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Ambulance: Superspreaders

Written by RSS Poster Medic Scribe

Recently in the New York Times there was article that suggested “Most People with Coronavirus Won’t Spread it. Why Do a Few Infect Many?

Covid, it seems, is like a forest fire that can simmer and then sudden flash over.  While many diseases have a steady rate of infection (each person passes it on to two or three more), COVID seems different, It appears dependent not on the mass of victims to spread the disease,but on a few super spreaders.  10 percent of the positive seem to be infecting 80 percent of the subsequent positives. How is this possible?

In the right situations, the article explains, one person can become a “virus chimney”  All it takes is:

  1. The right day (likely a few days after infection)
  2. The right place (a crowded bar?  A church choir?  A meat packing plant?  A nursing home.
  3. An extended period of time where that superspreader is in contact with a group of people.

This is why we all need to wear masks and also to avoid contained spaces for extended periods of time.  We need to do this not only to help avoid corona ourselves,...

Continues, Read More...



Ambulance: More Opioid Deaths?

Written by RSS Poster Medic Scribe

Is the COVID epidemic causing increased opioid overdose deaths? No one knows for certain, but the head of the White House Office of Drug Policy is speculating that it has, citing increased death statistics from a few states such as Kentucky.

Pandemic unleashes a spike in overdose deaths

Here in Connecticut we won’t have an official answer until the Connecticut Medical Examiner’s Office releases its first six months of 2020 data (likely at the end of August).

I am involved with a statewide SWORD program that tracks EMS reported opioid overdoses.  Unfortunately, this program under reports fatal overdose deaths.  There are several reasons:

  1. EMS compliance with reporting is estimated to be only 70%.
  2. EMS often cannot ascribe the cause of a death to an overdose lacking eyewitness accounts of visible paraphernalia on scene.  (Example –A fifty year old lying dead in bed with rigor mortis and dependent lividity could have died from any number of causes from a heart attack to sniffing a bag of heroin that was either flushed down the toilet or removed...

    Continues, Read More...


Ambulance: Forced Sedation

Written by RSS Poster Medic Scribe

Interesting article on NBC news about the use of ketamine for sedating patients in police custody. 

Elijah McClain was injected with ketamine while handcuffed.  Some medical experts worry about its use during police calls.

The reporter centers the story around the tragic case of Elijah McClain, who was apparently walking down the street, wearing a face mask and listening to headphones when a 911 caller said he was acting strangely.  The police stopped him and ended up taking him down with a chokehold.  He said he couldn’t breathe and he vomited.  EMS came.  The officers told them he was on something and was exhibiting inhuman strength.  The medics gave Elijah a large dose of ketamine, and shortly after he was in cardiac arrest.  He was resuscitated, but suffered a brain injury and was unplugged.

In light of today’s awareness of cases of brutality, this case has aroused considerable attention and controversy.

The article seems to take the positions that 1) people should not be injected with a sedative during a police action and 2)  they should not...

Continues, Read More...



Ambulance: Golden Hour of Trauma

Written by RSS Poster Medic Scribe

R. Adams Cowley, the founder of Maryland’s well-known Shock Trauma hospital in downtown Baltimore, famously said:

“There is a golden hour between life and death. If you are critically injured you have less than 60 minutes to survive. You might not die right then; it may be three days or two weeks later — but something has happened in your body that is irreparable.”

The Merriam-Webster On-Line dictionary defines “golden hour” as “the hour immediately following traumatic injury in which medical treatment to prevent irreversible internal damage and optimize the chance of survival is most effective.”

The 2nd edition of the Prehospital Trauma Life Support said “The critical trauma patient has only 60 minutes to reach definitive surgical care or the odds of a successful recovery diminish dramatically.”

(It is my guess that this is no longer in the current edition.)

The following quotes are from a 2001 Academic Emergency Medicine journal article:

“The Golden Hour: Scientific Fact or Medical Urban Legend?”

“The golden hour justifies much of our...

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Ambulance: Yet to Come

Written by RSS Poster Medic Scribe

My daughter had her first softball game of the summer yesterday. It was the first time she wore a uniform since her basketball team’s playoff run was stopped in March with the first Corona cancellations.  Last night they got mercied 17-5 but it was a beautiful night and she got two hits. They were supposed to play again tonight, but a thunderstorm came up and drenched the fields. Afterward there was a gorgeous rainbow, but with more rain on the way, they called the game.

We came home and had dinner. Earlier that afternoon, I stopped at Bear’s Smokehouse and picked up our local “farm share” along with two pounds of smoked burnt ends. Every Tuesday we pick up a bag of fresh picked farm products. Tonight they had a head of butter lettuce, peapods, zucchini, mint and fresh picked strawberries, juicy berries that actually taste like strawberries not the bland flavor the fat pretty-looking grocery store ones have.

After dinner I lay down and read some news stories about COVID on my computer. Connecticut dropped under 100 hospitalized cases and their...

Continues, Read More...



Ambulance: Covid-19 and Race

Written by RSS Poster Medic Scribe

Nationwide, blacks make up 13% of the population and account for 23% of the deaths.  According to the COVID Tracking Project, through today 25,932 black lives have been lost to COVID-19.  The project says “black people are dying at a rate more than 1.5 times higher than their population share.”

The COVID Racial Data Tracker

In Connecticut blacks make up 10% of the population, but account 15% of the deaths.

State-by-State Dashboard

Why might that be?

Here are some reasons:

Blacks could more genetically susceptible to COVID-19.

Or, more likely it could be because black people in America are more likely to live in poverty, in more crowded living quarters, have higher risk of hypertension and diabetes, have poorer diets, less access to health care, and be less likely to have jobs that allow them to work from home and mitigate their risk of contact with carriers.

Certainly the reasons for the above have a lot to do with American history, politics, and long-standing discrimination and disadvantage.

We have lived too long as two Americas. 

As we battle...

Continues, Read More...



Ambulance: Penetrating Trauma

Written by RSS Poster Medic Scribe

With the onset of summer, one of our more long standing epidemics is raising its head and demanding it not be forgotten

In the north end of Hartford that means penetrating trauma — the knife and gun club.  In my earlier years in the city, I often worked nights when the trauma numbers were highest,  The last several years my shift was Sunday through Tuesday 5:30-AM-5:30 PM, not really prime hours for trauma.  Lately, I have been working Fridays from 9 AM to 7 PM in a city fly car where I respond to all 911s, often arriving before the ambulance and in many cases, before the fire department first responders.  Along about four on a Friday afternoon, people start to get riled up. 

I am slowly getting back in form.

Transport times are very short in Hartford with two level one trauma centers not two miles apart.  I find traumas challenging, but often unsatisfying.  The challenge is to accomplish as much as you can in as short a time as possible.  The lack of satisfaction is that the call is often over in minutes.

I am 100% in the “bag and drag”...

Continues, Read More...



Ambulance: Rt Numbers

Written by RSS Poster Medic Scribe

Connecticut has the second lowest Rt number in the United States, behind only Massachusetts and the District of Columbia.  Rt number is the average number of people who become infected with COVID-19 by an infectious person. If it’s above 1.0, COVID-19 will spread quickly. If it’s below 1.0, infections will slow.

In March, Connecticut’s Rt number was above 3.  By April 1, it had fallen to .99, and is now estimated to be at .76.

In contrast Nevada has the highest Rt number in the country at 1.52.  It began March at 2.17, fell below 1 in April 1 when its shelter policies started, dipped as low at .71, but then when the state reopened, the number has climber back to 1.52.

You can check out your state here:

Rt Number COVID-19

Bottom Line:  If you practice physical distancing and wear masks in public, this germ can be beaten back, but crowd into bars or packed churches with poor ventilation, and disregard the use of masks, then the germ will have the upper hand and people will die.



Ambulance: Seroprevelence of Antibodies

Written by RSS Poster Medic Scribe

The CDC (Center for Disease Control) has just released a study of the seroprevelence of antibodies to SAR-CO-2 (COVID-19) in Six U.S. states, including Connecticut between March 23 and May 3, 2020.

The study estimated that these states had between 6 to 24 times the number of reported cases.

Commercial Laboratory Seroprevalence Survey Data

In Connecticut the seroprevelence (percentage of people in the population with antibodies) was estimated at 4.94%, which would mean the state at the beginning of May, had six times the number of reported cases.

New York City Metro region had the highest estimated seroprevelance at 6.93%, or 12 times the number of reported cases.

Missouri had a seroprevelence of only 2.65%, but this represents 24 times the number of reported cases.

The CDC will be conducting this study in additional states as well as retesting these areas.

South Florida, for instance, likely has a much higher seroprevelance now than when the study was taken in April.

The reason for the underreporting of cases, according to the authors,...

Continues, Read More...



Ambulance: COVID-19 Antibodies May Not Last

Written by RSS Poster Medic Scribe

Ideally, if someone gets COVID-19, their body produces antibodies and they become immune from ever getting it again or they get immunity that lasts for several years. The answer to this is still unknown, but it doesn’t appear likely if we judge on the presence of antibodies in patients who have been infected.

A recent Chinese study showed that antibodies produced in response to COVID-19 may not last more than a few months, particularly if the infected patient was asymptomatic.

Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections

COVID-19 Antibodies Can Disappear After 2-3 Months, Study Shows

The study of 37 people with symptoms and 37 infection but no symptoms found after two months, 40% of the people without symptoms showed no antibodies and 18% of those who had symptoms with their infection showed antibodies.

The authors concluded: “Together, these data might indicate the risks of using COVID-19 ‘immunity passports’ and support the prolongation of public health interventions, including social distancing,...

Continues, Read More...





Latest Medic Scribe Stories

Superspreaders
More Opioid Deaths?
Forced Sedation
Golden Hour of Trauma
Yet to Come

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