We are called for an unconscious and find the man out cold on his feet near Pope Park.  He is a tall man in his early thirties with a ghost white complexion, standing there on the side of the road, his head nodded forward, arms hanging down swaying.  Another drug user on the nod in Hartford.  I shake him and he opens his eyes and says he is fine, but then he drifts back out.  My partner wheels the stretcher over and we gently push him down onto it.  He wakes enough to again, say he is fine, but he drops back out.  In the ambulance, I check his ETCO2 and his pulse saturation.  The numbers are 66 and 90.  I can stimulate him and the numbers come up a little, but if I leave him alone, he doesn’t breathe well enough on his own.  I put in an IV, which he doesn’t feel.  I take a 10 cc syringe, squirt out one cc, then add 1 cc of Naloxone to the syringe.  I slowly give him one cc of the mixture, delivered 0.1 mgs of Naloxone, a tiny dose.  When he doesn’t respond, I give him another 0.1 mg dose, and soon he is talking to me.  He doesn’t...

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I attend the Department of Public Health’s 2019 Connecticut Opioid & Prescription Drug Overdose Prevention Conference on May 2.  The featured speaker is Austin Eubanks, a survivor of the Columbine shooting. He and his best friend were golfing and fishing buddies. He shows us pictures of the two of them smiling, no idea what fates life had in store for them. In the school library, they hear an odd sound from out in the hallway. Another student says it sounds like gun shots. But they are in a school. Guns aren’t allowed in schools. (This was of course the first mass school shooting, while today students drill for such occurrence).  Then more commotion and a teacher bursts into the room and says “Everyone get under the tables!” Even with that they stand around for a moment, thinking “really?” Then the gunmen, armed with shotguns and automatic weapons, enter the library. His best friend and he hide under a table as the shooters walk through the room systematically executing their fellow students....

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In Hartford, EMS personnel call the Connecticut Poison Control Center (CPCC) after each opioid overdose they encounter, and answer a series of questions.

The specialists (CPCC) log the data and also input in into federal OD map software which produces a near real time map reporting overdose locations and types, and can automatically send spike alerts to local officials when certain county wide thresholds are reached.

This map which records ODs down to the block level can be accessed by local public health departments in Connecticut.

Additionally, data collected by the CPCC specialists can generate other alerts based on identification of bad batches or unusual events such as cocaine contaminated with fentanyl.

Specialists also follow up with the hospital for transported patients to record their outcomes.

The project began as a pilot in Hartford last May, and now after a year of data gathering and data sharing with the public health and safety community, has been expanded. On April 1, the North Central Region began reporting with...

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The Consensus on Science with Treatment Recommendations (CoSTR) from the International Liaison Committee on Resuscitation (ILCOR), the group that forms the basis for the AHA ACLS guidelines, has released a new draft guideline on Advanced Airway Management During Adult Cardiac Arrest.  The guideline is available for public comment until April 2, 2019.

Advanced Airway Management During Adult Cardiac Arrest

The recommended guideline takes into account the latest literature, including The Pragmatic and AIRWAYS-2 trials:

Pragmatic Airway Management in Out-of-Hospital Cardiac Arrest

Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest A Randomized Clinical Trial

Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome The AIRWAYS-2 Randomized Clinical Trial

Here areILCOR’s...

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It speaks for itself.

Please share.

Check out this powerful You-tube video

When I see another provider who is burned out, my reaction has always been:

“Get another job.  You have no business doing this kind of work.”

Until I saw this video, I never really considered the concept of moral injury.

If a fellow paramedic hurts his back lifting or wrestling with a patient, I would never thing to say, “Get another job.  You don’t belong in this work work anymore.”

Companies take great precautions to make our work physically safe.  There have been great innovations in stretcher design (when I started we used a two man dead lift), stair chairs, safety nets, and driver safety systems.  And while most services have employee assistance programs, I can’t think of any preventative measure routinely taken in EMS to prevent moral burnout.  Long shifts, holdovers, too few cars on the road, 911s holding, order-ins.

Meat in the seat.

There is always a new hiring class to pick up the fallen stethoscopes and take their places on the front lines. 

It is hard to change things overnight.

I am glad there seems to be an awakening ahead.

There are many qualities I appreciate in a BLS partner (Our system pairs either each paramedic with an EMT.)  These are my ideal attributes:

1. Strong, can lift.
2. Solid EMT.
3. Knows where they are going.
4. Pleasant disposition.

Over the years I have worked with partners who are missing some of these.  I have learned to work them.

If a partner can’t lift, I make use of first responders.

If a partner is not a good EMT, I never rely on them.

If a partner doesn’t know where they are going, I can direct them because I know the roads.

But if a partner isn’t pleasant, there is nothing I can do suffer.

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...

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