Hartford Mini Documentary

 Great mini-documentary on opioid use and racial disparities in Hartford, Connecticut.  

https://youtu.be/GFLnIQeEPRc

Listen to Julissa's story.  

My view's on the opioid epidemic and people who use drugs has changed dramatically in the over twenty-five years I have been a paramedic in Hartford.  Only by listening to my patient's stories, patient's like Julissa did I come to understand them and to see the world through their eyes.  Harm reduction works because it accepts people for who they are and recognizes the paths they have traveled.  Harm reduction is there to help.

I agree with Julissa when she says, "We all have to learn how to love each another.  We have to learn how to wake up and be grateful each day."

Amen.

 

Well Spent

 I admit I have been having a hard time adjusting to being a part-time field paramedic.  When I went part-time back in the spring (in order to accommodate both increased hours in my clinical coordinator job at the hospital and be around more to take my daughter to her sports events), my plan was still to work two shifts a week, which I managed to do for a while, but lately I have only been working my ten hour Friday shift.  True, it is a busy shift, in which I average 10-12 911 responses, of which I may only transport 3 or 4, but it is far less than I am used to doing in a week.  And while I miss the extra work both for the adventure and the experience, which keeps me on top of my game (or did when I was doing it), I am finding on days when I have a chance to go in and work an extra shift, I am choosing not to.  Sometimes I don’t pick up the shift because I am worried if I am held late, I will be unable to get home in time to take my daughter to her practice, other times, it will mean I will miss my scheduled swim or sometimes I admit, I just would rather be home.

This semi-retirement is giving me a glimpse of what full retirement from the road must be like, and I don’t think it will be something I will like.  All the years I have worked the street, have given me the identity of being a paramedic, and it is something I am proud of and greatly enjoy.  I love the comradery, the adventure, the stories, the takeout ethnic food, the feeling of accomplishment at the end of the day, and I get a paycheck on top of it all.  Most of all I think it is about being part of something I feel is important.

When I am at home now, I try to fill the time with other activities.  Bedsides driving my daughter and writing, I am focused on mental and physical wellness activities.  These include:

Swimming: (I now swim 5-6 days a week for 50 minute sessions.  Under the pool's COVID protocols, we can reserve one lane a day for 50 minutes.  My goal is to swim the fastest 50 yard freestyle I can.  I warm up slowly, and then do 6 sprints spaced out for recovery.  Most of the sprints are from the racing block, down 25 yards, flip turn and take a couple of hard strokes back before flipping on my back and doing a slow backstroke to the start.  Occasionally, I do the full 50 yards all-out.  I am slower than I was a couple of years ago.  I need to take more breaths than I used to and my leg kick at the end weakens considerably.  I haven’t officially timed myself, but I don’t think I am close to my record of 28.6.  I will be happy if I can break 30 again, but I feel like I am around 33 or 34.

Strength training:  I have made a small gym in my basement with dumbbells, kettleballs, a slam ball, ropes, and a jump box.  I work out two or three times a week, and not as hard as I should.  I need to get some heavier weights.  I am feeling fitter.  I am particularly proud of the jump box.  I bought it off amazon and assembled it myself.  I am no handyman.  It has three heights, 12” 14” and 16”.  I have already reached 16” although I am cheating slightly by jumping off a matt to begin with.  I can do 12 jumps at 14” and my heart pounds afterwards.  I don’t know if I will ever be able to get up to 20”, which would mean buying a bigger box, but it would be an accomplishment if I did.

Jumping Rope.  Okay, so I managed to do 50 jumps in a row that took my 27 seconds.  My short term goal is to be able to jump rope for a minute.  My long term goal is to jump rope like Muhammad Ali boxer-style, doing all those fancy moves.  I have watched the videos on how to do it, but I am not close yet.  Not by any stretch.  I probably will never be, but a man can dream.

Basketball:  I don’t have anyone to play with but my daughter.  Sometimes when her team practices at an indoor facility, I pay the owner of the place $20 and he lets me shoot if there is an empty court.  When I toss up a jumper and it rips through the net, it brings me great joy.  I am hoping my jumping practice will help me be able to touch the rim, but I can’t do it yet.  Once when I was 6’ 9” and 20 years old, I could actually dunk.  Now, at maybe 6’ 8” and 62 years old, it is sad I can’t even touch the rim anymore.

Reading:  I used to read at least a book a month from Amazon’s best books of the month list, and am trying to get back to doing it.  For January, I chose Drug Use for Grown-Ups, which I am about a third of the way through.  It is a provocative look at the effects of drug use on stable, healthy adults, from a doctor, who admits to being a recreational heroin user.  His argument is when used responsibly, drugs can enhance your life.  He writes well and makes many good points, but I am not drinking the Kool-Aid yet.  While I can agree that drug use likely can be good for some people, it so devastating to others that it is hard for me to see the way to make it available blanketly to all.  I do support decriminalization of possession, safe injection sites, widespread testing of drugs for contaminants, and could envision a country that made prescription grade heroin available to people instead of forcing them to buy the poison sold on the streets today.  I will likely write more about this book when I am done with it.

I just finished two books this week.  One called Breath, which is all about how we need to breathe through our noses to be healthier, rather than mouth breathing.  It had a fantastic tip in it. I now tape my lips shut at night with a little piece of medical tape in the center of my mouth to force me to breath through my nose.  My wife reports, I no longer snore.  Instead of getting up three times a night to pee, I am only getting up once and some nights not at all.  I do feel healthier.  A medical miracle, just like the COVID vaccine that I am ever grateful that I received.   The other book I just finished I listened to rather than read.  Promised Land by Barrack Obama is an account of his life and presidency right up to the point where they kill Osama Bin laden.  I really enjoyed the book, which he narrated.  Listening to this book, while also watching the three seasons of the show Designated Survivor on Netflix in which Kiefer Sutherland, an independent cabinet secretary, becomes President when the President and the Congress are killed in an explosion during the State of the Union. He is an awesome President, always managing to do the right thing and save every day with dignity and compassion.  That is right up to the last episode, when he has the chance to exonerate a racist with information he has, but doesn't because it will likely lead to the bad guy becoming President instead of the hero.  In the end, he wonders if he isn't the one full of shit now.  Great ending!  Between Promised Land and Designated Survivor and all the news about Trump and now Biden, I feel like I am West Wing veteran.  It makes me glad I am not president.  What a difficult and often thankless job.  Everyone else is always looking out for their own interests.  Republicans and Democrats fight each other as if the game is their own power and not the country.

It make me appreciate being a paramedic because no one can really say what we do is thankless.  Some of us are liberal, some of us are conservatives, but when do the job, it is just about helping our patients.  We are the good guys, and that is a nice feeling.

Chess.  I am studying chess because chess supposedly helps keep your mind fresh and your brain synapses firing.  I am not great at the game, but I am taking on-line lessons and playing against different levels of computer bots on the chess.com site.  (I easily beat the beginner bots and some of the lower rated intermediate bots.)  I have also been reading much about the game.  Some of the things I have read suggest that chess can swallow you alive and that it ends in madness for those who plummet into its depths.  I like beating the bots I can, but I admit to being leery of the ones I have difficulty with.  I make stupid blunders and don’t have the ability to see too many moves ahead.  I can easily while away the hours playing it.  Fortunately at many of my daughter’s sports events and practices, they don’t allow parents in due to COVID so I sit in the car playing chess on my phone.  I hope that it will keep my brain functioning, but sometimes I feel that it leads to nothing but lost time.  If I play for twenty years, I will still never be much more than a duffer at it.  I will not make the world better by playing the chess.

This leads me to the point of all this.  I feel that when I am being a paramedic, I am making the world a better place.  It doesn't matter if I can jump 16" or jump rope for one minute or touch the rim or checkmate my opponent.  I just have to show up with an open heart and do the job I was trained to do.   I know that as soon as I step out of the seat, someone else will sit it in, and the calls will go out and be answered, and lives saved, and people reassured in their fearful hours.  Even though we are just cogs in the EMS system, time spend as a paramedic is time well spent.  A life spent as a paramedic is a life well spent.

I hope to keep working as a paramedic as long as I can.  If it is only 10 hours a week, it is still 10 hours well spent.  Maybe all the physical and mental fitness activities I am pursuing will lengthen my career, even if it is now only part-time.  I hope so.

Be safe all.

COVID-19

Today at our state's EMS Advisory Board meeting (held via internet) they had a moment of silence for those in EMS who have passed recently as they do every month.  One of the deaths was an assistant fire chief and former state trooper who was one of the first responders at Sandy Hook.  He died of COVID-19 at age 50.  Other deaths included a husband and wife EMS team who both died of COVID-19 within weeks of each other.  An old partner of mine is in the hospital with COVID-19.  Another old partner of mine has been out for over a year and will likely never return to work thanks to COVID-19.

I am sure all of you who work in EMS, and even those who don't know of similar cases.

Wear your PPE when you are on duty and wear your masks when you go out.  Get vaccinated.  We have to protect ourselves, our families, our partners, our fellow responders and the people we serve.

Stay safe.

Patrick Dragon

Don and Christine Kutz 

Hot Zone

 

The official word is things are getting better in Connecticut as far as COVID goes.  We continue to slowly decline from our December high.  The governor has lifted the sports pause so my daughter is back having full scrimmages with her regional basketball team, although her middle school has cancelled their basketball season.  My wife who works at the VA has been vaccinating older veterans at a frenetic clip, but statewide there is not enough vaccine yet to meet the demand.  I am one of the lucky 1% that has received both doses, and just 7% of our citizens have received their first dose.

I am quite glad I have been vaccinated because at least on the days I work, I have been running into many patients who either have COVID or are good candidates for COVID.  I have often thought that the people working in the ICU have it the toughest as far as witnessing the emotional toll of COVID, watching their patients slowly struggle and die or weaken severely.  In EMS, we say good bye to our patients when we leave them at the ED.  Where we have it worse in my opinion is the risk for exposure.  Back in the spring most of the COVID patients were in nursing homes, assisted living facilities, group homes and prisons, all places where the scenes are easily controlled and the transfer is usually as simple as entering a room and placing the patient on your stretcher.  Now it seems the COVID is almost all in the community.  This week, I did a patient with COVID who was three hundred, wedged in a bathroom, with altered mental status, and with much body fluid no longer in the body.  His wife also had COVID, and while she had her mask on, his had fallen down his chin.  I had my N95 face mask, face shield, gown and gloves on.  But I was with this patient for an extended time in a cramped space trying to extricate him.  Picking him up and getting out of the bathroom, and onto a stair chair and then navigating down cramped stairs with a bookcase at the bottom that partially blocked our path, was difficult and involved prolonged close physical contact.  Add to this, as in many scenes, random maskless family members and neighbors appearing out of nowhere, wanting to know what is going on, or help, or merely say hi and goodbye to the patient.

Follow that with a naked maskless patient on PCP screaming to the demons in his head while we wrestled him onto the stretcher, a secretary at a health clinic, who admits she has a fever, and doesn’t have a mask, and for some reason is getting a nebulizer when you walk into the room without any report behind there is a sick employee, the assault victim lying bloodied on the sidewalk without a mask, crazy with rage and pain, the seizing patient in an apartment hallway.  I have come to realize that every scene today is a hot zone, not just the ones where dispatch warns you to use precautions following their dispatch screen.  Not everyone has COVID, but many admit to having exposure to people who have COVID. I wear my PPE, even though it is uncomfortable and I still can’t see out of the face shields half the time.

I marvel that COVID has not knocked me down yet.  Sometimes I think I had it in February, other times I wonder if I was asymptomatic, and the rest, I just have to admit if I didn’t have it, the damn PPE sure works.  Still I am grateful to be vaccinated, because after the last couple shifts, I have to believe COVID is not close to being defeated yet.

Get Vaccinated.  Wear you PPE  Be safe all.

EMS Harm Reduction

 I am thrilled that American Medical Response-Hartford and Aetna Ambulance are partnering with the Greater Hartford Harm Reduction Coalition to deputize the city’s EMS responders into the Harm Reduction army.  Crews will provide information cards to overdose patients and their families on where they can obtain everything from rehabilitation services to naloxone and clean needles for those not ready yet for rehab.  Harm reduction, which seeks to meet people where they are at, provide honest information and keep people alive has rarely been a part of any EMS curriculum.  EMS crews will also be encouraged to report all opioid overdoses in Hartford to the state Poison control center as part of the Statewide Opioid Reporting Directive (SWORD) to provide early warning surveillance of bad batches, demographic information of which cohorts are overdosing, and develop heat maps to identify the best areas for outreach.

Gone are the days of stigmatizing users and declarations for users to just say no, to be replaced by evidence-based harm reduction truths that will hopefully save lives and further embed EMS into our communities as a modern healthcare partner.

Here’s a great video describing what Harm Reduction is all about by the noted harm reduction activist Van Esher.

https://youtu.be/w7vptIKGOKo

 

Here are the handouts.

Vaccinator!

Connecticut has approved paramedics to administer COVID-19 vaccines.  They have also approved any EMT who has been trained in IM injection as part of the state’s epinephrine program.  Nurses are also able to administer the vaccine.  Paramedics and EMTs, however have to complete a state-approved training course in order to administer the vaccine, while nurses do not.  I am both a paramedic and a nurse.  I have received notification from the state in both my licenses asking me  to become a vaccinator, and have replied in the affirmative for both.  On Sunday, I took the training on-line, and today I attended a thirty minute skills evaluation.  While I am a little torqued that paramedics have to go through more hoops than nurses, I did find the training helpful.  It consisted of watching a thirty-four minute video, and then answering a twenty question quiz.  The skills session involved drawing up 0.5 cc of saline and giving two IM injections to a fake shoulder.  (I was complimented on my technique!) It was good to learn some of the specifics of the Pfizer and the Modern vaccines.

I am not sure when I will be called upon to start administering the vaccines.  Like the rest of the nation, Connecticut is having supply issues.  I heard today that the Johnson and Johnson vaccine may be ready by March, and that will increase the number who can be vaccinated.  The Johnson and Johnson vaccine only needs to be given once. 

I stand ready to help.

***

Here's a link to information on becoming a vaccinator in Connecticut:

Approved COVID-19 Vaccination Training Programs

 

The Door

 When I am in the rapid response paramedic fly car, I usually always arrive on scene, before the fire department, before the police, before the ambulance. (Unless, I am requested to stage for a violent psych or an assault if the assailant is still believed to be on scene).

I carry with me my paramedic house bag, my heart monitor, oxygen tank, and PPE bag.  I try to be mindful and always get my PPE on.

The call is for unresponsive with precautions.  “With precautions” is code for patient either has COVID or screens in as a possible COVID.

I stand now outside apartment 7J.  The door is closed and I can hear no sound from within. In the pre-COVID days, I would knock, and then if it is unlocked, open the door and say “Ambulance.”  Now before knocking, I set all my gear down in the hallway.  I open my PPE bag.  I take out a yellow infection gown.  I pretie the neck loops, drape it over my head, and then twisting to the side and trying to make myself thin, I tie the waist strings (some brands have plenty of string, but these the strings are too short to easily tie behind my back by myself.)  I take out an N95 mask, put that on.  Put my surgical mask over it.  Grab a face shield and apply that.  This may only take a minute, but it seems like an eternity.  I put on my gloves, pick up all my gear, knock on the door, open it and say “Ambulance.”

The hard part comes when the door is wide open when you arrive.  Even harder is when you pull in to the curb, and as you get out of the vehicle and go around to the back and lift the hatchback to get your gear and a young woman is standing there crying, shouting, “Please hurry! Please hurry!”  You throw the house bag over your shoulder, grab the monitor in one hand and the O2 tank and infection control bag in the other and follow her in through the front door, down the hall, up three flights of stairs,  and because she is only twenty and you are sixty two and are carrying heavy gear, she turns and waits for you begging you  “Please hurry!”  Down the hall and the door is open and her grandmother is lying motionless on the floor, and you are supposed to stop and take a minute and put all your PPE on  before getting near the patient, and the granddaughter does not understand why you are not moving quicker.  Please!

These are the choices that we have to make sometimes.  A doctor friend of mine said in a pandemic, you have to always put your PPE on – no exceptions.  In cases like this, I find that harder to do.  We are taught in cardiac arrest, every second counts.  It’s been at least four minutes since the 911 call was made.  If she has been without oxygen that long, she is already falling off the precipice of the living world, heading down into the void.

Apply the pads or put on your PPE?

It is an easy choice when the door is closed and you don’t know what is behind it, but when a person is dying in front of you, it is not so simple.

Severe Outbreak Again?

 Connecticut is back in a severe outbreak according to COVID ACT Now.

The upgrade seems to be largely based on the daily new cases per 100K population. 

For me, I think the daily hospitalizations is a far better measure of the state of the epidemic. 

Source: University of Minnesota COVID-19 Hospitalization Tracking

The cases chart shows COVID is far worse than in the Spring, while the hospitalizations show it is not.

I know at my hospital the hospitalizations have plateaued for weeks at about 25% below their early December high and well below their high of last spring.  When I work, I don’t see the number of COVID patients as I did in the spring, although as I have mentioned before, since people don’t seem to be avoiding the hospital like they did in the Spring, the COVID cases are going to be less concentrated.

I do know that I know more people in recent weeks who have been diagnosed with COVID than I did in the spring, and I suspect this has to do with more widespread testing catching asymptomatics and those with lessor symptoms who might not have been tested in the spring.  My own daughter for example is now getting tested once every two weeks in order to do her basketball clinics where in the Spring testing would not have been available to her.

Maybe this is wishful thinking.  I don’t want to admit that we are not making progress and that despite the vaccine; things are going to be grim for a long time.  A plateau is nothing to boast of.  It is still too high and more work needs to be done to get the numbers down.

I have been very disappointed in conversations I have had with many people in EMS who refuse to get vaccinated, citing what I believe are foolish, uneducated concerns, some even involving conspiracy theories.  I just shake my head.  And tell them they should get vaccinated.  We need to lead.  All of us.

Get vaccinated.  Wear your PPE.  Stand tall.  Stay safe.

Future of EMS Education

 

EMS continuing education has been changed forever over the course of the last year.  At UConn John Dempsey Hospital where I am the EMS coordinator, we hold EMS CMES monthly.  For years we held them in person.  Over the years we bounced around from venue to the next dealing with issues like parking (for attendees and for those on duty who needed access to their emergency vehicles when calls came in), adequate space, ability to eat and drink during the CME, noise from renovations, unpredictable computer equipment, and conflicts with other conferences, not to mention winter weather storms.  We were never able to find the right combination that met everyone’s needs.  On a good day we would get 50 people.

Then COVID came around and we were forced to go virtual using WEbex.  In no time at all, we had 100 attendees, better availability of speakers who can now teach from their works or home desks, reliable and readable PowerPoints, no parking issues, people able to attend who never could before.  For instance, every month we have Dr. David Banach, who I call Connecticut’s Faucci, our infectious disease doctor, call in and answer our responders’ questions about COVID.  It’s been great. 

And then along came Refresh2021, the free online on demand national refresher.  I finished it this week.  Thirty hours of education, most of it of the highest quality from many of the top EMS educators in the country, people you normally have to travel to a national conference to hear, people like Paul Pepe and Corey Slovis, who I have seen before and greatly admire.  The program was put together by Tom Bouthillett, who was the man behind the EMS 12-lead blog, who does a great job clearly explaining cardiac care.

I learned new things during this refresher.  I’ve been in EMS for 32 years and a medic for 27, but there is always stuff I don’t know.  Some of it is stuff I have forgotten, but much of it is new.  Props to all the instructors and most of all to Tom for organizing this.  What a great gift to all of us in EMS during this most difficult year.

If you haven’t taken the class, I encourage you to sign up before March 31 when the I believe the course will no longer be available.  Even if you don’t plan of watching all 30 hours, there are many fine lectures to pick from.

My favorite lecture was Rommie Duckworth’s  Immunological Emergencies, which centered on Anaphylaxis.  I like it not because he taught me anything new, but because he taught so well and so clearly something that we teach over and over – the need for EMS not to hesitate or be afraid of giving epinephrine and how life saving it is in anaphylaxis. 

Other lectures that I thought were home runs were Peter Antevy Pediatric cardiac Arrest, Tom Bouthilllet’s Acute Coronary Syndrome, Kenneth A Scheppke, Neurological Emergencies, and Douglas Kupas, Ambulance Safety.  There were many more that were great, but these ones were particularly so.

I am going to rewatch many of them before their availability ends.

https://link.prodigyems.com/refresh2021

I will be interested to see what comes next.  I can see our hospital possibly putting together lectures to be required for all our sponsored medics on topics of local importance.  I can also see a group of educators/hospitals here in Connecticut putting together programs for Connecticut responders.  Most of all, I am interested to see what Tom and his friends have for a second act on the national stage.

 

Second Dose

 

My first Pfizer shot was great.  Didn’t even feel the needle go in.  No side effects.  Shoveled my driveway the next day with no fatigue.  Yesterday at 10:30 A.M., I had my second shot.  Went to bed at 9:30 P.M. feeling fine.  Woke up at 11:00 P.M. feverish, chills, body aches, joint aches, bone aches, muscle aches.  I couldn’t lay on my left arm were I got the shot it hurt so much.  My wife kicked my lightly and I thought she’d broken my leg it hurt so bad.  Woke up on the hour, trying to lay as still as I could.  Fever this AM of 102.1.  Heart rate of 104 (I live at 60).  Now I have a headache that’s getting worse.  Good to know I have a functioning immune system.

The Common Side-Effects Of The Pfizer Vaccine