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Ambulance: A Mother and Son

Written by RSS Poster Medic Scribe

The woman with the cellphone stands outside the car. She explains that the male in the car has been smoking crack, taking benzos and doing heroin for several days. I ask if he is breathing. She says yes, but he is asleep right now. When she picked him at his friend’s house in their suburban town an hour earlier, he was out cold. His friends were going to give him Narcan, but the girl with them said don’t waste it. The girl then punched him hard twice in the chest and put ice in his pants.  I ask what is her relationship to the person in the car. He is my son, she says.

I approach the car. A heavily tattooed man wearing basketball shorts and an NBA jersey is fully reclined in the passenger seat. His mouth is open and his eyes are shut. I can’t tell if he is breathing. A police officer is standing next to me now. He opens the front door, I open the back door. A sternal rub and the man springs forward. “What? What the fuck!” he says. “What’s going on?” He is in his mid-twenties, a powerfully built thick necked...

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Ambulance: Fentanyl Skin Exposure: An MD’s View

Written by RSS Poster Medic Scribe

A story published in Slate magazine yesterday questions the assumptions behind the widely reported episode of the Ohio police officer who required four doses of Naloxone after brushing Fentanyl off his shirt.

The Viral Story About the Cop Who Overdosed by Touching Fentanyl Is Nonsense

Written by Jeremy Samuel Faust, an emergency physician at Boston’s Brigham Young Hospital, the story discusses the case with noted toxicologists, including Dr. Ed Boyer of the Harvard Medical School, who says,  “Fentanyl, applied dry to the skin, will not be absorbed. There is a reason that the fentanyl patches took years [for pharmaceutical companies] to develop.”

The story mentions that the widespread coverage of the Ohio episode and others has caused the American College of Medical Toxicology to speed up the publication of their forthcoming position paper on Fentanyl Exposure.

We should all welcome the toxicologists’ entrance into the debate before the viral stories of “life-threatening”...

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Ambulance: Fentanyl: A Briefing Guide for First Responders

Written by RSS Poster Medic Scribe

Carfentanil (which had previously been seen in neighboring states) has now been officially identified in Connecticut.  The discovery of this drug 100 times stronger than Fentanyl poses questions: How much danger does Carfentanil (or Fentanyl for that matter) pose to EMS?  How can we in EMS protect ourselves from exposure to these drugs? What should an EMS responder do if they believe they are exposed or one of their coworkers has been exposed?

Every EMS responder should ask these questions and seek answers from both their medical control and from their services.  Unfortunately, I have had a hard time finding a one-stop source of good information on this question.  What follows is my attempt to share what I believe based on what I have read and people I have talked to.  It should not replace the information you get from your service.

Can Fentanyl or Carfentanil kill you?  Yes, they can.  If you inhale a certain amount of powder, you can go into respiratory arrest.  If no one gives you...

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Ambulance: Narcan Man

Written by RSS Poster Medic Scribe

In troubled times in the metropolis, the unexpected rise up and battle the evils that enslave civilizations.  Today, such a tale is playing out on the streets of Hartford.  Behold…Narcan Man!

Few of us were paying attention when it started to happen.  We get called for a overdose at the bus stop, possibly not breathing.  We arrive in minutes.  There he is!  A man sits on a bench, leaning forward, head down.  We approach.  I can see his chest is moving.  Maybe four, six times a minute.  I give him a shake.  He responds slowly.  His eyes are pinpoint.  I recognize him as a regular on Park Street. His face is very pale.  I see some beads of sweat on his forehead.

Hey are you all right?

“Yeah, yeah, I’m fine,” he says.

I give him another shake.

He is breathing better now.

“How much did you do?” I ask.

“I didn’t do anything.  I’m good.  I’m good.”  He stands and looks around the street.  “I’m just.  I’m just tired, that’s all.”

“You know what day it is?”

“Monday,” he says.

Good...

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Ambulance: New Brands

Written by RSS Poster Medic Scribe

I called a meeting of the heroin dealers of Hartford at the pavilion in Pope Park. I had no authority to call the meeting since I am neither a heroin dealer nor affiliated with anyone who is.  I just felt like things had hit a critical point where something had to be said.  I admit I was disappointed when no dealers showed.  True about forty men and a smattering of women did come.  They were of various races and tended to dress similarly, hoodies and flat brimmed baseball hats.  But they all assured me they had nothing to do with dealing drugs.  They were opposed to it.  They just came out because they were interested in why I thought there was so much heroin dealing going on in their city.

What are you serious? I said.  Look around.  Just look at the ground.  See all those ripped bags in the grass.  Pick them up, look at them.  Kong, Amazing, Predator.  Howl.  Those are what the dealers package their heroin in.  (I’ll be talking more about those in a minute.)  And look over there, there’s a syringe not 100 feet from...

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Ambulance: Empty Wallets

Written by RSS Poster Medic Scribe

EMS responders go through more wallets than pickpockets.  Unresponsive person in an alley.  We need to ID them.  Check for a wallet.  Dead person in a hotel.  Got a wallet.  Unresponsive in car.  Check his pockets.  You are looking for the driver’s license, but you can’t help but notice how much cash they are carrying or not.

I will tell you this.  There are a lot of people out there without any green in their wallets.  Particularly opioid users.  Some may have been rolled before we got there, but it seems the same even when we find them in locked bathrooms or cars.  Not a single bill. 

OD in an apartment stairwell.  2 mgs Narcan IN.  Bag for a few minutes.  Comes around.  Immediately goes for his wallet.  It’s not there.  A firefighter holds it.  He has been writing down the demos.  He hands the wallet back to the man, who looks frantically through it.  “Where’s my money?  There was a twenty in there!”

“You were with people when you used?”

“Yeah, my boy,”

“Your boy, here?”

He looks...

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Ambulance: EMS Stroke Care

Written by RSS Poster Medic Scribe

Stroke Care should follow your local medical direction and treatment guidelines.  Here’s how we do it in North Central Connecticut.

EMS Role

When Emergency Medical Services (EMS) recognizes stroke in the field, and notifies the hospital either by radio patch or transmission, the hospital stroke team can be activated prior to the patient’s arrival. With enough notification, the patient can often go directly to CT Scan on the EMS stretcher. This single intervention has led to a marked decrease in door-to-needle time and improvement in patient outcome. The patient can receive an immediate evaluation by hospital neurologists and the decision can be made whether or not the patient meets the criteria for rTPA. The American Heart Association, recognizing the role EMS can play, has established a new goal of door-to-needle time of 60 minutes.  Even if the patient does not meet the narrow criteria for rTPA, the immediate neurological evaluation will lead to swifter interventions such as blood pressure control that will lead to better...

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Ambulance: Hello, Kitty

Written by RSS Poster Medic Scribe

Many years ago, the R.J Reynolds tobacco company got into trouble with its Joe Camel campaign, which featured a cool cartoon camel in human clothing who like to smoke.  The ad campaign was controversial because it seemed to target kids.  The American Medical Association tried to get the company to shut down Joe Camel after a study showed as many six-year-olds knew that Joe Camel was associated with cigarettes as Mickey Mouse was associated with Disney.  Sales statistics backup up a huge increase in underage sales of cigarettes that were also disproportionately camels.  Tobacco company documents were made public that revealed they were indeed targeting kids.  Finally, in 1997, they terminated the campaign and settled to the tune of $10 million dollars to be targeted to teen smoking prevention efforts.

The heroin industry in Hartford seems to be taking a similar tack these days and it is quite disconcerting.  Among the brands to hit the streets in recent weeks are Bugs Bunny, Hello Kitty, Dino babies and Smurfs to go along with...

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Ambulance: High Risk

Written by RSS Poster Medic Scribe

The dispatch is for an unresponsive overdose, likely fatality.  We are coming from a fair distance, but we are the only unit available.  There no updates.  No PD dispatcher asking if we are a medic unit or the message that CPR is in progress.  PD and fire have beaten us to the scene, but as we pull in, we know the story.  Friends and family members are gathered outside the triple-decker as word has no doubt gotten around the neighborhood.  The firefighter standing by the engine, nods to us.  A police officer comes out of the house and walks towards his cruiser.  I still grab my red in-house bag and cardiac monitor, and hike up the narrow stairs, and then through the open apartment door, down a hallway and into a bedroom where a man lays back against the bed like he was sitting up, and then just fell immediately backwards.  He has rigor and lividity.  Asystole in all three leads.  I announce the time.  It doesn’t take long to get the picture.  On a small table is a cardboard box, the kind glassine envelopes come in, and...

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Ambulance: New CDC Report: Characteristics of Fentanyl Overdoses

Written by RSS Poster Medic Scribe

Yesterday the CDC released a fascinating new report, Characteristics of Fentanyl Overdose — Massachusetts, 2014–2016.

The Massachusetts Department of Public Health, the state’s Medical Examiner’s Office and the CDC gathered 20 heroin users from three counties (Barnstable, Bristol, Plymouth) with high fentanyl overdose death rates (Two-thirds of overdose deaths were attributed to fentanyl) and interviewed them about their thoughts and experiences with opioid overdoses.

While the fact that the respondents were recruited by local harm reduction coalitions, suggesting they were knowledgeable about overdoses and naloxone training, likely skewed the results, the results are still informative.

Respondents

95% had witnessed an overdose in the previous 6 months

42% had overdosed themselves in the previous six months.

88% attributed the rising death toll to fentanyl.

They often did not know if they had purchased fentanyl or heroin.  While some wanted fentanyl and others wanted to avoid it,...

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Emergency Shorts:
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