When I first became an EMT, a friend asked me why I liked the job so much. When I come through the door, people look at me like I am an angel, I said. What is it like driving lights and sirens? Another friend asked. Awesome — I feel all powerful. I hit wail and…
Category: ems-topics
Manual Versus machine Blood Pressures
How do you want to be known as a Paramedic/EMT? A. Reliable B. Frequently wrong According to a recent article in JEMS, Ditch the Machine to Improve Accuracy in Blood Pressure Measurement and Diagnostics, “automated blood pressure readings are frequently inaccurate.” Is this a surprise to anyone? Yet, many of us continue to relay on automated…
Safe Injection Sites
I wrote an op-ed this month that was published by the Hartford Courant. Insight: I See What Heroin Does. Let People Shoot Up Safely Included was a checklist: 5 Things to Know About Heroin Addiction I read an article a few days later that said that when called an “overdose prevention site,” as opposed to…
Epinephrine in Cardiac Arrest
The use of epinephrine in prehospital cardiac arrest showed no difference versus placebo in determining favorable neurological outcome according to a long awaited randomized controlled study published yesterday (July 18, 2018) in the New England Medical Journal. The trial showed epinephrine produced a higher rate of survival at 30 days than placebo, but that was…
Bad Batch?
Hartford Cops: Rash of Heroin Overdoses Part of Upward Trend After a lull of a few weeks, the overdoses started going out again this week. An hour after I left work Tuesday night, there was a triple OD that is widely being reported in the news, along with two other overdoses not long after. The…
Trick or Treat
Some heroin dealers in Hartford have switched up their drug stamps to celebrate Halloween. Drug Users are being treated to brands such as Killer Clowns, Freddy vs. Jason and Casper (the Friendly Ghost). The question for the users on Halloween (and one every day they buy): is their special envelope a trick or treat?Are they…
Dead Man
I mentioned that we had a patient this week who said she stayed away from the white powdered heroin because of her fear of Fentanyl. Powdered Fentanyl is white and very hard to distinguish visually from white powdered heroin. A number of years ago drug dealers started enhancing their heroin with Fentanyl. Fentanyl is stronger…
OMG
Two weeks ago, it was Black Jack. This week it is OMG. Oh, My G**. The woman lays on a parking lot sidewalk behind the school. Her face is blue and she is only breathing one or two times a minute. She is wearing tight spandex and bright pink tank top. She has tattoos on…
Black Jack
I did three heroin ODs on one shift last week. Another medic did four in a shift the day before. Lots of OD calls going out. All three of these ODs used the same brand. Black Jack. For years, dealers in the Northeast have been branding their supply, stamping or printing it on the glassine…
Three Lives
The heroin epidemic continues unabated in Hartford. I called the time on two fatal overdoses in a recent week. Both men were in their 40’s. One was in a low-rate motel. He sat by the window in his breeze-less room, the curtains pulled just enough so he could see the cars rolling past on the…
Conrad Castonguay
Conrad Castonguay died this week at 81. In 1992-93, he helped teach my paramedic class. Pharmacology was his specialty. He wasn’t a paramedic, but he knew what he was talking about and we paid him mind. He was a challenging instructor, and took his work seriously. It became an honor for paramedics to say they…
EMS Sports Pages
When I started in EMS, the term “EMS Sports Pages” referred to the Obituaries. It was where we turned to see how our critical patients did. Get pulses back on a cardiac arrest or bring in an unresponsive patient with multiple trauma from an MVA or a seizing patient with left sided paralysis, you checked…
BLS Fentanyl
A new article* published in Prehospital Emergency Care (on-line April 8, 2016), concludes that Basic EMTs can safely give subcutaneous Fentanyl for acute pain in the prehospital setting. *Subcutaneous Fentanyl: A Novel Approach for Pain Management in a Rural and Suburban Prehospital Setting BLS EMTs in Canada received a four hour training course, and then…
New EMS Books
This past year has been a banner year for new EMS books, memoirs and fiction. Each book that reaches an audience outside of the EMS world increases the public’s understanding of what we do and hopefully, increases their respect for us. Here is a roundup of recent books. Lights and Sirens: The Education of a…
American Pain
Two tattooed muscle head dudes in their twenties, one a convicted felon, who used to work construction as well as sell steroids, started a small business in which they hired a doctor to write prescriptions for pain medicine to most anyone who came through the clinic’s doors during business hours. The doctors got $75 a…
EMS Opiates and Chronic Pain – 2
I wrote recently about my new found concern about giving opiates to patients with chronic pain. Opiates for Chronic Pain Subsequently as a member of our regional medical advisory committee, I submitted the following draft proposal: Paramedic Chronic Pain Management Guidelines (Draft) Providing opiates to certain patients with chronic pain conditions may not always be…
Opiates for Chronic Pain
Should paramedics give opiates to patients with chronic pain? I want the answer to this question. Now, until recently I have not questioned this practice. Today, I still medicate (well, most*) patients with chronic pain of 4 or more, who do not have contraindications, and who say yes when I ask them if they want…
EMS Memoirs/EMS Fiction
An EMS memoir can take any form, but there are usually only two. 1) The Newbie enters strange new world of EMS, struggles to prove self, and in the end makes good. 2) The Old Dinosaur looks back on his career, telling tales, etc. Sometimes the two are combined together. In the nonfiction books, the…
Heroin: Cape Cod, USA
If you have access to HBO, you should watch their new documentary Heroin: Cape Cod, USA. It is also an excellent companion to the book Dreamland: The True Tale of America’s Opiate Epidemic, which details the rise of pain pill addiction and the resulting shift over to heroin among the pill abusers. The documentary follows…
10 Cardiac Arrests!
I once did 10 cardiac arrests in one day. They were all v-fib arrests. I managed each code from the moment I arrived to find CPR in progress to the moment the patients were whisked off to the cardiac cath lab. I got 10 successful ET tubes, and despite the studies that show ET intubation…