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Ambulance: Naloxone in Schools

Written by RSS Poster Streetwatch: Notes of a Paramedic

Several years ago I sat in a meeting of an overdose committee and listened to a woman argue that we should have naloxone in all the middle schools.  I am a data person and I pointed out that middle schools are not where people are overdosing.  If you only have a limited amount of resources, you want to put those resources where they can do the most good.  On the rare occasion you might need naloxone in a middle school 911 is just minutes away.  Police, fire and EMS all carry it.  Someone will be there quickly.

A week ago a middle schooler (13-years old) in Connecticut died of a fentanyl overdose suffered while in school.  There has been a subsequent outcry to require naloxone in schools.  As a friend of mine, Mark Jenkins, the executive director of the Connecticut Harm Reduction Alliance, pointed out, “You have fire extinguishers in schools, but how often do you see a fire in schools? We have to become proactive in making sure we have responses in case an overdose takes place because it’s a...

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Ambulance: Two Red Lines

Written by RSS Poster Streetwatch: Notes of a Paramedic

They say the omicron wave is past its peak here in Connecticut.  The infection rate is declining as are dailey cases.  Even wastewater measurements seem to say the wave is receding.

While we didn’t have the deaths we saw with the first wave (thank you vaccines), our hospital had record numbers of admitted hospitalized patients with COVID and are still near first wave highs.  How many of these patients were incidental COVID patients (admitted for something else who happen to test positive)? I don’t know.

From an EMS perspective, it seems like we are responding to more COVID patients than ever.  And from a front line health care provider’s perspective it seems more coworkers have tested positive than ever.  Some of this is attributable to the infectiousness, some to a definite laxing of mask/full PPE wearing (I still wear my mask everywhere).

But I am weary from gowning up, putting my arms through the decon suit, tying it around my neck and waist,  wearing an N95 mask, the elastic holding it tight to...

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Ambulance: 13

Written by RSS Poster Streetwatch: Notes of a Paramedic

This past week in Hartford, a 13-year old boy brought some bags of fentanyl to school.  He later collapsed and received CPR from a school teacher.  EMS arrived and resuscitated the child, who died two days later in the hospital.  Bags of fentanyl were recovered from the scene and the boy tested positive for fentanyl.  Two of his classmates were also transported, but media reports were unclear whether or not the boys also used fentanyl or were merely exposed to it. 

A search of the grounds with drug sniffing dogs revealed 40 other bags of fentanyl hidden in various places in the school.

It was a tragic event.  

The paper referred to the death as an overdose.

His death was a poisoning.   

Overdose implies taking more than a regular dose.

Our drug supply is poisoned.  The problem with heroin/fentanyl in Connecticut is that no one can tell the potency of any individual bag.  Fentanyl is sold on the street here in small glassine envelopes mixed with a great amount cut. Each bag goes for $3-4 A typical bag may...

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Ambulance: COVID Non-Transport Protocol

Written by RSS Poster Streetwatch: Notes of a Paramedic

The patient has a fever, headache and cough.  He can’t smell anything and he can’t taste his food.  He feels too short of breath to even get out of his chair. He sits there with his hand over his eyes as if not seeing might make how sick he feels go away. His sister says he’s been ill for a week.  She called 911 for him.  She wants him to go to the hospital and get tested.  She is counting on them making him feel better.

I am standing there in a gown that barely reaches my knees, N95 mask, covered by a surgical mask, a plastic face shield and gloves.  In my hand I hold the state’s COVID-19 Emergency Medical Services Non-transport Guidance protocol, which has just been activated in the city of Hartford for any patients wanting to go to the hospital in the north end, which is overwhelmed with patients.

The man’s BP is 100/52.  His heart rate is 120. He is breathing at a rate of 32.  His room air SAT is 96%.  His skin feels cool not hot.

He doesn’t meet the protocol. He needs IV...

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Ambulance: Recerts

Written by RSS Poster Streetwatch: Notes of a Paramedic

I’m recerting PALS (Pediatric Advanced Life Support), ACLS (Advanced Life Support) and CPR today in one all-day session. After this, I’ll be good for another two years. If you are in EMS, you can measure your career by how many American Heart Association recerts you have taken.  For me this is the 15th time for PALS and ACLS, the 18th time for CPR. It’s a lot of hours rehashing the same basic material.  It is pretty much universally required.  You have to maintain these three AHA certifications if you want to stay working in EMS.

When I started ACLS and PALS were nerve racking.  Not everyone passed.  Remediation and repeating stations was common. You had to study before and then do one on one sessions with ED doctors.  Now, all you do is watch videos, push on some mannequins, and take a multiple choice test that is hard to fail.

I am fortunate that our union contract requires the company to offer us the training at no cost, but still it is a day off of work.  I’m not saying knowing the subject...

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Ambulance: Omicron Thoughts

Written by RSS Poster Streetwatch: Notes of a Paramedic

Our ED has seen record volumes of patients in recent weeks, many with COVID.  Most of these COVID positive patients recently tested positive, and not feeling well with minor shortness of breath fever or body aches, come to the ED where they are evaluated and sent home.  Our in hospital COVID admissions are only 50% of the heights achieved during the first COVID wave of March/April 2020, and are 70% of the second lessor wave of November/December 2020, but exceed the small third and fourth waves of April 2021 and September 202.

Statewide, COVID ACT Now rates Connecticut at Severe Risk despite the fact that 74.6 % of our population is fully vaccinated with 88.6% having received at least one dose.

Many of our 911 calls are for these COVID positive patients not feeling well.  I have not seen any of the severe respiratory distress patients or the patients who appear okay, but who have oxygen saturations in the 70s like I saw during the first COVID wave.  This may be because omicron supposedly doesn’t infect...

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Ambulance: Change is Gonna Come?

Written by RSS Poster Streetwatch: Notes of a Paramedic

Overdose on the avenue — a woman in a tattered hoodie and black winter coat lays on the sidewalk next to a streetlight, with bystanders surrounding her.  The woman, who looks to be in her forties, was talking to them and then she slowly collapsed against the pole and then to the ground.  If I stimulate her, she breathes, opens her eyes and emits a high-pitched wail. Leave her be, and she stops breathing, her mouth open.  I stimulate her again, and then again.  Her pupils are pinpoint, her oxygen saturation is in the 90’s when I am stimulating her,  We are just a block away from the local harm reduction center.  Some of the staff who I know have come out to help.  They tell me her name.  She used about ten minutes ago.  Normally, they say, they just sit her up in a chair and watch her.  From her pristine veins, I surmise she snorts her heroin.  I can hear the ambulance sirens coming up the street.  I am thinking I will get her in the ambulance, and if she keeps going apneic, I will put in an IV and give...

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Ambulance: Christmas

Written by RSS Poster Streetwatch: Notes of a Paramedic

These are two old Christmas posts I wrote years ago, reposted now.


***
Fifteen on the Scale

It’s Christmas eve. We get called to one of the local nursing homes for rib pain. The room number sounds familiar. As we wheel our stretcher through the lobby, “Good King Wencelous” plays through the speakers.

Gently shone the moon that night, thou the frost was cruel.
When a poor man came in sight, gathering winter’s fuel.

In the East Wing, the nurse hands me the paperwork. “Mr. Ryder says he needs more Percocets. He’s requesting transport.”Mr. Ryder is a tattooed biker, an emaciated COPDer with a long white beard. Almost sixty, he can’t weigh more than a hundred pounds. He sits in his wheel chair, in his Rebels motorcycle jacket, wearing an oxygen cannula.

“I’m in real bad pain,” he tells me in his whisper of a voice. “Fifteen on the scale.” He nods as if to say it is the truth.

“Well, we’ll check you out when we get you out in the ambulance,” I say.

It seems he fell a couple weeks ago and cracked a...

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Ambulance: Comfort and Time

Written by RSS Poster Streetwatch: Notes of a Paramedic

I try to time my calls so that I have everything done that I need to have done by the time the ambulance backs into the hospital ED bay.  I know some medics are taught to do everything on scene.  If a patient is sick and needs immediate care, I will absolutely treat them on scene, but in most cases, it is more time and patient efficient to do things on the move.  By the time I get to the hospital, I need to have done the following: full assessment, at least two sets of vitals, 12-lead and IV if indicated, any needed treatment, patient history, meds and allergies, patient demographics (name, DOB, SS#).  Much of this can be done simultaneously while also moving toward the hospital.  I insert an IV while asking about history, all while the wheels are moving toward our destination.  The farther I am from the hospital, the sooner I like to start transporting. If I am close, I may take a little time before transporting just to get the bare essentials done.   I also need to radio the hospital about the...

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Ambulance: Sense

Written by RSS Poster Streetwatch: Notes of a Paramedic

An old man sits on a bench in front of the police substation in one of the worst areas of town. When he sees the narcotics sergeant, he says, “How goes the War on Drugs?” The sergeant says, “Great. We put twenty dealers away this week. Sent them all to prison.” The old man sees the sergeant the next week and says, “How goes the War on Drugs?” “Outstanding,” the sergeant replies. “We put thirty-seven dealers away this week.” This goes on week after week, the number of arrests goes higher and higher. Finally, one day, the sergeant answers the old man, “Best week ever. We put away 178 drug dealers just today alone.” The old man laughs and says, “Pretty soon, no more prison cells.”

So goes the war on drugs.  More drugs on the street, the drugs are more lethal than ever, the bodies are piling up, and the jails are overflowing. No end in sight.

New laws set heavy sentences for dealers who sell to a user who dies of an overdose, even if the sale is only a $4 bag between users.  Meanwhile the...

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