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Ambulance: Rescue Breaths or Compressions in Overdose?

Written by RSS Poster Medic Scribe


Should unresponsive overdose victims receive rescue breaths or chest compressions from lay bystanders?

If a person is apneic but not in cardiac arrest, failing to give rescue breaths may lead this person to fall into cardiac arrest.

But, if the person is apneic and in cardiac arrest, failure to do quality chest compressions, will lead to their death.

This is a difficult question that we debated in our opioid overdose working group last year. We chose to follow the American Heart Association standards and tell lay rescuers to do chest compressions in apneic patients rather than attempting rescue breathing.

Chest compressions-only are simple, easy to learn, and backed by science.

I like the chest compression for the lay public because:

Chest compressions while providing some circulatory support also provide passive ventilation. *
Chest compressions are also a great stimulus to revive someone from an apneic state.
Most people don’t do rescue breathing very well.

The Ontario Canada Ministry of Health...

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Ambulance: Follow Up

Written by RSS Poster Medic Scribe

Overdose on Babcock Street. In an alley behind a building. Fire is there before us. A familiar scene. As I approach I can see them hunched over the patient, the bag valve mask out. They have already given her four of narcan. I stand over them looking at the patient. I can’t see her face because the mask obscures it, but I notice that she is quite tiny. I look at her neck then and can see the butterfly tattoo sticking out from under her winter coat. It is Veronica. I last saw her a month and half ago, and had wondered what was going on with her. Did she go back to Woodbury to stay with her sister as she always does when she tries to get clean? Or had she died alone in an alley such as this one? At least I know she is alive. I have the firefighter stop bagging for a moment, and can see while she is still unresponsive, her respirations have picked up. The ground is cold, so we lift her up onto our stretcher, and then bag her on the way to the ambulance. We load her in back, and I barely have her hooked up to the capnography, when she...

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Ambulance: Undetermined

Written by RSS Poster Medic Scribe

Opioid deaths are generally classified as accidental overdoses. In 2017 Massachusetts began reporting opioid deaths as “All Intents” where they previously reported them as “Unintentional/Undetermined.” They point out that adding suicide deaths only marginally adds to the count. By their statistics only 2 percent of the total opioid deaths were confirmed as suicides.

Massachusetts Opioid Death Data

Connecticut reports opioid deaths under the term accidental drug related deaths. If a person left a suicide note, and then injected themselves with heroin, they would not count in the state’s totals.  In most cases, it is hard to say with determination the overdose was a suicide.

An article published on March 28 in Medscape asks “How many Opioid Overdoses Are Suicides?” It offers fairly persuasive arguments that the numbers are much higher than reported.

How Many Opioid Overdoses Are Suicides?

Dr. Maria Oquendo, the past president of the American Psychiatric Association, is quoted as saying based on published studies, the...

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Written by RSS Poster Medic Scribe

I recently participated in a project to describe the daily routine of an EMT to help people considering a career in EMS.  The final product was published this week on the website below.


Here is an excerpt:

5:30 AM:

I punch in and checkout my equipment, my house bag which contains my medications, IV and airway supplies, my heart monitor, and then the equipment on the ambulance shelves, while my partner checks the ambulance to see that the siren and emergency lights are working and that we have plenty oxygen to make it through the shift. He also checks the oil and engine fluids.

Then, we sign on with our dispatcher and already there is a 911 call for us. No time for coffee. A 68-year-old woman has been vomiting all night. I feel her forehead she is burning up. Her tongue is also dry and cratered. I give her Zofran for her nausea and IV fluid for her dehydration. We transport her to the hospital.

6:23 AM:

I am writing my PCR (Patient Care Report) on my laptop computer in the hospital EMS...

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Ambulance: Connecticut Overdose Deaths Plateau

Written by RSS Poster Medic Scribe


Overdose deaths are declining in some states, but appear to be plateauing in Connecticut.

Overdose Deaths Fall in 14 States

In data released by the CDC, covering the time period July 2016-June 2017, 14 states showed a decline in overdose deaths, while nationwide deaths rose 14 percent. The data showed an 15.9% increase in Connecticut, but even more recent data released from the Connecticut Medical Examiner’s office tells a more promising story. 

Number of Connecticut overdose deaths surpassed 1,000 in 2017

While deaths increased by 13 percent in Connecticut between 2016 and 2017, the last six months of 2017 showed a 6.7% decrease from the first six months of the year.

This is still a horrendously high level of overdose death, and it may only represent a temporary lull before escalating, but it does reflect what I have been sensing lately.   Over the last several months, 911 calls for overdoses are still abundant, but they don’t seem to be getting worse.

As to why the death rate may have plateaued, it is...

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Ambulance: Mother and Son

Written by RSS Poster Medic Scribe

She curls on the couch sobbing. She found her son not breathing when she came home from her midnight shift. He is on the floor now.  The fire department first responders do compressions on his bare chest.

The man is lean and muscled with jailhouse tattoos on his arms, chest, and neck. It isn’t a stretch to think heroin.

His mother’s boyfriend confirms this to us. The man on the floor was a user.  They argued about it every day, but he kept using. Two torn heroin bags are found on the floor.

We work him for twenty minutes with no response.  Asystole throughout.  His skin is cool, his pupils fixed and dilated. There is already some stiffening in his jaw. We call the hospital for permission to cease the resuscitation. It is granted.

We remove the airway,  electrodes and defib pads and place them along with our gloves in the bag the ambu-bag came in.

His mom kneels over him now, kissing his face, her tears falling on his cold skin. “Vente conmigo, vente conmigo, “ she cries.  Come with me, come with me.  “No te vaya, no te...

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Ambulance: Hunt lied and the DH continue to hide the truth......

Written by RSS Poster Garth Marenghi
Above is a response from the Department of Health (DH) to my MP, Layla Moran who very kindly sent them a question about pre-conditions to negotiation of the junior doctor contract.  The background to this is complex but this specific issue can be summarised fairly concisely.  Jeremy Hunt has repeatedly stated that there were never any 'pre-conditions' to negotiating the junior doctor

Ambulance: Dancer

Written by RSS Poster Medic Scribe


I first picked Veronica up on Hungerford Street one afternoon two years ago. We had been called for an unresponsive, but instead, we found a small woman with a club foot staggering along the street.  She was half on the nod and covered with leaves. I asked her if she was okay, as we walked up.  She just mumbled, and tried to keep walking. We stood in front of her and at twice her size, it became hard for her to ignore us. We were called, we have to at least see if she was okay, we explained.

“I’m fine,” she said.  “I just want to go home.”

“Why are you covered with leaves? I asked.

She wiped tears from her eyes.  “The kids robbed me and threw me in the bushes.  It happens all the time.  They like having their fun with me.”

At least she seemed to have managed to buy and use some heroin before they accosted her. Her pupils were pinpoint and she had a weakness in her knees while standing. Perhaps the kids had been warned by the block enforcer not to rob her until she had contributed her few crumpled dollars to the day’s take.

“You don’t...

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Ambulance: The NHS 'crisis'

Written by RSS Poster Garth Marenghi
There's no doubt that some of the most used cliches are so widely used for a reason, probably relating to them holding a fair bit of the truth fluid.  I think the cliche along the lines of 'you learn most about yourself when times are tough' is a pretty good one.  Where am I heading with this?  Well I think you can apply it to those within a system in positions of power during times of genuine

Ambulance: Ambulance or Nurse?

Written by RSS Poster

The Independant have an interesting story where, due to the shortage of ambulances the plan is to send community nurses first for patients over the age of 65 who have had a fall.

This is a bad idea.

But first, as a quick update on my career, I went from nursing into the ambulance service, and then returned to nursing. At the moment community nursing. So I’ve done both of the roles that the article is talking about.

The ambulance role is very much different from community nursing. When a community nurse sees a patient, it is not in an emergency situation. If you have a leg ulcer, or cancer, or a surgical wound that’s not healing as it should, then the community nurse is ideally placed to see to your needs. However if you have fallen and either can’t get up by yourself, or have broken your hip, then what you need is an ambulance.
This isn’t to say that comunity nurses don’t already keep people from going into hospital. Community Treatment Teams (CTTs as they are known in my patch, your acronym may vary) work hard to...

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