Surviving Post Naloxone

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You find the patient – a young man – in respiratory arrest in a Honda with tinted windows behind a service station.  His head is back, his mouth is open, and he is deeply cyanotic.  His skin is warm and despite having no respirations, he has a pounding carotid pulse.  On the floor board you […]

Wild Wild West

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There is an anxious crowd on the corner of Hungerford as we come lights and sirens down Park Street.  A woman with tattooed arms waves for us to hurry.   A man is on the ground with a crowd clustered around him.   I can see another man kneeling over his chest. His arms together like he […]

Call of Duty

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“I’m a shit bag,” he says to me.  “I’m supposed to be taking my boy trick or treating tonight.  I can’t fucking believe I did this.  You said I wasn’t breathing?  After all I’ve been through to die like this.  Fuck me.  I’ve got shit for brains.” The young man got out of jail an […]

Grade A

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The man kneels in the grass next the pickup truck that has its door open. He vomits.  The fire department is standing over him.  “Citizen Narcan found him in the truck passed out, squirted him with two doses and then took off when we got here,” a firefighter tells me. I see the two 4 […]

Fentanyl Safety

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Finally! The Federal Government has listened to the experts and released sensible evidenced-based recommendations on safety for first responders when encountering fentanyl and fentanyl analogues, including carfentanil. Fentanyl Safety for First Responders The document issued yesterday by the White House National Security Council is the product of their Federal Interagency Working group with collaborative support […]

Hope

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The call is for an overdose in the stairwell of the apartment building. Fire has arrived just before us – they have propped the front door open. I enter with my house bag over my shoulder and carrying the cardiac monitor in my right hand. There is no one in the dim lobby to direct […]

Controversies and Carfentanil

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Great article in the November 2017 edition of the  American Journal of Emergency Medicine about the  controversies surrounding the dangers of carfentanil, fentanyl and other fentanyl analogues.  The physician authors, John B. Cole and Lewis S. Nelson, take the Drug Enforcement Agency (DEA) and the media to task for sensationalizing the dangers to responders of these synthetic opioids. […]

Endocarditis

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The patient is “a skin popper.”  She injects heroin into her skin rather than snorting it or injecting it directly into her veins.  Her arms are covered with sores in various stages of ulceration from old scars to open weeping sores.  example of skin popper The ambulance crew is there not for an overdose, but for […]

Non-Opioid Pain Management

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The state of Massachusetts just passed an emergency protocol change requiring all paramedic ambulances to carry non opioid pain management alternatives, including Ibuprofen PO, Acetaminophen PO and Ketorolac IV or IM.  Acetaminophen IV is optional.  The changes are to take place January 1, 2018. Massachusetts Pain Management Protocol Emergency Non-Opioid Pain Treatment Options Update Here […]

The Opioid Epidemic: The EMS Role (Free On-line CME)

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The Connecticut Office of Emergency Medical Services (OEMS) in conjunction with UConn John Dempsey Hospital has just released a free 1 hour on-line EMS CME: The Opioid Overdose Epidemic: The EMS Role. The auto-narrated program discusses the background of the opioid epidemic, Connecticut death statistics, Connecticut CORE initiative, the science of addiction, the dangers of […]

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