There is a cartoon hero named Narcania created by the same guy who wrote Lil’Dope Fiend Overdose Prevention Guide.  In the mini comix, Narcania rescues people who have overdosed and gives them new life.  As one character who has been resuscitated remarks, “I don’t know if there is anything worth living for, but at least now, I’ll get to find out!”

In San Francisco there is a Narcania mural, Narcania vs. Death proudly painted in an alley.

In 2017 I wrote about Narcan Man, the mysterious person or force who seemed to always arrive and be gone before us, leaving only an empty vial of narcan and sometimes a confused, or vomiting person at the spot where we were dispatched for the overdose.  I imagined a man with bandoliers of Narcan and a gold tooth who roamed the metropolis, keeping people safe, and then disappearing into the mist.  Who was that man?!

I believe I have finally met the real life Narcania, the female Narcan Man.

Her name is Carrie.  She is a smallish woman in her late twenties, whose face shows both the promise of...

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“That’s not unexpected, but it still wakes you up like a cold shower,” Lamont said about the rising number of positive tests, which suggest that the virus is spreading more quickly.

COVID cases have increased steadily in Connecticut since early September.  Nearly every day, the Governor’s response has been, “That’s not unexpected.”   He has often added, it bears watching.

Daily coronavirus updates: Connecticut’s positivity rate hits 4.1% and hospitalizations near 300; Lamont urges municipalities to enforce pandemic rules

I have been watching it.  So has the web site COVIDexitstrategy.org, which now lists Connecticut as on the states where COVID is in “Uncontrolled spread.”

https://www.covidexitstrategy.org/

I know the governor has done his best to walk the fine line between keeping the state open and keeping it safe, but we all need to pay attention to what is happening in the world.

Cases are skyrocketing. 500,000 new cases this week alone in the US. 

We have 40 states and 2 territories on our state’s...

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In the summer of 1977, when I was 18, my best friend Brad and I drove 1400 miles across the country in an old Oldsmobile Cutlass.  We had no plan other than to see America.  We started off in New England, headed to Washington D.C. and then down through the Blue Ridge, Virginia, North Carolina.  We jutted back out to the coast to Charleston, South Carolina,  where we body surfed in the ocean and swam among porpoises..  We went down to Statesboro, Georgia, where we drank in a juke joint and ended up watching two local heroes duel in a street race.  We crossed the Florida panhandle, went through Alabama and Mississippi,  In New Orleans a Louisiana lawman with mirrored sunglasses threatened to lock up for sleeping in a park.  We drove clear across Texas, with a stop in Juarez, Mexico where we bought colorful rugs and switchblade knives. At nights we slept in the car, sometimes paying $5 to stay at a KOA campground so we could use the showers.  Once a week we splurged on a motel.  We headed west across New Mexico and stood on a...

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Johns Hopkins University Press is running a sale on public health books, and my new book is in it! Save 30% on Killing Season and other select books with code HPHB when you purchase before 11/6: http://bit.ly/publichtw

Killing Season will be published April 6, 2021.

The new American Heart Association Cardiopulmonary Resuscitation and Emergency Cardiovascular Care guidelines were released this morning. While the AHA does a major update every five years, since they went to online updates a few years back, the changes are not as momentous as they once were.

After reading the executive summary, here are the key takeaways that affect EMS.

Adult Basic and ACLS

Good CPR remains the bedrock of resuscitation.

Double sequential defibrillation is permitted but it usefulness if not considered established.

EMS should first attempt an intravenous access before intraosseous. While IO access has become increasingly popular, its efficacy compared to IV is considered uncertain. IO access should only be attempted if IV attempts fail or are not feasible. For me, not feasible would be in a person with no veins, including jugular.

Epinephrine should be administered as early as possible in cardiac arrest patients with non shockable rhythms.

Epinephrine should be delayed in cardiac arrest patients...

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Lay rescuers should not wait for naloxone to take effect before activating 911 in patients suspected of opioid overdose.

Trained EMS responders when treating an opioid overdose patient in suspected cardiac arrest should focus on high quality CPR (compressions plus ventilations) before considering the use of naloxone.

These are two recommendations from the American Heart Association’s latest 2020 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care released this morning.

2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Here is a key line:  Because there are no studies demonstrating improvement in patient outcomes from administration of naloxone during cardiac arrest, provision of CPR should be the focus of initial care. Naloxone can be administered along with standard ACLS care if it does not delay components of high-quality CPR.

Whether you are a lay person or a professional providers, for suspected opioid...

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I am on my knees, wearing a yellow decontamination gown that has already torn at the right forearm and left wrist. I listen to rhonchi in the lungs of an obese febrile man, who likely aspirated on the brown emesis he threw up on himself. The apartment is dim, and smells heavily of cigarettes and urine. There is no bulb in the overhead light and the shades are pulled. Dust rises up from the thick carpet that has likely never seen a vacuum cleaner. My face mask has fogged up to the point I can barely see the blood pressure gauge record 70 something systolic. The man’s SAT is 88%. The visiting nurse doesn’t know anything about him beyond what she can read on her laptop. It says, he had a COVID test three months ago that was negative, she says. He is in no shape to answer any of my questions, foremost among them, does he hang out with or share an aide with the guy on the 2nd floor who’s in the ICU with COVID pneumonia.

When the ambulance crew arrives there is no room to get the stretcher in. I now have a nonrebreather on the...

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The Hartford Courant this week noticed what most everyone else around here has– panhandlers are on nearly every corner of big intersections these days. Many carry the standard signs drawn on ripped cardboard “Homeless and Hungry.” Some wear masks, others don’t. Some make eye contact, others look down at their feet. They almost universally say “God Bless,” when you roll down your window and give them a dollar. I suspect that is more panhandler etiquette than religious belief.

How many of them have lost their jobs, and their homes due to COVID and the economic downturn? And how many of them are substance users? What are they doing with the money? Buying bread to feed their families or buying liquor or drugs and/or alcohol to fight off withdrawal sickness?

The article reports that several towns are asking people not to give panhandlers money for fear it will encourage them and increase the problem. Instead, they advocate donating money to local homeless shelters and other charities that service the homeless population.

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When I started as a paramedic over twenty-five years ago, I had a number of set views.  Here are two.

1. People who use heroin have character flaws and are criminals. They deserved their fate. 
2. People who go to jail or have been in jail went because they had character flaws and were criminals. They deserved their fate.

In time, I learned that addiction was not a character flaw, but a chronic relapsing brain disease and that many people became addicted through no fault of their own, but because of system that allowed pharmaceutical companies to prey on people leading to mass prescription of addictive pain pills not in the interest of patient care, but profit.  Users were sons and daughters, fathers and mothers, friends and neighbors, people who should be treated with love and compassion.

Working in the north end of Hartford, I have encountered people with substance use disorder and many people who either been in jail or are no doubt headed there. 

I am sixty-two years old now, and while I am not ready to embrace murders and...

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I was bruised and battered…I was unrecognizable to myself.”

–The Streets of Philadelphia

Bruce Springsteen

On November 3, 2020, let’s make America a country we can recognize again.

Vote!