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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. […]

Katrina Journal: What’s Important

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In view of Hurricane Harvey and the rescue efforts now underway, I am posting notes from my journal when I was posted in Gulfport, Mississippi in the aftermath of Hurricane Katrina. Day One: Waiting On the morning of September 17, we meet at the office and a chair van driver takes us up to the […]

Light Weights – Heroin Math 2 (Why We Don’t Get Robbed of our Fentanyl)

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You carry four 100 mcgs vials of Fentanyl in your controlled substances kit.  How much would those vials be worth on the street? Let’s do the math. 100 mcgs of Fentanyl is the equivalent of 10 mgs of Morphine. Morphine is 50% as strong as heroin. Morphine is the equivalent of 50% pure heroin. A […]

Fact or Fiction

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Great article on ems1.com Medical commentary on the issue of danger to first responders of transdermal fentanyl exposure. Dr. Tan, discussing transdermal fentanyl exposure, agrees that exposure as would be typically encountered by first responders is an extremely low risk. “It is not zero risk and certainly not impossible, but extremely low,” he said. Fact or […]

A Mother and Son

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The woman with the cellphone stands outside the car. She explains that the male in the car has been smoking crack, taking benzos and doing heroin for several days. I ask if he is breathing. She says yes, but he is asleep right now. When she picked him at his friend’s house in their suburban town […]

Fentanyl Skin Exposure: An MD’s View

A story published in Slate magazine yesterday questions the assumptions behind the widely reported episode of the Ohio police officer who required four doses of Naloxone after brushing Fentanyl off his shirt. The Viral Story About the Cop Who Overdosed by Touching Fentanyl Is Nonsense Written by Jeremy Samuel Faust, an emergency physician at Boston’s Brigham […]

Fentanyl: A Briefing Guide for First Responders

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Carfentanil (which had previously been seen in neighboring states) has now been officially identified in Connecticut.  The discovery of this drug 100 times stronger than Fentanyl poses questions: How much danger does Carfentanil (or Fentanyl for that matter) pose to EMS?  How can we in EMS protect ourselves from exposure to these drugs? What should […]

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