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Ambulance: Narcan Dosing and Delivery

Written by RSS Poster Medic Scribe » Medic Scribe

The heroin epidemic continues to rage in Hartford and across our state and nation.  While nearly every other day there seems to be an article in the paper about fatal overdoses in various towns, most of the overdoses we see on the EMS streets, even the fatal ones do not make the news, though they certainly add to the growing statistics documenting the unprecedented epidemic.

My fellow medics and I often share our preferred routes and doses, and the pros and cons of each.  With so many calls, we are all able to experiment with various dosings and delivery.

When I first began in EMS, I gave narcan always IV as my first choice.  Usually, 1.2 mg to start.  I considered this conservative as a paramedic instructor had demonstrated for us his preferred method.  Draw up two of narcan, put in the lock, as you came through the ED doors, slam it so the patient would vomit on the battle ax triage nurse.  I kid you not.

In my then limited experience with narcan, I tended to be impatient, and yes, I will take a...

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Ambulance: Bad Behavior

Written by RSS Poster Medic Scribe » Medic Scribe

Years ago I worked for a United States Senator.  One of my early jobs for him was driving him around the state to campaign functions and speeches.  Every now and then someone would give him a hard time about all the rotten people in Washington.  He had a great answer.  He said we were a representative democracy, and that it shouldn’t surprise anyone that Washington had crooks and womanizers and deviants, likely in the same proportion as all walks of life and the general population.

He had a point.

Unfortunately, the same is true of EMS.  While we have many selfless individuals, we have our share of wayward souls, likely in the same proportion of any other profession.

Regularly it seems we see news stories like this one:

N.M. Paramedic Accused of Charging $11,000 on Dead Man’s Debit Card

I wonder when I read these stories what drove these EMS criminals to their actions.  Was this paramedic completely evil?  Did he lack positive role models? Was he mentally ill?  Or was there something more complex and...

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Ambulance: The End of Pain Scales?

Written by RSS Poster Medic Scribe » Medic Scribe

A bill has been introduced in Congress that will eliminate the financial penalty (in the form of reduced Medicare reimbursements) hospitals pay for failure to keep patients pain-free.

Currently the amount of money Medicare pays a hospital is affected by the results of a patient satisfaction survey known as the “Hospital Consumer Survey of Healthcare Providers and Systems.”  If a hospital does poorly on the survey, they receive less money from the government than if they ace the survey.  Hospitals devote an enormous amount of time and resources to score well on this survey as well as to do well on numerous care benchmarks and quality indicators (Door-to-Balloon times, hospital readmission rates, infection rates etc) that are also tied to reimbursement.

The survey has three pain management questions:

1. During this hospital stay, did you need medicine for pain?

2. During this hospital stay, how often was your pain well controlled?

3. During this hospital stay, how often did the hospital staff do...

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Ambulance: Amiodarone vs. Lidocaine vs. Placebo

Written by RSS Poster Medic Scribe » Medic Scribe

The results are in.  In an article, Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest, published in yesterday’s New England Journal of Medicine by Peter J. Kudenchuk, M.D., Siobhan P. Brown, Ph.D, and others, the results of a major randomized double blinded study involving paramedics from ten major cities in North America (The Resuscitation Outcomes Consortium (ROC)), and enrolling over 3,000 patients, concluded there was no significant difference in outcomes between the drugs and a placebo when administered to patients in refractory v-fib or pulseless v-tach arrests.

Here are the numbers on survival to hospital discharge:

Amiodarone   24.4%

Lidocaine        23.7%

Placebo            21.0%

While amio and lido outdid placebo, the margin was too small to be statistically significant.

The researchers, who thought the drugs would show a greater effect, now admit that they should have done a larger study.  If these results had held true over 9000, not 3000,...

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Ambulance: Burnout (With Footnotes)

Written by RSS Poster Medic Scribe » Medic Scribe

I wrote this a couple months ago when I was feeling really burned out.  The burnout passed, as I knew it would, and I am back to myself, so I can post it now. (1)

I have been responding to 911 calls for twenty-six years, 21 as a full time paramedic with a busy urban commercial service (2). I have had periods of burnout, more when I first began than in my later years. Once you get used to the business, the stress and emotions of the job are easier to handle; they become almost routine. Lately, however, I confess, I have felt burnout creeping back up on me. It is less a burnout from the emotions of the job and more a larger existential tiredness.

I can identify a number of causes:

Our call volume is as high as it has ever been or perhaps a better way to put it is the ratio of calls to the number of available units is as high as it has ever been. (1/2) Most days I am cranking from the moment I sign on at 5:30 A.M. to the inevitable late call I get twelve hours later as I am trying to get back to the...

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Ambulance: New EMS Books

Written by RSS Poster Medic Scribe » Medic Scribe

This past year has been a banner year for new EMS books, memoirs and fiction. Each book  that reaches an audience outside of the EMS world increases the public’s understanding of what we do and hopefully, increases their respect for us. Here is a roundup of recent books.

New Picture (24)

Lights and Sirens: The Education of a Paramedic by Kevin Grange published by Berkley. This a great account of a young man going through paramedic school. I reviewed it in more detail in this post:

Lights and Sirens

New Picture (43)
A Thousand Naked Strangers: A Paramedic’s Wild Ride to the Edge and Back by Kevin Hazzard published by Scribner. This is also a tremendously well written book covering the EMS career of an Atlanta, Georgia paramedic from eager EMT to eventual burn out and fade away nearly a decade later.

New Picture (44)

Our friend Michael Morse of the Rescuing Providence blog has had his first two excellent books Rescuing Providence and Rescue 1 Responding  combined into one book and published by Post Hill Press and distributed by Simon and Shuster.  Morse also...

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Ambulance: Junior doctor contract imposition is flawed on every level

Written by RSS Poster Garth Marenghi
Background The government is currently in the process of unilaterally imposing a contract on the junior doctors of England.  The Scottish, Welsh and Northern Irish government have decided it is not in the public interest to do the same.  The Review Body on Doctors’ and Dentists’ Renumeration (DDRB) report published in July 2015 forms the backbone for the government’s rationale for contract


Ambulance: American Pain

Written by RSS Poster Medic Scribe » Medic Scribe

New Picture (39)
Two tattooed muscle head dudes in their twenties, one a convicted felon, who used to work construction as well as sell steroids, started a small business in which they hired a doctor to write prescriptions for pain medicine to most anyone who came through the clinic’s doors during business hours. The doctors got $75 a prescription, and were encouraged to see as many patients as possible, and $1000 a week for the use of their DEA MD number to order the pills. In no time, the clinic’s waiting room and parking lot was overflowing. Within two years the Florida business, officially named “American Pain,” was bringing in $40 million a year, 1000 other pain clinics had opened in the state and places like Kentucky and West Virginia* as well as other Eastern states were besieged by a public health and crime crisis of addicted citizens bent on their next fix. Two years after its doors opened American Pain, as the largest pill mill in Florida, was shut down by the DEA and the young entrepreneurs were on their way to jail,...

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Ambulance: EMS Opiates and Chronic Pain – 2

Written by RSS Poster Medic Scribe » Medic Scribe

I wrote recently about my new found concern about giving opiates to patients with chronic pain.

Opiates for Chronic Pain

Subsequently as a member of our regional medical advisory committee, I submitted the following draft proposal:

Paramedic Chronic Pain Management Guidelines (Draft)

Providing opiates to certain patients with chronic pain conditions may not always be in the best interests of the patient and has the potential to cause them harm.

Paramedics may consider deferring opiate pain management for patients with chronic pain if they have any of the following high risk flags:

Poly-Hospital, frequent EMS calls for same condition, allergies to analgesics and other relevant non-opioids, transfer request to distant hospital, history of substance abuse.

Paramedics should still document patient’s pain and institute other pain management techniques such as positioning, distraction therapy and guided imagery.

Paramedics should continue to treat acute pain and cancer pain aggressively. They...

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Ambulance: A Cigarette

Written by RSS Poster Medic Scribe » Medic Scribe

The mental health team meets us outside. “We should wait for the police,” the clinician says. “She’s a big woman. When we went back up there she had a knife near her that wasn’t there the first time we were up with her. She’s very anxious today. When she’s off her meds, she can be volatile. I’ve seen her tear a door off its hinges.”

“Okay,” I say. “We’ll wait for the PD.”

When the first officer arrives, she repeats the story to him. He calls for backup.

Once backup arrives, we walk up the three flights of outdoors stairs and then force the door open because she will not come to it. Inside we find a completely bare apartment. I am always surprised when I walk into what is actually a fairly common occurrence — a psychiatric patient living in an empty apartment. In the kitchen there is a bare table with no chair and in the living room, there is no furniture, except the single folding chair in which the woman sits facing the window sill, smoking a cigarette. She wears a dirty flowered robe and...

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Ambulance Blog List

Hampshire & Isle of Wight Air Ambulance (806)
InsomniacMedic (219)
Trying My Patients (194)
Trauma Queen (178)
Street Watch: Notes of a Paramedic (158)
Garth Marenghi (118)
Xf (92)
Minimedic's Blog (71)
A Life In The Day Of A Basics Doc (57)
Medic Scribe » Medic Scribe (53)
StorytellERdoc (50)
Brian Kellett (dot) Net (49)
Medic ScribeMedic Scribe (46)
Jerome Mowat (26)
Emergency Egg (19)
BrianKellett.net (18)
ambcontrol999 (16)
Hampshire and Isle of Wight Air Ambulance (14)
Purpleplus (11)
Minimedic's Musings (10)
Random Acts Of Reality (6)

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