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Ambulance: Connecticut EMS Opioid Overdose Data

Written by RSS Poster Medic Scribe

In Connecticut, when EMS responds to an opioid overdose, after they have taken the patient to the hospital, accepted a refusal, or presumed a patient dead, they are required to contact the state poison control center and answer a series of questions about the overdose.

The program, known as SWORD (Statewide Opioid Reporting Directive), that went statewide on June 1, 2019, recently released the results of its first year of data collecting.

Here are the highlights:

There were 4,505 suspected overdoses including 337 fatal overdoses, reported by EMS to the SWORD program between June 1, 2019 and May 31, 2020.

Males accounted for 74% of the overdoses; females 26%.

People between the ages of 25 and 39 were most likely to overdose.

When the drug of exposure was known, 87% of the overdoses were due to heroin or fentanyl versus 11% for prescription opioid and 2% for methadone or suboxone.

Bystanders gave naloxone in 15% of the overdose cases where 911 was called.

88% of overdose victims were transported to the...

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Ambulance: Heartbeat

Written by RSS Poster Medic Scribe

Labor day weekend I had an irregular heartbeat.  I had a funny feeling in my chest and when I took my pulse, son of a gun, I was missing a beat every now and then.  I wasn’t near any place where I could put myself on the monitor and see what was actually going on, but every time I checked, even when I wasn’t feeling anything, i couldn’t get to 30 without a dropped beat.

I am sixty-two years old, and while I feel I have been in somewhat of a physical decline over the last two years, particularly this last year with the COVID altering my normal workout eating and mental health routines, I have never questioned the strength or health of my heart before.  I admit that it scared me.

I tried to determine what might be causing the missed beat and focused on two culprits.  A medication I take for my thyroid which can cause palpitations and caffeine.  I did- against my better interests have several coca-colas that day of and the day before.  I am somewhat addicted to Coke, but often go months without it because it makes me cough quite badly...

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Ambulance: Shock Index

Written by RSS Poster Medic Scribe

I attended a CME recently where I heard a term I had never heard before.

SHOCK INDEX

The shock index (SI) is heart rate divided by systolic blood pressure. The normal range is 0.5 to 0.7.

The shock index has been shown to be a predictor of increased likelihood of shock, hospital admission, and mortality.

Someone is likely at risk for shock if their SI is over 0.8.

If my systolic blood pressure is 120 and my heart rate is 60, my SI is 0.5.
If my systolic is 120 and my heart rate is 120, my SI is 1.0 –in the danger zone.

While most paramedics can just look at a patient and tell you whether or not they are in shock, the shock index can help raise concern for someone in who is at risk for decompensation.

Here’s some studies on the shock index.

A prehospital shock index for trauma correlates with measures of hospital resource use and mortality

Shock index in patients with traumatic solid organ injury as a predictor of massive blood transfusion protocol activation

Here’s a great article on shock.

Approach to Shock

 



Ambulance: Nalmefene

Written by RSS Poster Medic Scribe

I heard today that Opiant, the company behind the 4 mg Narcan Intranasal spray, is at work on a new product to combat opioid overdose — Intranasal Nalmefene.

Nalmefene Nasal Spray

Nalmefene is an FDA approved medication to reverse opioid overdoses when used intravenously. It has yet to be approved in a nasal form suitable for first responders and laypeople.

The company cites the more rapid onset and longer lasting properties of Nalmefene as a better (stronger, longer acting) drug to combat “longer-lived synthetics.”

The theories behind IN Nalmefene are as follows:

It may be needed to battle stronger synthetic opioids.
It lasts longer than naloxone.
It works faster.

I have some questions about the need for a longer acting drug. Heroin lasts longer than fentanyl. I get this both from the pharmacology of morphine versus fentanyl, but from conversations from street users who tell me heroin lasts for them 6-8 hours versus 3-4 hours for fentanyl. Keep in mind that the effects go down rapidly from their peak so that by the end of these time...

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Ambulance: Back in the Water

Written by RSS Poster Medic Scribe

This week the local aquatics center opened for the first time since the COVID scare locked the state down back in late March.  I have already swum twice and have lanes reserved nearly every day of the week ahead.

I missed the pool terribly when it was closed.  The water has always been my buffer between the world and my home.  I finish a long shift at work, I stop at the pool and plunge into the cool water and all of the city comes off.  By the time I get home, I am relaxed, feel great and am totally into chilling with the family. 

With the pool closed, I suffered.  I suffered physically and mentally.  My physical conditioning declined.  I was irritable.  I slept poorly.  I felt older, stiff and slower moving.  I hurt my back a year ago and have occasional numbness in my legs that worsened.  My diet went out of whack.  I felt stressed all the time.

I used to walk over to the aquatics center and look in the center’s back windows where I would see the pool, still filled with water, but the lights darkened.  Why did they have to...

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Ambulance: Masks and Herd Immunity

Written by RSS Poster Medic Scribe

You can wear a mask and still get COVID.  The mask is not fool-proof, but masks can reduce the viral load you are exposed to.  With a smaller viral load, you may get COVID, but it is likely to be much milder than if you got a full blast of the virus.

A new commentary by researchers in the New England Journal of Medicine speculates that masks may be helping develop herd immunity.  People who wear masks are still getting COVID, but they are often either asymptomatic or have only mild symptoms.  Mask wearing allows the spread of a mild form of the the disease and resulting immunity through the population and is preferable to people without masks, getting larger viral loads and becoming much sicker.

In other words, in areas where people wear masks, they are speculating that a larger number of infections will be asymptomatic than in areas that don’t don’t because of people getting the virus from smaller loads of the virus.

Facial Masking for Covid-19 — Potential for “Variolation” as We Await a Vaccine

It should be...

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Ambulance: COVID Vaccine

Written by RSS Poster Medic Scribe

I am pro-vaccine.  I believe in science and in the public health model.

When I was in high school, I read a book called The Tragedy of the Commons.  It basically said that if people acted in their own self-interest rather than in the interest of the group, tragedy would result.  Resources would be depleted.  To survive as a species, you need cooperation.

This applies to vaccines.  There may be a small individual risk to vaccines.  A person acting in their own self-interest might avoid the vaccine, trusting others to take the small risk.  If all others get the vaccine, herd immunity results, and the person who avoided the vaccine, not only avoids the vaccine risk, they gain the benefit of the group action.  With everyone else vaccinated, the virus is much less apt to make its way through the population and infect the individual.

Of course, if everyone acts in their own perceived self-interest and refuses the vaccine, then everyone is at much higher risk of getting the virus.  Herd immunity is never achieved and the virus runs rampant...

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Ambulance: Whole Blood

Written by RSS Poster Medic Scribe

Last week, I carried a new “drug” for the first time.  Not Torodol or Acetaminophen which were recently added to our med kits as an alternative to opioids, but whole blood.

That’s right — whole blood.

My service (American Medical Response of Hartford under the medical control of Saint Francis Medical Center) is the first ground EMS service in New England to carry whole blood.  Currently it is only being carried by our fly car medics (my Friday shift) and the evening and night supervisors.  We carry a 500 ml bag in a cooler that is monitored for temperature around the clock.  The bags are visually examined at the end of every shift and the temperature can be accessed at any time over an internet application.

The protocol calls for blood for hemorrhagic shock including trauma, GI bleed, AAA, and postpartum hemorrhage.  Patients should have a BP less than 90 or a heart rate over 120.

To administer, we spike the bag with a line which has special heating coils in it, then we attach the line to a battery, which within 25 seconds heats...

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Ambulance: Poop

Written by RSS Poster Medic Scribe

A college student in Arizona has a bowel movement in his dormitory and then goes about his everyday business.  Were this a dormitory at most universities, there would be little interest in this young man’s excrement.  But Arizona State University is very interested in their students’ stool.  They are studying it in an effort to identify outbreaks of COVID 19.

How investigating wastewater can help solve the COVID-19 crisis

In this case the sewage does come up positive for COVID-19.  The students in the dorm are quickly tested and two, including the sample donor are found to be positive for COVID 19 despite their asymptomatic state.  They are immediately quarantined and a large outbreak is likely averted.

The University of Arizona says it caught a dorm’s covid-19 outbreak before it started. Its secret weapon: Poop.

Sewage or wastewater testing is capable of picking up fragments of COVID that are released from the body in feces.  This type of testing can not only inform the public health community of the presence of COVID, it can track the...

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Ambulance: Northeast Island

Written by RSS Poster Medic Scribe

There was a spike in COVID cases a week ago in Danbury, a city in western Connecticut near the New York border.  The state and city responded by urging residents to stay home and avoid large gatherings.  The city also canceled all youth sports for the fall to not leave their homes.  They also limit activities in public parks and close the boat launch at the local lake, as well as ask churches to limit in-person services.

In East Windsor, a small town in North Central Connecticut, there was an outbreak of COVID among migrant farm workers, who shared housing.

Over 50 returning students at the University of Connecticut test positive along with two staff and faculty members.  An entire dormitory is quarantined.  Football practice is postponed as members of the team test positive. Several students have already been kicked out of their dorms for partying without masks in close contact with other students.

Grade school kids will be returning next week and many are still uncertain how that will play out.  Each district is different, Many...

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