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.

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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