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Ambulance: Cardiac Arrest – Pearls

Written by RSS Poster Medic Scribe

Paramedics all take ACLS every two years, and we all have roughly similar protocols. We all know that the key to resuscitation is high quality CPR and early defibrillation. I love this graph I found on Rogue Medic‘s blog a number of years ago.

This graph is the answer to the test. We read about the latest gizmos and approaches over the years – everything from high- dose epinephrine, the ResQPOD, CPR machines, double sequential defibrillation to the latest head up CPR, but despite their early promises, few innovations make a difference beyond the basics. Those basics will likely always be good CPR and early defibrillation.

What I will offer in a series of posts is not a new way of doing CPR or a new device, just some pearls that I have learned to include in my resuscitations over the years that work for me.

Pearl #1  Recognizing Cardiac Arrest

Ambulance: Two Man Dead Lift

Written by RSS Poster Medic Scribe

This was sent to me by an old medic.  This is how stretchers were when I started in 1989.  In the days of the dead lift, careers in EMS were much shorter than they are now.  I remember each new stretcher innovation as they arrived, and fought against them all, but within days was sold on the new technologies, from the one man to the new self-loading I tried for the first time a week ago (on another service’s ambulance).

In my thirtieth year in this profession, only now battling my first back issue, I am grateful to the innovators for allowing me to last as long as I have.  Hats off to to the inventor of the tractor stair chair.

Maybe someday someone will invent a way to prevent stress, PTSD and other mental injuries so many of our coworkers struggle with.

Peace to all.


Note: I wasn’t able to track down the original source of the cartoon, but thanks to the artist for great drawing.



Ambulance: Fentanyl Test Strips

Written by RSS Poster Medic Scribe

Mark Jenkins of the Greater Hartford Harm Reduction Coalition passes out fentanyl test strips as part of his mobile needle exchange. He has set up on a Sunday in the parking lot of 1200 Park, a shopping plaza/strip mall across from Pope Park where users often congregate.

Once the users see him out there, word spreads, people come from under the highway overpass, cars pull up and users step out. It is a Sunday and the local needle exchange van only operates Monday through Friday. Many have already run out of their supply of fresh needles, so this is a welcome event. The users hand over their old needles counting them out as they drop them in the sharps box and Mark hands them new syringes ten to a package.

One of the advantages of needle exchange is users pick up used needles, knowing they can exchange them for new ones. They use some of the needles for themselves and sell others a dollar a needle to other users. Mark also provides them with clean tourniquets, small cookers which look like quart bottle caps, a saline bullet, an alcohol wipe and...

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Ambulance: Sunrise on Albany Avenue

Written by RSS Poster Medic Scribe

Ambulance: Judge Rules for Safe Injection Site

Written by RSS Poster Medic Scribe

A federal judge ruled yesterday that a nonprofit group in Philadelphia’s effort to open a safe injection site where people can use drugs under medical supervision does not violate the federal crackhouse statutes prohibiting the operation of a space “for the purpose of manufacturing, distributing or using controlled substances.” 

U.S. District Judge Gerald McHugh wrote: “The ultimate goal of Safehouse’s proposed operation is to reduce drug use, not facilitate it.” 

The federal government has not only vowed to appeal, they have threatened to shut down anyone who attempts to open such a site.  Deputy Attorney General Jeffrey Rosen said, “Any attempt to open illicit drug injection sites in other jurisdictions while this case is pending will continue to be met with immediate action by the department.”

Ten years back I would have thought a safe injection site was a foolish idea, but after witnessing the sorrow, devastation and death caused by the opioid epidemic, I have come to see these spaces as essential.  The evidence from safe...

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Ambulance: Back on the Rise

Written by RSS Poster Medic Scribe

After a slight decline in 2018, overdose deaths are projected to hit an all-time high in Connecticut in 2019.  

94% of the deaths were caused by opioids with fentanyl being the biggest culprit.

For full breakdown, click here:

Connecticut Accidental Drug Intoxication Deaths Office of the Chief Medical Examiner

Ambulance: Two Boys

Written by RSS Poster Medic Scribe

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 even know I have...

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Ambulance: Austin Eubanks

Written by RSS Poster Medic Scribe

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. They are under the...

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Ambulance: Connecticut SWORD

Written by RSS Poster Medic Scribe

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 the rest of the state...

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Ambulance: Draft ILCOR Advanced Airway Recommendations: Banning Paramedic Intubation-What System will be the First?

Written by RSS Poster Medic Scribe

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 the key draft...

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Latest Medic Scribe Stories

Pearl #10 Involve the Family
Pearl #8 Anticipate LOSC
Pearl #7 Use ETCO2 to Predict Arrest Cause
Pearl # 6 Use ETCO2 to ensure CPR Quality

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