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Ambulance: Vaccinator

Written by RSS Poster Medic Scribe

Connecticut has approved paramedics to administer COVID-19 vaccines.  They have also approved any EMT who has been trained in IM injection as part of the state’s epinephrine program.  Nurses are also able to administer the vaccine.  Paramedics and EMTs, however have to complete a state-approved training course in order to administer the vaccine, while nurses do not.  I am both a paramedic and a nurse.  I have received notification from the state in both my licenses asking me  to become a vaccinator, and have replied in the affirmative for both.  On Sunday, I took the training on-line, and today I attended a thirty minute skills evaluation.  While I am a little torqued that paramedics have to go through more hoops than nurses, I did find the training helpful.  It consisted of watching a thirty-four minute video, and then answering a twenty question quiz.  The skills session involved drawing up 0.5 cc of saline and giving two IM injections to a fake shoulder.  (I was complimented on my technique!) It was good to learn some of the...

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Ambulance: The Door

Written by RSS Poster Medic Scribe

When I am in the rapid response paramedic fly car, I usually always arrive on scene, before the fire department, before the police, before the ambulance. (Unless, I am requested to stage for a violent psych or an assault if the assailant is still believed to be on scene).

I carry with me my paramedic house bag, my heart monitor, oxygen tank, and PPE bag.  I try to be mindful and always get my PPE on.

The call is for unresponsive with precautions.  “With precautions” is code for patient either has COVID or screens in as a possible COVID.

I stand now outside apartment 7J.  The door is closed and I can hear no sound from within. In the pre-COVID days, I would knock, and then if it is unlocked, open the door and say “Ambulance.”  Now before knocking, I set all my gear down in the hallway.  I open my PPE bag.  I take out a yellow infection gown.  I pretie the neck loops, drape it over my head, and then twisting to the side and trying to make myself thin, I tie the waist strings (some brands have plenty of string, but these the strings...

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Ambulance: Severe Outbreak Again?

Written by RSS Poster Medic Scribe

Connecticut is back in a severe outbreak according to COVID ACT Now.

The upgrade seems to be largely based on the daily new cases per 100K population. 

For me, I think the daily hospitalizations is a far better measure of the state of the epidemic. 

Source: University of Minnesota COVID-19 Hospitalization Tracking

The cases chart shows COVID is far worse than in the Spring, while the hospitalizations show it is not.

I know at my hospital the hospitalizations have plateaued for weeks at about 25% below their early December high and well below their high of last spring.  When I work, I don’t see the number of COVID patients as I did in the spring, although as I have mentioned before, since people don’t seem to be avoiding the hospital like they did in the Spring, the COVID cases are going to be less concentrated.

I do know that I know more people in recent weeks who have been diagnosed with COVID than I did in the spring, and I suspect this has to do with more widespread testing catching asymptomatics and those with...

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Ambulance: The Future of EMS Education

Written by RSS Poster Medic Scribe

EMS continuing education has been changed forever over the course of the last year.  At UConn John Dempsey Hospital where I am the EMS coordinator, we hold EMS CMES monthly.  For years we held them in person.  Over the years we bounced around from venue to the next dealing with issues like parking (for attendees and for those on duty who needed access to their emergency vehicles when calls came in), adequate space, ability to eat and drink during the CME, noise from renovations, unpredictable computer equipment, and conflicts with other conferences, not to mention winter weather storms.  We were never able to find the right combination that met everyone’s needs.  On a good day we would get 50 people.

Then COVID came around and we were forced to go virtual using WEbex.  In no time at all, we had 100 attendees, better availability of speakers who can now teach from their works or home desks, reliable and readable PowerPoints, no parking issues, people able to attend who never could before.  For instance, every month we...

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Ambulance: 2nd Dose

Written by RSS Poster Medic Scribe

My first Pfizer shot was great.  Didn’t even feel the needle go in.  No side effects.  Shoveled my driveway the next day with no fatigue.  Yesterday at 10:30 A.M., I had my second shot.  Went to bed at 9:30 P.M. feeling fine.  Woke up at 11:00 P.M. feverish, chills, body aches, joint aches, bone aches, muscle aches.  I couldn’t lay on my left arm were I got the shot it hurt so much.  My wife kicked my lightly and I thought she’d broken my leg it hurt so bad.  Woke up on the hour, trying to lay as still as I could.  Fever this AM of 102.1.  Heart rate of 104 (I live at 60).  Now I have a headache that’s getting worse.  Good to know I have a functioning immune system.

The Common Side-Effects Of The Pfizer Vaccine

 



Ambulance: Pediatric Cardiac Arrest-Stay and Play

Written by RSS Poster Medic Scribe

I just watched a fantastic and very thoughtful lecture of pediatric cardiac arrest given by Dr. Peter Antevy as part of the Refresh2021 free national registry program, which I encourage everyone in EMS to sign up for.

Register for Refresh 2021

 When I precepted as a paramedic in 1995, my preceptor told me when we had a baby code that we should “OJ Simpson” it.  This was in reference to the old OJ Simpson Hertz commercials where the former football star and future killer ran through the airport, leaping benches and cutting through the crowds like he was on a 100 yard touchdown run.  The point was, waste no time, get moving– that way we don’t have to deal with everyone freaking out at the scene, and we can get the baby to the hospital and do what we can on the way. 

My first baby code I intercepted with a basic ambulance crew.  No sooner did I climb into the back of the ambulance, then the driver hit the gas and I went flying.  When I recovered myself, I saw his partner and a police officer doing CPR on...

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Ambulance: COVID Non-Emergency Calls (Transfers)

Written by RSS Poster Medic Scribe

If you work in commercial EMS, you are also likely to do what we call transfers.  These are non-emergency calls where you take a patient to a destination that is not the emergency department.  This can be a trip to dialysis, from a hospital or nursing home to a home or from a home to a direct admit at a hospital or a trip to a doctor’s office.  If the patient is going to a doctor’s office or to a hospital for a procedure that doesn’t take too long, you often wait with the patient and then return them to where they started.  These trips are called wait and returns.  Dispatch tries to give them to the basic ambulance crews  in order to leave the paramedic ambulances available to take 911 calls, but on days when the paramedic rooster is full, medics can be asked to help out with the transfer load.

In the age of COVID, there are now COVID transfers.  I have been involved in a few of them.  Back shortly after the epidemic began in the spring the state started opening skilled nursing facilities (SNFs)...

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Ambulance: Christmas – Winter’s Fuel

Written by RSS Poster Medic Scribe

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 rib.

I have...

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Ambulance: Connecticut Opioid Crisis Forum

Written by RSS Poster Medic Scribe

On December 18, 2020, I participated in a panel hosted by United States Senator Richard Blumenthal and Connecticut Attorney General William Tong to discuss the opioid epidemic. 

I want to thank both of these fine public leaders for their consistent and longstanding involvement in the fight against opioid deaths.  We were joined by several other leaders in the state, including my friends, Mark Jenkins of the Greater Hartford Harm reduction Coalition and Bobby Lawler, of the New England HIDTA (High Intensity Drug Trafficking Area).  I also want to thank Brandon Bartell, the operations manager at American Medical Response Hartford, who let me adjust my paramedic shift at the last moment so I could participate.

It was a great discussion that can be viewed in its entirety at this link.  

Forum with Attorney General Tong and U.S. Sen. Blumenthal on the Opioid Crisis During the COVID-19 Pandemic

 

I start speaking at the 42 minute mark.  I was told I could speak for five minutes, and I managed to keep within my...

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Ambulance: On the COVID Front

Written by RSS Poster Medic Scribe

In the last couple days, Connecticut was downgraded from severe outbreak to active outbreak on the COVID ACT Now web site  (Hartford County remains listed as severe outbreak).  Being labeled active outbreak is not great, but at least we seem to be moving in the right direction.  While I am only working one or some weeks two shifts a week on the road, my sense is that things are getting better.  I further back that up by my work at the hospital where I track COVID patients being brought in by EMS, and can report that after a significant rise several weeks back, the counts have been relatively stable.  I am not seeing the regular severity of cases that I saw in the spring, which is not to say there are not sick COVID patients and that no one is dying.  There are very sick patients and people are dying.  It just doesn’t seem as bad as it was in the spring.  Park of that reason is that in contrast to the spring, regular patients are now calling 911 where in the spring they stopped.  In the spring, it seemed the only patients we...

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