Monthly Archives: July 2017

What Heroin/Opiod Epidemic??

I heard something rather humorous while on the way to work tonight. The radio broadcaster mentioned “the new heroin epidemic”.   Really!?!?!?  Where in the hell have you been? Heroin, a respiratory depressant, has been sweeping the streets of “innocent American’s” by the minute.   By innocent, I mean your everyday honor roll student, the athletic star etc etc. Yeah folks, its not just your typical junky in the city.

I can not even attempt to estimate how many times I have administered nasal narcan to an overdose patient.  I find it amusing how people say “why do you do that and save them? Why don’t you just let them die?”. Well, aside from it being a lot easier to push two shots of an atomizer in their nasal cavities than to do CPR for at least 30 minutes; I revert to my credo:  I AM HERE TO SAVE LIVES!!!

I have worked overdose patients that range from ages 14 to 80 years old, from all different creeds and lifestyles. Let me be clear when I say, heroin does not target one certain type or group of people. Two that I remember the most vividly, are 26 and 27 year old males that overdosed and could not be revived.   As I’ve stated before, heroin is an opioid based respiratory depressant,  Therefore, it shuts down your drive, ultimately leading to cardiac arrest if not discovered and treated immediately.   These kids had their whole lives ahead of them. One even had a 4 year old daughter. He was fresh out of the service and recently separated from his high school sweetheart by 6 months.  When I went in and felt the lividity and rigormortous, I knew he was gone.   Upon exiting to break the news to his mother, she looked at me with a straight face and said, “I knew it was going to happen sooner or later”.   There was no emotion in her speech or face at all.   I gave my condolences and apologies and leave for the PD to take over and set up funeral home arrangements.

Oh that’s right, I started to tell you about an 80 year old as well….   My partner and I were alerted to a “skilled nursing facility” for a semi-responsive, male patient.  Upon the initial assessment, it appeared as your everyday nursing home patient suffering from sepsis.  The patient was treated ALS and transported to a local hospital.  Upon returning to the hospital with an additional run, we followed up with the attending ER doctor who amazingly asked if we had thought of giving narcan.  (We thought: Why in then hell would we give Narcan??). He then proceeded to advise us that the patient was administered too much pain medication at the “skilled nursing facility”.  Wow, talk about eye opener.

On another call months earlier, we were dispatched to an apartment complex for an emotionally disturbed patient.   While speaking to the [approx] 35 year old patient, he advised us that he had a plan to commit suicide.  (A plan makes a big difference, as it shows the intent and thought. )  This patient was going to do what he did everyday; he was  going downstairs to the 75 year old lady who had her hips replaced, and was on Hydro-morphine. She would sell her tablets for $5 each. I learned that day, that crushing up and snorting opiates strengthened their efficacy by 20 times, and this man had planned to intentionally overdose by doing exactly that.

Being in the field, the overdoses come in waves.   You can tell when the police departments and homeland security make decent drug busts.   It almost goes calm for a while before they get more into the US and our innocent towns and cities across America.

Again, it’s not just your junky down the street, it’s your everyday, average neighbor.

It’s an addiction similar to drinking and smoking. Unfortunately the death rates are much higher.


BLS Glucometry is a must!! 

One of the best protocols that NYS DOH did was privilege BLS agaencies to utilize blood glucose testing.

I feel on any general illness, obviously diabetic emergencies, and the biggest one “possible stroke/TIA.

With that being said we need to remember that the brain needs two things.  Sugar and Oxygen!  It is amazing how if you deviate one of those you now have a stroke patient.

The biggest proof of this for me was when my BLS agency was dispatched for a elderly female having a possible stroke.  Upon arrival entry had to be gained through a back door as our patient had 110% left sided paralysis behind the front door.  After gaining vitals and putting our semi conscious stroke patient on the reeves for transport i just happened to look behind me at the coffee table near where the patient was found.  Seeing a glucometer I said to the paramedic (that I have worked with since I joined the services) “hey I think we have a diabetic”.  The initial blood glucose reading was oh 32.    Now with a IV established and a amp of D-50, yeah that’s how long ago it was, still in the protocol there was a major improvement.  After a few minutes the patient could have walked to the ambulance.   What went from a semi conscious patient on reeves now was a diabetic emergency on our stair chair.

This was the first of many examples to me of what the brain needed to function and the similarities as you deviate one from the other.  Also taking many continuing education courses at our new “stroke center” offering the newest in thrombectomy procedures it made even more sense.

Recently while at a 86 year old female having a possible stroke, Stewart’s hot dog gray, semi conscious sitting in a chair being held up I snuck around the interviewing EMT to perform a accucheck.  The EMT who has been around for many years and is very competent looked at me and said “oh she is a diabetic?”  Rather then get into the laws of the brain I just responded with “just checking”.  After a reading of  156 I said with my inner voice “yup this is not a diabetic emergency”.

The female had a history of TIA’s (still going to check every time), hypotension, and Bradycardic.  This patient was transported ALS to the proper receiving facility for stroke care.

Please get a limited liability license and become certified to test blood glucose levels.  You pay for the strips and they will give you the meters.  I suggest Contour meters (no commission here) as they are the easiest and most dependable to use.  For lancets use the single use safety lancers.  No loading and self retractable= less chance of exposures.

With that being said prick away!!

When have you seen too much???

The hot topic on numerous forums these days are about EMS, PD, and Fire workers and the PTSD that is built up along your career.   There are support groups out there such as: The Code Green Campaign, who offer skills and help with PTSD.

I am the leader who wants to deal with it and shield the younger members or even the older members form seeing things that they really do not have to.    Something as simple as going in to confirm an unattended.  I remember a 66 year old, with a self inflicted GSW, and how a younger member (who already had psychiatric issues) was mad that I didn’t let him approach the body.  The gun Was moist from the humidity that day which had also coagulated the blood to a mold behind the patients head.   While questioning the patients wife, she stated “I went to work at 09:30 and found him at 17:30 when I came home”.   The wife also noted,  ” I did not even go down there, I knew if he was going to do it he was going to do it right”.

This was also the year of the heroin outbreak,where once a week I was telling a mother, girlfriend, and or wife that their loved one was deceased.   That their lives had not even started but were cut short by a “quick fix”.  A  27 year old who came home to score by heroin, score by having sex with his girlfriend only to have her wake up after to find him dead.

I try to shield other members so that I absorb the gory, nasty, traumatic  scenes to try and keep their minds fresh.

I can remember one summer a couple of years ago now where my “body count” was through the roof.   From 66 and 77 year old males, both suicide by handguns,  to a double fatal motorcycle where I had to call the male, and work on his female girlfriend.   One that I will no doubt take to my grave, is a MVA on the TSP late one weeknight.   A famous anthropologist adopted a family from Papua New Guinea and was traveling from New York City to her Vermont summer house when she lost control and struck a rock wall.   The female driver was killed instantly.   By the grace of god, there was a NYS Trooper who I had worked with, and after this incident became quite close with,was within moments of the poll.   The Trooper removed everyone from the car as it started to catch fire.   Just doing what he does.

Upon my arrival there were 5 patients 4 of whom were laying on the side of the road in the grass, a scene from MASH.   All I could here was moaning and crying. My eye caught site of a fireman doing CPR on a very small child.   Instantly it clicked like second nature, “that’s where I need to be”.   I remember how small this adopted immigrant from a third world country was, I had to resort to compressions consisting of 2 fingers.   Soon after, an ambulance pulled up from the jurisdictional agency with a medic who I have known for years.   We both loaded the male child onto the stretcher and into the ambulance while we continued to breath for him and pump his heart by compressions.   About 3 minutes in route to the hospital the patient regained a pulse.  Arriving at the trauma center with the “team” waiting for us and the other patients to arrive, we handed off the patient.   In 23 years I have done CPR a million times and unfortunately, only two patients have walked out of the hospital to a “normal life”.   Thinking with the extent of the blunt trauma and potential head injury not to mention the lack of oxygen that this child will either not make it or be vent dependent for the rest of his life.   I followed up as just regaining a pulse was enough to jump start my heart……

This young man walked out of the hospital, a true miracle.   While I have received pictures  of him I never did get the chance to see him after his discharge from the hospital.  I can see him every night or time when I recall the accident.  I can see face, his jaw is clenched as I am trying so heard to get a airway adjunct or ET tube into him.

That summer I started to drink, more then normal.   As my psychiatrist said it was a coping skill, “not a good one” but it was a coping skill.  I remember being very short fused at home with my family who has stood by me 100% in y career from day one.   I have since grown older and have rekindled my role as a husband and father to a level that I have never been to.   I have always thought: When is enough enough?  Will I snap one of these days?

Or most recently while attending a baby shower at the firehouse we were dispatched to a MVA with a possible car fire.  I hopped in the ambulance as the driver as there was a somewhat new EMT who had her card for a little while but was not cleared to drive.   In 23 years I have never had 911 tell me upon response that I had “a report of fatalities on the scene”.   I remember looking over at her and saying “the game just changed” and that “Someone will drive and I will be in the back with you”, again my instinct.   In route to the scene approximately 3 miles away the column of black smoke was more then I have seen at some structure fires.   Arriving on the scene to a fully involved car rolled over on its roof, you could feel the heat as we drove past. We parked where we would have the safest, and quickest access to a male patient lying on the shoulder of the road.   The patient’s wife laid 6 feet away already pronounced deceased prior to our arrival.  The car was 25 feet away, the heat from the sun and the fire were both blistering.  Somehow, once again, the good humanity showed as both were pulled from the car by bystanders.  This was NO easy task as this gentleman was fairly large…..   I turned to my now EMT partner and said “I need suction and a BVM yesterday”.   We all worked as a team to treat this patient and remove him to definitive care.   Returning to the baby shower to see my family I realized that my pants had 3 decent size blotches of blood from my patient on them.   I wondered if they would understand why I left? where I was? what I saw?  What I did?  Who’s blood was on my pants?

I can tell you, when the shit hits the fan, I want to be the one.  The one in the “danger zone” or horrific scene.  Why is that?  One reason is, I have been there and done that, I have absorbed it and been back for more.   I do not want anyone to see anything that I can shield them from to protect them.  I guess how a senior member should be?