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Ambulance: Narcan Thoughts

Written by RSS Poster Medic Scribe » Medic Scribe


A story on the news this week said the Hartford Fire Department has saved 136 lives with Narcan since they began carrying it last November.  They have used it 172 times with 136 positive results, according to the article.  (Kudos to an outstanding department!) The story also mentions the Connecticut State Police have saved 100 lives with Narcan since October 2014.  Google almost any fire or police department in the state who has started carrying Narcan and there are glowing reports of lives saved by their members.

Hartford Firefighters Save 135 from Opiate Overdoses

Connecticut had 415 heroin deaths in 2015, and over 600 fatal opiate overdoses of all types.  I have seen nothing to suggest that the number is declining in 2016.

Neighboring Massachusetts had 1,379 opiate overdose deaths in 2015, an increase of 7 percent over 2014.  According to MA state data,  Narcan was administered to 9,128 EMS patients in 2015.

Mass EMS Stats

The articles claiming lives saves to each administration of Narcan are a bit...

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Ambulance: OMG

Written by RSS Poster Medic Scribe » Medic Scribe


Two weeks ago, it was Black Jack.  This week it is OMG.  Oh, My G**.

The woman lays on a parking lot sidewalk behind the school.  Her face is blue and she is only breathing one or two times a minute.  She is wearing tight spandex and bright pink tank top.  She has tattoos on both arms.  I am guessing she is in her thirties.  Our response is routine.  A shake to see if we can get her respiratory rate up.  It increases to 6.  She briefly opens her eyes, then goes back out.  We lift her up and put her on the stretcher, and get her into the back of the ambulance.  Her ETCO2 is 70.  Without stimulation, her breathing is agonal.  We give her 0.25 of Narcan IN up each nare (We continue to experiment with dosing.  How little can we give and still get the response we need.).  My partner puts in an IV and we take out a 100 cc bag of saline that we put 0.5 mg of Narcan in.  By the time she has received 20 cc (0.1 mg) her ETCO2 is down to 35 and her eyes open on prodding.  We shut the drip off.

She wants to know what...

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Ambulance: Black Jack

Written by RSS Poster Medic Scribe » Medic Scribe

I did three heroin ODs on one shift last week. Another medic did four in a shift the day before. Lots of OD calls going out. All three of these ODs used the same brand. Black Jack. For years, dealers in the Northeast have been branding their supply, stamping or printing it on the glassine envelopes the heroin is sold in. While many areas of the country get their heroin in small balloons made from the tips of latex gloves or torn off shopping bags, in Hartford (which is supplied from the New York I-95 route) it is almost always sold in the small glassine bags. One bag $5. A bundle of ten bags – $50. Black Jack is evidently pretty strong as there seems to be a big demand for it, and it is knocking people down. The more deadly, the greater the appeal. That is why many of the brands promote the idea of danger.

Big dealers take a kilo of heroin and cut it down, mixing it 50/50 with baking soda. It is enough to fill 25,000 glassine envelopes, which are usually prestamped with the brand, before being distributed...

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Ambulance: Three Lives

Written by RSS Poster Medic Scribe » Medic Scribe

The heroin epidemic continues unabated in Hartford. I called the time on two fatal overdoses in a recent week. Both men were in their 40’s. One was in a low-rate motel. He sat by the window in his breeze-less room, the curtains pulled just enough so he could see the cars rolling past on the highway. His head had rolled back, his mouth open when he died. He was riggored in his chair, surrounded by half unpacked moving cartons that held his tattered belongings. The room was dirty. The TV showed footage of the Dallas shootings. The ashtrays overflowed with butts. There were scattered glassine envelopes with a monkey stamped on them. The other man was in the guest bedroom of a small apartment where he was staying with his sister and her four year old son. He lay back on the neatly made bed, his feet on the floor, his eyes staring at the ceiling, his skin cold and grayish blue. On the bureau was his prescription for Buprenorphine. His sister said he had been clean for three months. She and her son had spent...

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Ambulance: Update: Nursing School Failed To Kill Me!

Written by RSS Poster Minimedic's Musings

Soooooo…where do I start?

Oh yeah, survived two years of an associate degree program in nursing, set to take that lovely NCLEX within a month now…and it only became two years because the beginning of my final semester started off with a divorce hearing…


It was a divorce that was a long time coming and not wholly unexpected for me, but it is a complex story of a woman thinking she could fix a man…

…ignoring red flags of anger management issues…

…discovering he may have classic narcissism…

…hey, awesome, it’s domestic violence without physical violence…

…get. me. out. of. this. marriage.

For now, I am somewhat functional with a job and preparing to more baby steps towards financial independence, but I’ve definitely become a different person over the past few months.

I’m back, kids. For better or for worse.

Ambulance: Cat Burglar

Written by RSS Poster Medic Scribe » Medic Scribe

One of my greatest joys on the job is the opportunity to play cat burglar. By this I do not mean the opportunity to break into homes to steal jewelry and works of art. I am talking about the chance to break into homes to rescue people (with police permission).

The person has fallen and can’t get up or, perhaps, it is a medical alarm, and no one knows if there is a person in distress or merely a false activation. We arrive on scene. All the doors are locked and there is no key under the flowerpot (almost as good as doing a second story entry is being the guy who finds the key under the flowerpot. Brilliant!).

I have broken into dozens of homes over the years. I consider myself a top tier cat burglar second story man. My three advantages are: 1) my height(and thinness), 2) my ability to lift myself up with my arms, and 3) my quickness to volunteer. After a boost from my partner or a police officer, I usually go in head first, my legs high in the air, providing a chuckle for the earth bound. I hit with arms...

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Ambulance: Sinners and Saints

Written by RSS Poster Medic Scribe » Medic Scribe

As each of us will ultimately find ourselves before our god, many will find themselves before their paramedic. But unlike their god, their paramedic does not sit in judgement. We treat all of our patients the same. That is the creed. The man in the Mercedes Benz gets the same care as the man pushing the shopping cart full of cans. The model gets the same priority as the toothless crack whore, the All-American the same careful assessment as the bed sore ridden amputee, the police officer the same professionalism as the thief.

Most of my patients are anonymous. But sometimes they are not. I have cared for famous politicians, athletes, entertainers, scholars, businessmen and criminals. Sometimes I like to talk to my patients. I ask them about their lives, how they ended up here on my stretcher, what lessons or regrets do they have from their journeys. When my patient’s public history is known to me, and I suspect my letting on that I know who they are will make them uncomfortable, I try not to let on...

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Ambulance: Conrad Castonguay

Written by RSS Poster Medic Scribe » Medic Scribe

Conrad Castonguay died this week at 81. In 1992-93, he helped teach my paramedic class. Pharmacology was his specialty. He wasn’t a paramedic, but he knew what he was talking about and we paid him mind. He was a challenging instructor, and took his work seriously. It became an honor for paramedics to say they were his students.

Conrad Castonguay

That was 24 years ago when he was 57. The last time I saw him was in 2003 at a funeral for Dr. Philip Stent who was the medical director of my paramedic class. Dr. Stent was also the state OEMS Medical Director, and I had worked with him when I was the Executive Assistant at the State Health Department from 1991-1995, just before I started full time as a paramedic. He was instrumental in creating our state trauma system and in moving paramedicine into the modern era.

Dr. Philip Stent

There are many paramedics still out on the street today who remember both men, and are grateful for having known them. We, as paramedics, are a collection of all the knowledge and...

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Ambulance: EMS Sports Pages

Written by RSS Poster Medic Scribe » Medic Scribe

When I started in EMS, the term “EMS Sports Pages” referred to the Obituaries. It was where we turned to see how our critical patients did. Get pulses back on a cardiac arrest or bring in an unresponsive patient with multiple trauma from an MVA or a seizing patient with left sided paralysis, you checked the obit section each day. It might be day three or day five or sometimes, day 13, but in most cases, you’d recognize the name,and you’d feel a little down. Never see the name and you’d wonder if maybe it appeared on a day you didn’t check. Followup at many of the hospitals was hard to get.

This was around the time Rescue 911 was on TV. In that show heroic rescues were reenacted, and afterwards the victims came by the EMS station for a celebratory picnic with their rescuers. We didn’t have a station. We went from street corner posting to street corner posting. And we never got a picnic.

Once I got called for a stroke. I found a man sitting on a neighbor’s garbage can, where he had been talking...

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Ambulance: My thoughts on the junior doctor contract vote

Written by RSS Poster Garth Marenghi
This post may be unpleasant reading for some of you but frankly it needs to be said given the way some of the 'debate' is heading. Firstly I'm not going to spin cheap sound bites and propaganda in order to push your opinion into voting 'Yes' or 'No'. It has been clear throughout all this that we are all big enough and ugly enough to analyse the evidence to make up our own minds. Secondly be

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