 2015 that recommendation was reviewed and maintained.

While you should always follow your protocols and your local medical direction, in Connecticut, sodium bicarb in cardiac arrest is reserved for “suspected pre-existing metabolic...

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You and another medic are on the scene of a cardiac arrest. You find the patient in ventricular fibrillation and immediately defibrillate him into a narrow complex rhythm. You have pulses back and while you take a blood pressure – 130/84, the other medic inserts an IV. The other medic then says to you, “Pass me the amiodarone.”

What do you do?

A. Pass it to him.
B. Say, “No.”
C. Say “Why?”

You go with C. The other medic says, “To give to the patient (Dummy!). He was in v-fib.”

You say, “No, it’s not indicated.”

Who’s right? You or the other medic.

It is amazing how many medics have different views on this question, and some of this depends on when they were trained and how well they have kept up on changing guidelines. It also depends on their local medical control and the protocols they operate under.

Here in Connecticut our state protocols for cardiac arrest call for amiodarone or lidocaine for patients “unresponsive to CPR, defibrillation, and vasopressor therapy.” There is no protocol that...

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A fellow paramedic here in Hartford, Greg Shovak runs a great educational program called EMS and PTSD – Learning from Combat Veterans to Understand PTSD.  I attended one of his sessions a few years ago and thought it was excellent.  I learned a lot of PTSD, and also had my first introduction to service dogs.

Here is his organization’s facebook page, which has lots of great information:

EMS and PTSD

Service dogs are not just for combat veterans, but also for first responders.  Several of the medics I work with (including Greg) have them and they often bring them to CMEs.  Their dogs are awesome and that means something coming from me (see my dog history below).  I can see how the dogs bring them great comfort.

Greg has been a true leader in helping those in EMS recognize and seek help for their PTSD.

Here are a couple articles he recently wrote on PTSD, including one that mentions his own service dogs.

https://www.emstoday.com/emerging-voices-content/2018/12/makingstrides.html

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