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Ambulance: Xylazine-Mind F

Written by RSS Poster Streetwatch: Notes of a Paramedic

Xylazine, a horse tranquilizer, has been increasingly found as an adulterant in the East Coast street supply of fentanyl.    In 2019 in Connecticut, xylazine and fentanyl were found together in 71 overdose deaths.  There were 141 deaths of this combination in 2020, and in 2021, through August with still many cases outstanding, the number has risen to 172.

In Puerto Rico dealers began mixing xylazine with heroin in the early 2000s. While xylazine has not been the subject of much human research and is definitely not approved for human use, it is believed to produce prolonged sedation and likely works synergistically with opioids to create a longer high.  This is significant because fentanyl has largely replaced heroin along much of the east coast, due to its economic advantages for dealers.  Fentanyl typically lasts 4-6 hours while heroin lasts 6-8 hours.  Fentanyl’s shorter duration requires people to use more often to fight off withdrawal.  It is speculated that xylazine’s longer sedative effects may...

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Ambulance: Graveyard

Written by RSS Poster Streetwatch: Notes of a Paramedic

I came to work the other day and saw a chilling site in the parking lot. Ambulance 911 — the ambulance that was assigned to me for many years when I worked the 5:30-17:30 shift, the ambulance that had been my EMS home — sat battered and wrecked in a line with other battered and wrecked ambulance and fly cars in our lot that at times seems like an emergency vehicle repair/burial yard. It sent a chill through me. (Fortunately, I found out the crew involved in the rollover accident was okay.)

EMS work is not safe. I know coworkers who wear bulletproof vests; others are meticulous in their infection control habits, always gloving and gowning up and washing their hands thoroughly. But if you really want to protect yourself in EMS, you should be wearing a crash helmet and a St. Christopher cross around your neck.

Here is a post I wrote back in 2006, describing an incident where I almost died. In the years since, I have had other close calls, but still nothing significant as far as ambulance safety or dispatch...

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Ambulance: Pediatric Poisoning

Written by RSS Poster Streetwatch: Notes of a Paramedic

You’re called to an urgent care center on a priority one.  The nurse is holding the front door of the center open for you and directs you back to a treatment room, where a PA and another nurse are providing ventilations to a two year-year-old.  The story they tell you is the the child fell off the couch and was not acting right.  His mother drove him to the urgent care center where they found the child somnolent and hypoxic.  The PA is questioning a head injury.  The child has no pertinent medical history and there was no seizure activity described at any time.  The child’s pupils are smallish, but equal under the bright light of the exam room.  The mother sits quietly in a chair in the room.  She can’t be more than twenty herself and seems detached from the emotion in the room.

You quickly reexamine the child and see no bruising.  While your partner straps a pedi-mate to the stretcher to secure the child, you take over bagging and find good compliance. The pulse oximeter probe you attach to the...

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Ambulance: Safe Supply

Written by RSS Poster Streetwatch: Notes of a Paramedic

In the last two days, there were two big news stories about famous people dying of suspected opioid overdoses.  One involved the death of one of my favorite actors, Michael K. Williams, who played Omar in “The Wire.”  The other was a triple fatal where the victims were believed to have used cocaine contaminated with fentanyl.

Actor Michael K. Williams, Who Played Omar on ‘The Wire,’ Has Died At Age 54

Comedian Fuquan Johnson among 3 dead after suspected drug overdose in Venice

The New York Times recently ran an article “The Cocaine Was Laced With Fentanyl. Now Six Are Dead From Overdoses,” which attributed a recent string of deaths to dealers deliberately lacing cocaine with fentanyl. 

 I believe they got it wrong.  From all the people I have talked to and most of what I have read, these cocaine deaths are more likely caused by cross contamination than deliberate lacing.  Many dealers, at least here in Connecticut, sell both fentanyl and cocaine.  If they fail to properly clean their...

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Ambulance: Paramedics Indicted

Written by RSS Poster Streetwatch: Notes of a Paramedic

I have been a street paramedic since 1995.  Up until 2008 I often worked 70 hours a week.  That’s when I got a part-time job as an EMS Coordinator at a local hospital.  In that position, I do quality assurance on the paramedic services that we oversee.  I stayed full time as a medic, working Sunday through Tuesday 12 hour shifts, and then sat at the desk Wednesday to Friday.  Two years ago, they bumped up my hours at the hospital, and for a while I worked 20 hours on the ambulance, but now I am down to Fridays in the city fly car, responding to 911 calls all day.

I like doing both jobs.  Working in the street keeps me honest.  On Monday I read another paramedic’s run form and wonder what he was thinking.  On Friday, I find myself in the same situation and better understand what that medic was thinking.  I am always reminded, it is never straight forward.

When I heard of the case of Elijah McClain (the young man who was by many accounts was assailed by police officers simply for acting strangely,...

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Ambulance: Overdose Awareness Day 2021

Written by RSS Poster Streetwatch: Notes of a Paramedic

800,000 Americans dead since 2000. No end in sight.

People are dying because they use alone and their drug supply is contaminated. In the age of fentanyl, every bag or counterfeit pill bought on the street could contain a lethal dose.

Stopping fentanyl at the border isn’t going to work.

The War on Drugs (Interdiction and Prohibition) has been a failure. Community naloxone only goes so far. To significantly decrease the deaths, we need safe injection sites, decriminalization and creation of a legal safe drug supply.



Ambulance: Conditions of Employment

Written by RSS Poster Streetwatch: Notes of a Paramedic

Many years ago, a paramedic I know who worked for another company got into a spat with a nurse at a dialysis center.  I don’t know the details of the spat.  It sounded like nothing more than two people in a bad mood snapping at each other.  Nothing that occurred resulted in a suspension or discipline for the medic or the nurse.  The paramedic, however, based upon the nurse’s complaint to her supervisor, was barred from the dialysis center by the center.  The center told the ambulance company he cannot enter our premises. To my knowledge he had no hearing, no chance to present a case.  He was simply banned by a private business from entering their facility.  What did this lead to?  His apparently apologetic bosses had to fired him from his job.  Not for poor performance or for anything he did or said that day. he was fired simply because as a condition of his job, he would at some point in the future, be required to enter that center either on a transfer or an emergency call, and his banishment...

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Ambulance: Apparition

Written by RSS Poster Streetwatch: Notes of a Paramedic

Tim was working for the company when I started.  As tall as me and twice as broad, he was a strong EMT — a good lifter, quiet sense of humor, hard worker, gentle with patients.  And if he was standing behind you, no one would think of causing trouble.  One night fifteen years ago, he came in off-duty and turned his uniforms in.  Laid them on the supervisor’s desk.  Said he’d had enough.  He left without another word.  That was the last I saw of him.

Coming into work on Friday, walking into the cavernous ambulance garage that looks the same as it has for the last twenty-five years (except for different people checking out the ambulances or changing oxygen tanks) I didn’t need to close my eyes to see him.  He was still there, walking with a limp from all the back pain, all the patients carried in the days when we did two man dead-lifts, walking away from the life that night, walking out into the darkness.

“What are you looking at?” an EMT friend said to me when she saw me standing there.

 “Just thinking about the past,” I said.

Tim passed away on August 4 at age 64.



Ambulance: Street Lessons

Written by RSS Poster Streetwatch: Notes of a Paramedic

 In 2012, I wrote a series called Street Lessons, but I could just as well call it any of the following:

Things They Didn’t Teach Me in Paramedic School

Things They Might have Taught Me in Paramedic School, but I Was on a Bathroom Break.

Oh Shit!

Things I Learned The Hard Way

Trial and Error

Eureka! or Light Bulb Moments

***

Street Lesson # 1

Don’t Carry Hypotensive Patients in a Stair Chair

Over the years, I have had five patients go into cardiac arrest while I carried them in a stair chair. What does that tell me? It could mean that I carry a lot of patients in stair chairs. It could mean there are not very many elevators in the city I work in. It could mean I have done a ton of calls in my twenty plus years in the field. All would be true. And I can say I have never had an ambulatory patient go into cardiac arrest on me — at least not while I have been ambulating them. My first words to my partner on arriving at patient bedside are usually, “Get the stair chair.” The old...

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Ambulance: Blog Under Construction

Written by RSS Poster Streetwatch: Notes of a Paramedic

Hello all. I have recently moved my blog to a new server/host. It will take me awhile to get it set up properly, but I will be posting regularly. Keep checking back for updates. Thanks for your support through the years. best, Peter




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