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Ambulance: The Price is Right

Written by RSS Poster Medic Scribe » Medic Scribe


I have been writing much lately about heroin with the backdrop of Hartford’s Park Street which is one of many epicenters of the current heroin epidemic.  Today, I am going to briefly change the backgrounds.  Instead of Park Street with its back drop of bakeries, bodegas, Spanish restaurants,  and young tattooed men, with crooked baseball caps, standing  in the doorways minding their own business, we are going to your typical elderly housing/assisted living facility.  Imagine a room of geriatrics in the common room, with their walkers on tennis balls or canes at the side of their chairs.  Imagine perhaps also a 50 gallon aquarium, with clean bubbling water and a large lazy fish or two.

Now let us focus on our subject — a Caucasian woman of 62.  She is obese, maybe two hundred sixty pounds, her hair is grey and tied back behind her head in a pony tail.  Her clothing is threadbare and could use a laundering.  She has two canes beside her with which she walks slowly and painfully on skinny legs that can...

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Ambulance: Dead Man

Written by RSS Poster Medic Scribe » Medic Scribe


I mentioned that we had a patient this week who said she stayed away from the white powdered heroin because of her fear of Fentanyl.  Powdered Fentanyl is white and very hard to distinguish visually from white powdered heroin.

A number of years ago drug dealers started enhancing their heroin with Fentanyl.  Fentanyl is stronger than heroin, so adding it was a good way to boost the reputation of their product.  Deaths increased as users were hit with more potency than they expected, or in some cases, the heroin and Fentanyl were not evenly mixed and so even a user with high tolerance might die with the syringe in their arm if they got a “hot spot” of disproportionate Fentanyl in their buy.

The deaths and subsequent warnings of dangerous heroin only drew more users to the brands as many users sought the powerful mixtures.  More dealers began adding Fentanyl to their batches.  Also, while years ago, it was common practice to cut heroin to increase profits, many dealers now keep their heroin strong in order to...

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Ambulance: EMS Distributes Narcan

Written by RSS Poster Medic Scribe » Medic Scribe


Paramedics in North Carolina and in Cleveland, Ohio are providing Narcan kits to high risk patients in their communities.

Cleveland EMS Providers to Distribute Overdose Kits

N.C. County Allows Paramedics to Provide Precautionary Narcan Kits

My partner and I often spend time on heroin overdose calls educating the patient’s family, friends or bystanders/social circle on the availability of Narcan (where to get it — local clinic, pharmacy, etc) and how to administer it.  We recently had one patient’s neighbor (who had found his friend unresponsive) express gratitude for our lesson and say he would immediately go down to the clinic and get a kit.  A woman this week told us she had Narcan in the bathroom, kitchen, living and bedroom in her apartment, and had one kit always in her purse (which unfortunately had been taken from her while she nodded off in the bushes — thus prompting the 911 call for the woman unresponsive).  Leaving a Narcan kit with people who were present at an overdose scene makes clear...

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Ambulance: Connecticut Statewide EMS Protocols

Written by RSS Poster Medic Scribe » Medic Scribe

state protocols

On January 1, 2017, Connecticut will launch their first set of statewide EMS protocols.  They are largely modeled after those in New Hampshire.  Paramedics and EMTs will be expected to know all the protocols even though their local sponsor hospital may not approve all the drugs and treatment modalities listed.  Any service wanting to do something not in the guidelines will have to petition the state and EMS Medical Advisory Committee.

Previously, the North Central Region where I practice had unified regional guidelines, which worked fairly well, and were copied by some other areas in the state.  Many of their features are incorporated into these statewide guidelines.  While as a regional council member I had a great deal of ability to shape the guidelines, and now will have less ability to influence them, I am still in favor of the statewide guidelines.  The plan is for them to be formally and regularly updated by the statewide Medical Advisory Committee to reflect the latest research and...

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Ambulance: Park Street

Written by RSS Poster Medic Scribe » Medic Scribe


I only went to one heroin overdose this one and one PCP overdose.  The heroin overdose was on Park Street in the South end and the PCP was on Capen in the north end.  You get get called for an overdose on Park Street and it is pretty much always heroin.  You get called for an overdose at Garden and Capen, it is going to be PCP.  The North end is mainly black, the South end Hispanic.  The blacks control the PCP trade, the Hispanics the heroin.  There is some mixing, but that is pretty much the divide.  You go to Keney Park in the north end, and you find lots of tiny empty clear plastic baggies with no markings.  PCP.   You go to Pope or Colt Park in the South and you will find empty glassine envelopes with stamps on them marking the heroin brands.  In just one month of looking, I have already counted 96 different brands (some of the envelopes are likely months old (one was branded Super Bowl 50), others freshly tossed from the car window where the junkies sit low in the seats shooting up, and chilling before...

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Ambulance: #IAM999

Written by RSS Poster ambcontrol999

I am the one who answers your call
I am the one who sends help when you fall
I am the one at the end of the line
Do you know who I am? I am 999

I am the one to give help and advice
I am the one being calm and concise
I am the one that will hear the worst things
Dreading what’s next when the red phone rings

I am the one teaching you CPR
When your loved one collapses or is hit by a car
I am the one who remembers your screams
Those screams come to visit me during my dreams

I am the one receiving abuse
I am the one talking you down from a noose
I am the one at the end of the line
Do you know who I am? I am 999



Ambulance: Public Enemy

Written by RSS Poster Medic Scribe » Medic Scribe


Last week I speculated that despite increased access to Narcan, the opiate epidemic would continue to rage with deaths in 2016 exceeding those of 2015.

Narcan Thoughts

Sadly, this was borne out in just released data from the state medical examiner.  Through the first six months of 2016,  444 people died of fatal overdoses in CT, which projects to at least 888.  729 died in 2015.

A story in the Hartford Courant lays much of the blame on Fentanyl , which was involved in 25.8% on the deaths in 2015, and already in 50.2% on those in 2016.

Fueled By Fentanyl Spike, Overdose Deaths Continue To Climb In Connecticut

How powerful is a drug that you know can kill you easily, and yet you still take it — often alone with no one to watch over you?

It isn’t a slow death like that one inflicted by cigarettes or gluttony.  Most of us have encountered the dead with the needle still in their vein.

Too many people giving Narcan to EMTs and to family members was a drastic step, unheard of a few years ago.  Maybe we need to think...

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Ambulance: Public Access Narcan

Written by RSS Poster Medic Scribe » Medic Scribe


Medical emergencies, like cardiac arrest, anaphylaxis, heroin overdose, (and being bitten by a Black Widow spider), require quick treatment to save a life.   Our public health system recognizes this.  We have AEDs, epi-pens and now increasing access to Narcan.  All great initiatives.  Before I advocate for public access anti-spider bite kits, let me address Public Access Narcan.

Public Access Defibrillators are put in spots where patients are more likely than others to suffer sudden cardiac arrest.  We see public access defibrillators in airports, casinos, health clubs and in town halls, outside the tax assessor’s office.  Epi-pens are given to school nurses in case students with allergies to substances like peanuts have sudden anaphylaxis.  These devices have been credited with saving many lives.  I wonder how effective or realistic a public access Narcan program would be.  I would not put Narcan in health clubs or outside the tax assessor’s office, but I might consider putting it in the bathrooms...

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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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