Meditations of an Overcast Day

 

It has been a great summer here as far as COVID goes, low numbers, very few cases.  On the ambulance we all wear our face masks, and I wear a face shield when I remember to grab it, and while I carry my isolation bag into the scene with me, I haven’t put on a gown for months.  The fire department, who used to gown their crews before it seemed they even stepped out of their trucks, is rarely seen in gowns anymore.This week, the NBA finals begin, the hockey Stanley Cup was decided, a full slate of college and NFL games were played and major league baseball begins its playoffs.  Not that long ago, it seemed they were talking doom and gloom that all these seasons would shut down again once they tried to start.  Those declarations haven’t proven true.  Yet.  Breaking news today of an NFL team -the Tennessee Titans - who have had a number of players test positive putting next Sunday’s game in jeopardy.

It is overcast this afternoon with periods of misty rain.  I’m sitting in the car watching my daughter’s soccer practice while reading the news on my phone.  

Today Connecticut had its highest test positivity rate (1.75%) since late June.  New York City also hit its highest rate (3.25%) since early June.  The news is full of talk about a second wave this fall.  While many attribute the rise to kids being back in school, I have also heard that a rise in youth positivity may precede a rise in the elderly positivity, and that’s where COVID had done most of its damage.  At the hospital where I work no sooner did they finally reach 0 COVID patients than two new ones came in yesterday.  Not elderly from nursing homes, inmates from jails or residents of group homes, but middle aged working folk with shortness of breath, fevers, positive tests and chest x-rays showing the lung opacities consistent with COVID pneumonias.

Daily coronavirus updates: COVID-19 positivity rate, hospitalizations hit highest levels in months; Connecticut to use new contact tracing tool

N.Y.C. Reports Large Uptick in Virus Cases

This weekend at a sporting event, I stood in line behind a young woman whose temperature was 101.  This was the first time I had ever seen or even heard of a person record a fever at one of these checkpoints.  I usually always test at 96 or 97.  The thermometers run low.  They told her to come back in ten minutes for a retest and I later saw her walking about in the facility.  One of the teams was from a quarantine state, although they certainly didn’t play like they had any disease.  In Connecticut if you plan to stay more than 24 hours and are from one of the states on our quarantine list, you must quarantine for two weeks or face a fine.  If you are staying less than 24 hours, you are apparently free to do whatever you like as long as you leave the state before the 24 hour timer goes off.  The facility we were at was well ventilated and everyone wore masks and there was adequate spacing, so I wasn’t too concerned.

Here in Connecticut even as our rates tick up, the state is about to raise its restaurant occupancy limits to 75%, despite studies that show restaurants are among the highest risk places to get COVID.  Will this be okay -- our state has been very conservative in its approach and I believe lives have been saved by it--or is it a terrible mistake, a sign of our tiredness of COVID and desire to get on with our lives at just the moment that COVID is about to strike again?

Here’s a joke.

Dr. Faucci and I walk into a bar…

Just kidding...We’re not stupid!  That’s where you get COVID!

Speaking of which, today I read an article where the head of the CDC Dr. Robert Redfield is overheard on a private phone call saying of the president’s top COVID advisor Scott Atlas,  “Everything he says is false.”

CDC director takes aim at Trump's Covid adviser: 'Everything he says is false'

Doesn’t give you a lot of confidence.

Florida just opened up all its bars.

Fauci Says Florida Is ‘Asking For Trouble’ By Fully Reopening Restaurants And Bars

I have a bad feeling.

  

Coming in April 2021

As posted a few days ago, I am pleased to announce Johns Hopkins University Press will be publishing my newest book, Killing Season A Paramedic’s Dispatches from the Front Lines of the Opioid Epidemic.  The book will be released in April 2021, but is available for preorder now on Amazon.

Preorder Here

The book tells the story of how I went from a new medic 25 years ago who believed that heroin users had major character flaws and that telling them to just say no or they will end up dead or in jail was the solution to the problem, to a proponent of harm reduction, which recognizes that addiction is a chronic relapsing brain disease and whose victims deserve our compassion and not our scorn.  In the book I share the stories that users have told me after I have resuscitated them, stories that show how they were all normal like the rest of us until fate, usually an injury or illness sent them down a difficult path they couldn't have imagined and which many were powerless to stop.

Topics include Stigma, the History of the Opioid Epidemic. The Science of Addiction, Naloxone, Fentanyl, Provider Safety, Harm Reduction, Safe Injection Sites, the War on Drugs, Pain Management and much more.

The book is a mixture of calls I have done, intermixed with a discussion of addiction and public policy issues.  There are footnotes, but the book I believe reads easily, and is full of EMS scenes.

I am grateful to the editors (Robin Coleman) at Johns Hopkins for choosing to publish the book and to my agent, Jane Dystel for championing the project.

I am also thankful to all the readers of this blog who have supported and encouraged my posting about the opioid epidemic. 

Twitter and Social Media

 

At the behest of the people at Johns Hopkins University Press, I will be expanding my social media presence to help promote my new book.  I have done this blog for over 16 years, but have not yet ventured onto Facebook or Twitter, which I will now embark to do.

Today while watching football (Go Pats!) I have set up my Twitter account and even tweeted twice.

My Twitter account will cover all topics paramedic, including addiction and COVID, as well as a few personal tweets.  I also have a fledgling Instagram account.  I will appreciate anyone who wishes to follow me.  Thanks for your support.

Medicscribe on Twitter

Medicscribe on Instagram

Be my first Twitter follower!  I have 0 at this moment!

GOAL!

 Over the years I have missed many sporting events of my children, although I have always done my best to try to get there.  Since I went part time earlier this year, I have made every one of my daughter's softball, basketball and soccer games.

Instead of being in the front seat of an ambulance posted on a street corner, I was sitting near the corner of one of our town's soccer fields watching my daughter's team when she got this breakaway.

https://www.instagram.com/p/CFp5Rn6nLFW/?utm_source=ig_web_button_share_sheet

After she scored, the coach looked around and seeing me said, "You saw that?"

Yes, I did.

Reporting on EMS Opioid Data

 Great article in The Hartford Courant about the first year's worth of data from the SWORD project, which collects EMS reports of opioid overdoses.

First report on Connecticut’s real-time, opioid overdose tracking system reveals higher number of cases in Hartford County

I was also interviewed by the local FOX news channel about the project.

UConn Health: Opioid data reporting project is saving lives

.

(The long hair and mustache are my COVID look.  One of these days I will get back to the barber.)

Thanks to the Hartford Courant and Fox 61 for reporting on this important project and issue.

Killing Season

 

Coming in April 2021 from Johns Hopkins University Press.

Now available for preorder on Amazon.

Killing Season: A Paramedic's Dispatches from the Front Lines of the Opioid Epidemic

COVID Tracking

There are to COVID tracking sites I follow every day.   They both have color coded maps that show how each state is doing according to their metrics.

Connecticut is not doing as well as it has in the past.  Our dailey cases and test positivity rate have gone up and stayed there over the last couple weeks.  Much of this is likley attributable to the influx of college students into the state as well as local grade and high school students going back to school. 

Daily coronavirus updates: Higher positivity looks like new normal as metrics flatten; Sacred Heart president says students could be sent home; U.S. reaches 200,000 coronavirus deaths.

The EMS system here hasn’t felt any real uptick yet.  I don’t know if it is just a matter of time or maybe because the increase in cases is largely attributable to younger people, we are not seeing and may not see the devastation we saw in the spring in our nursing homes, prison, and group homes.

Let's hope so.

Keep wearing your masks.

 

COVID ACT Now

 

COVID Exit Strategy 

Minority Overdose Deaths Rising

 Recent data on fatal overdoses in Connecticut shows overdoses among black and Hispanic citizens are increasing as a proportion of total overdose deaths.

To date in 2020, 29% of overdose deaths in Connecticut have been black or Hispanic people compared to 18% in 2015, 21% in 2016 and 2017, 24% in 2018, and 28% in 2019.

Source: Drug Overdose Deaths in Connecticut

Accessed September 21, 2020.  Data updated through 8/27/2020 (Chart by medicscribe)

I have had more than a few people from minority communities express bitterness to me that this country only began to care about the opioid epidemic when white sons and daughters started to die, while when it affected people of color in the inner city, the government instead of showing compassion toward the sick, invented the War on Drugs to attack black and poor people.

The disparity between treatment of white and minority is often illustrated in the heavy sentences for crack cocaine users (preferred in black community) versus the lighter sentences for cocaine users (more preferred by white users), a disparity that is a terrible miscarriage of justice in a country that professes to treat all citizens the same.

For years, people in the cities died, and no one seemed to care about the “addicts” and “junkies” who threw their lives away with poor choices. (To be fair, I did overdoses of white people in the old days, too, but at those times, white society more completely stigmatized and cast out its own than they do today until the numbers finally reached a turning point.) That the opioid epidemic has gained attention in the suburbs in the near past to the point that people began talking about it, and using their political power to fight on behalf of their addicted sons and daughters instead of disowning them, is not a bad thing. For years the suburbs were silent as their children died.  Their voices have helped all people who are addicted.   But while the death rate in the suburbs seems to be improving, similar gains are not happening in Hartford. Nationwide, as in Connecticut, the epidemic is still growing in the inner cities.

It is vital that programs for substance users don't neglect those in our cities or those of those of lessor economic means.

We as a nation--suburb and city--must speak out on behalf of all sufferers.

I would like to think that this crisis will bring us all together so that we treat everyone the same. There are millions out there in the cold who need our help to find their way home.

This country and our military have a saying: “We leave no one behind.” In EMS, as in all medicine, we have an obligation to honor the Hippocratic Oath: “Into whatsoever houses I enter, I will enter to help the sick.” 

The epidemic won’t be over and our efforts should not cease until people of all colors and races no longer have to suffer for the deaths of their own.

Peace to all.

***

THE OPIOID CRISIS AND THE BLACK/AFRICAN AMERICAN POPULATION: AN URGENT ISSUE

Connecticut EMS Opioid Overdose Data

 In Connecticut, when EMS responds to an opioid overdose, after they have taken the patient to the hospital, accepted a refusal, or presumed a patient dead, they are required to contact the state poison control center and answer a series of questions about the overdose.

The program, known as SWORD (Statewide Opioid Reporting Directive), that went statewide on June 1, 2019, recently released the results of its first year of data collecting.

Here are the highlights:

There were 4,505 suspected overdoses including 337 fatal overdoses, reported by EMS to the SWORD program between June 1, 2019 and May 31, 2020.

Males accounted for 74% of the overdoses; females 26%.

People between the ages of 25 and 39 were most likely to overdose.

When the drug of exposure was known, 87% of the overdoses were due to heroin or fentanyl versus 11% for prescription opioid and 2% for methadone or suboxone.

Bystanders gave naloxone in 15% of the overdose cases where 911 was called.

88% of overdose victims were transported to the hospital.

2% of overdose incidents involved multiple patients.

11% of overdoses occurred in motor vehicles.

There were 131 “spike alerts” generated. 

109 public health and public safety agencies are registered in Connecticut to view the data.

The full report can be found here:

SWORD ANNUAL REPORT

For more information on the program, check here:

Connecticut SWORD Program

Here’s a video explaining how the program works:

Heartbeat

 Labor day weekend I had an irregular heartbeat.  I had a funny feeling in my chest and when I took my pulse, son of a gun, I was missing a beat every now and then.  I wasn’t near any place where I could put myself on the monitor and see what was actually going on, but every time I checked, even when I wasn’t feeling anything, i couldn’t get to 30 without a dropped beat.

I am sixty-two years old, and while I feel I have been in somewhat of a physical decline over the last two years, particularly this last year with the COVID altering my normal workout eating and mental health routines, I have never questioned the strength or health of my heart before.  I admit that it scared me.

I tried to determine what might be causing the missed beat and focused on two culprits.  A medication I take for my thyroid which can cause palpitations and caffeine.  I did- against my better interests have several coca-colas that day of and the day before.  I am somewhat addicted to Coke, but often go months without it because it makes me cough quite badly when i do drink it.  Still I love the taste in a glass with lots of ice cubes and I just sip it.  I particularly enjoyed the flavored varieties.  Coke with lime, first among them.  It is hard for me not to relapse.

So I cut out the caffeine, even the green tea that has been my sad replacement for Coke.  I also stopped my other medication for two days.  I resumed that med, but kept off the Coke, and after a few days, not only could I go a sixty count without a missed beat, every time I checked I was at a perfect 60.

This post originated as I stood in the cafeteria looking at the fountain Coke machine that lets you add whatever flavor you want.  I was really close to getting one, and I thought I would write about how despite my irregular heartbeat, I still couldn’t kick the habit.  But will power prevailed and I still haven’t had a Coke (Shh-there was an old 20 ounce bottle of Cherry Coke on my desk with maybe 3 ounces left in it.  I filled a Dixie cup up with ice and poured a couple sips worth into it, and I did this a couple, three times till I was holding the bottle over my head and trying to shake the last drops out before tossing the bottle into the trash, never to have Coke again. Ha!).  We need to be stronger as we grow older.

When you start out as a medic you are usually of the age where you feel an invincibility about your life.  You know that someday you may end up like your patients but it is so far off you don’t need to worry about it.

My hand on my neck, I count sixty steady beats.

I don’t want to think about the future, but I know it's out there.

***

Judge Ruth Bader Ginsburg died two days ago at 87.

May we all use the remaining time we have left on this earth in the service of our families, fellow humans, country and world.

Peace to all.

Nalmefene

 I heard today that Opiant, the company behind the 4 mg Narcan Intranasal spray, is at work on a new product to combat opioid overdose -- Intranasal Nalmefene.

Nalmefene Nasal Spray

Nalmefene is an FDA approved medication to reverse opioid overdoses when used intravenously. It has yet to be approved in a nasal form suitable for first responders and laypeople.

The company cites the more rapid onset and longer lasting properties of Nalmefene as a better (stronger, longer acting) drug to combat “longer-lived synthetics.”

The theories behind IN Nalmefene are as follows:

It may be needed to battle stronger synthetic opioids.
It lasts longer than naloxone.
It works faster.

I have some questions about the need for a longer acting drug. Heroin lasts longer than fentanyl. I get this both from the pharmacology of morphine versus fentanyl, but from conversations from street users who tell me heroin lasts for them 6-8 hours versus 3-4 hours for fentanyl. Keep in mind that the effects go down rapidly from their peak so that by the end of these time periods, users who are addicted are starting to feel sick and are beginning withdrawal. Maybe there are other synthetics that last longer, but I am unaware of them.

While in EMS we often tell people that naloxone doesn’t last as long as heroin. I hear people saying naloxone only lasts 30 minutes. (Its half life is 1-2 hours.) There is a fear that the naloxone resuscitated person will go back into overdose when the naloxone wears off. I have yet to see a person go from alert and talking post resuscitation to suddenly apneic again at the stroke of 30 minutes. Depending on the dose and route of naloxone, especially if titrated carefully, I have had patients who needed a bit more. The second wave overdose is more a concern with long acting opioids such as time-released pills or methadone, not so much with street heroin or fentanyl. Many studies have shown that most heroin users are safe to release from care if they are alert and have good oxygen saturations post naloxone.

For an excellent discussion of the safety and literature behind naloxone refusals read this article from ems1.com.

The post-naloxone patient: Optimizing opioid overdose refusals

I am also not certain that we need a stronger drug than naloxone. While there is much talk and anecdote about fentanyl requiring more doses than heroin, I have not really found this to be true. (And I have done hundreds of fentanyl resuscitations).  It can be a self-fulfilling prophecy where medics hear that fentanyl requires more so they give more without waiting patiently for the first dose to take effect. I know of cases of people getting huge doses, but on inquiry, the timing between doses was not well spaced. Are you waiting five minutes between doses while you bag and are you seeing signs of improvement--increasing respiratory rate and decreasing ETCO2?   I have yet to hear of an opioid that does not respond to naloxone.

What does appeal to me about Nalmefene is the claim that it works quicker than naloxone. That I think would be great when used by lay people or single responders who lack the ability to effectively use bag-valve mask ventilation. Lay people often come upon overdosed patients who are not breathing. Without the ability to ventilate them, a quicker acting drug would clearly be life-saving. I have often been on scenes were patients have received three, four and five rapid fire doses from laypeople, who basically empty all the Narcan they can find into a person hoping to get them breathing again. 16 mg in one minute is not unheard of when the laypeople have four autoinjecters at hand.

We of course are left with a combative, vomiting patient once we arrive. This is better than finding someone apneic, but still hard to deal with.

I continue to be against the use of the Narcan 4 mg IN for EMS providers who respond as more than a single responder because of its increased likelihood of side effects when the standard of care is for EMS providers to titrate with the smallest possible dose while they use bag valve mask ventilation.  Vomiting and agitation are common in patient put into withdrawl by the 4 mg IN dose, which is equivalent to 2 mg IM.  Paramedics should start with no more than 0.4 mgs as a first dose.  i know many medics who start with 0.1 IV and add 0.1 each minute until respirations are stored.  Many times their patients don't even realize they have been given naloxone the effect is so gentle.

It is my understanding that IN Nalmefene is still at least two years away from approval/distribution, and needs additional study.

Fighting Fire with Fire: Development of Intranasal Nalmefene to Treat Synthetic Opioid Overdose

Shock Index

 I attended a CME recently where I heard a term I had never heard before.

SHOCK INDEX

The shock index (SI) is heart rate divided by systolic blood pressure. The normal range is 0.5 to 0.7.

The shock index has been shown to be a predictor of increased likelihood of shock, hospital admission, and mortality.

Someone is likely at risk for shock if their SI is over 0.8.

If my systolic blood pressure is 120 and my heart rate is 60, my SI is 0.5.
If my systolic is 120 and my heart rate is 120, my SI is 1.0 --in the danger zone.

While most paramedics can just look at a patient and tell you whether or not they are in shock, the shock index can help raise concern for someone in who is at risk for decompensation.

Here's some studies on the shock index.

A prehospital shock index for trauma correlates with measures of hospital resource use and mortality

Shock index in patients with traumatic solid organ injury as a predictor of massive blood transfusion protocol activation

Here’s a great article on shock.

Approach to Shock

 

Back in the Water

 

This week the local aquatics center opened for the first time since the COVID scare locked the state down back in late March.  I have already swum twice and have lanes reserved nearly every day of the week ahead.

I missed the pool terribly when it was closed.  The water has always been my buffer between the world and my home.  I finish a long shift at work, I stop at the pool and plunge into the cool water and all of the city comes off.  By the time I get home, I am relaxed, feel great and am totally into chilling with the family. 

With the pool closed, I suffered.  I suffered physically and mentally.  My physical conditioning declined.  I was irritable.  I slept poorly.  I felt older, stiff and slower moving.  I hurt my back a year ago and have occasional numbness in my legs that worsened.  My diet went out of whack.  I felt stressed all the time.

I used to walk over to the aquatics center and look in the center’s back windows where I would see the pool, still filled with water, but the lights darkened.  Why did they have to close it down? I asked the night sky? 

I support all the people who have taken the often unpopular decisions to shut down society while we tried to get a handle on the epidemic and keep people, particularly our elderly, safe. 

Still I railed at individual decisions that affected me.  Why take the hoops down from the basketball courts that my daughter and I used to shoot at when there was never anyone else playing?  Why shut down sixth grade basketball playoffs held in a giant gym attended by maybe thirty people in a space that could accommodate a couple thousand?  Why close my pool, my beloved pool, that when I went there at 8 at night, usually offered my choice of multiple empty lanes?  Some nights when the high school swimmers weren’t practicing I was the only one there in the 11 lane pool.

Couldn’t they have instituted the procedures they have now to keep it open?  Wear a mask into the building, maintain social distancing, you are required to reserve your lane.  Everyone leaves the pool at 50 minutes after the hour and the next group comes in at the top of the hour.  Twice a day the pool is closed briefly for cleaning.  Limited people in the building.  No showers.

When I swam last night, in the lane next to me was a man who I have seen there for years.  Instead of swimming he walks back and forth in the water.  He is a large man and moves slowly, but he rarely misses a night.  After his walk and my swim, we would often sit with others in the large spa (hot tub/Jacuzzi) and pass small talk or just nod good evening.  The spa is closed still for more obvious reasons.

I wonder what this man did all those nights when the pool was closed.  Another man who used to swim every night discovered walking and I would often see him out walking with his wife.  I hope it helped.  I wonder about all the others who used to swim as often I did.  How did they make out these past hard months?

I write all this not to whine about what has passed or to celebrate what has opened.  I write it to reflect on all the ways the epidemic has injured us.  Many have suffered grievous losses.  (Far more than my minor complaints). Some have lost lives, lost health, lost work, lost joy.  It isn’t over yet, and there will still likely be more hardships ahead, but we should be kind to each other, and we should all work for safe ways to find our way back to what we lost.  I am ever so thankful I can swim again.

Stay safe everyone.

 

Masks and Herd Immunity

 You can wear a mask and still get COVID.  The mask is not fool-proof, but masks can reduce the viral load you are exposed to.  With a smaller viral load, you may get COVID, but it is likely to be much milder than if you got a full blast of the virus.

A new commentary by researchers in the New England Journal of Medicine speculates that masks may be helping develop herd immunity.  People who wear masks are still getting COVID, but they are often either asymptomatic or have only mild symptoms.  Mask wearing allows the spread of a mild form of the the disease and resulting immunity through the population and is preferable to people without masks, getting larger viral loads and becoming much sicker.

In other words, in areas where people wear masks, they are speculating that a larger number of infections will be asymptomatic than in areas that don’t don’t because of people getting the virus from smaller loads of the virus.

Facial Masking for Covid-19 — Potential for “Variolation” as We Await a Vaccine

It should be emphasized that the authors are not recommended mask wearing as a substitute for an effective vaccine, only suggesting that mask wearing is assisting in the development of herd immunity.

The paper represents just a theory.  It is supported by animal research that showed animals who received larger loads of virus were sicker than those animals exposed to smaller doses and research that animals (hamsters) who wore simulated masks were less likely to get COVID and when they did they were less likely to be sick than those hamsters without the simulated masks.

The authors point out that conducting similar research on humans would be unethical.  But studies of populations during COVID have shown that in those areas where mask wearing is more prevalent, there are more asymptomatic infections.

They also site examples from both cruise ships and meat-packing plants where people wore masks versus those where they didn't, the asymptomatic rates were much higher in the mask wearing groups.

The authors conclude:

Ultimately, combating the pandemic will involve driving down both transmission rates and severity of disease. Increasing evidence suggests that population-wide facial masking might benefit both components of the response.

Wear your masks!

Are Masks a Kind of Vaccine Against COVID-19?

COVID Vaccine

I am pro-vaccine.  I believe in science and in the public health model.

When I was in high school, I read an essay called The Tragedy of the Commons.  It basically said that if people acted in their own self-interest rather than in the interest of the group, tragedy would result.  Resources would be depleted.  To survive as a species, you need cooperation.

This applies to vaccines.  There may be a small individual risk to vaccines.  A person acting in their own self-interest might avoid the vaccine, trusting others to take the small risk.  If all others get the vaccine, herd immunity results, and the person who avoided the vaccine, not only avoids the vaccine risk, they gain the benefit of the group action.  With everyone else vaccinated, the virus is much less apt to make its way through the population and infect the individual.

Of course, if everyone acts in their own perceived self-interest and refuses the vaccine, then everyone is at much higher risk of getting the virus.  Herd immunity is never achieved and the virus runs rampant through the commons.  The individual is at a much higher risk.  The society is f---ed.

The same scenario applies to face masks.  If people exercise their “liberty” to not wear masks, then the virus spreads much more rapidly among the commons and increases everyone's risks, where if people are willing to wear the masks for the common good, the virus is less likely to spread to the benefit of all.

My parents made certain I had all my childhood vaccines.  I never had to worry about getting polio because of the great success of the polio vaccine. 

I get the flu vaccine every year.  I understand that because the flu mutates and there are many strains.  The vaccine makers are not certain how effective each year’s vaccine will be, but in general I believe the science that says it will make me less likely to get the flu or if I do get it, it is more likely to be mild.

The world has high hopes that science will save the day and come up with an effective vaccine for COVID-19.  I hope we get one, but I am nervous, particularly when there is talk of rushing standard safety protocols.  Some have speculated there will be political pressure put on the FDA to approve a vaccine prior to the general election in November.

Scientists worry FDA could be pressured to approve COVID-19 vaccine before it's fully tested

Today, the nine largest companies involved in the vaccine race issued a joint letter pledging to make certain their vaccines were safe before seeking federal approval to market them.  Let’s hope they mean it.

With Trump promising a COVID-19 vaccine 'very soon,' industry developers pledge to keep politics out of science

Vaccines need to be fully trialed.  They need to be safe.  Rushing a vaccine for political or other reasons can jeopardize not only lives of those who receive the vaccines, but the entire system of vaccinations, which is already under attack by “non-believers.”

I have read that first responders will be the first to be offered the COVID vaccine when it is approved.

Scientific advisory committee: First responders should get 1st phase of COVID-19 vaccine

Will I get it?

Will I accept it even if I feel it has been rushed and safety measures bypassed?

Drum roll.

Yes, I will. 

I am willing to be a test subject in the interest of the community. But I won’t let my kids get the shot until I am convinced that it is safe.

***

There is an interesting survey on EMS attitudes on the flu and COVID vaccines at EMS1.com.

Survey: Are you obligated to get a COVID-19 vaccine? 

Whole Blood

Last week, I carried a new “drug” for the first time.  Not Torodol or Acetaminophen which were recently added to our med kits as an alternative to opioids, but whole blood.

That’s right -- whole blood.

My service (American Medical Response of Hartford under the medical control of Saint Francis Medical Center) is the first ground EMS service in New England to carry whole blood.  Currently it is only being carried by our fly car medics (my Friday shift) and the evening and night supervisors.  We carry a 500 ml bag in a cooler that is monitored for temperature around the clock.  The bags are visually examined at the end of every shift and the temperature can be accessed at any time over an internet application.

The protocol calls for blood for hemorrhagic shock including trauma, GI bleed, AAA, and postpartum hemorrhage.  Patients should have a BP less than 90 or a heart rate over 120.

To administer, we spike the bag with a line which has special heating coils in it, then we attach the line to a battery, which within 25 seconds heats the blood to body temperature.

The blood should only be given after stopping the bleeding with tourniquets, compression dressing etc. where applicable.

We carry 0 negative blood so the risk of a transfusion reaction is extremely small.

I did a couple heroin overdoses, a chest pain, a nausea and diarrhea, and a couple other calls, but no need for the blood.

In a future post, I will summarize the whole blood literature, which is quite compelling for prehospital use. 

Poop

 A college student in Arizona has a bowel movement in his dormitory and then goes about his everyday business.  Were this a dormitory at most universities, there would be little interest in this young man’s excrement.  But Arizona State University is very interested in their students’ stool.  They are studying it in an effort to identify outbreaks of COVID 19.

How investigating wastewater can help solve the COVID-19 crisis

In this case the sewage does come up positive for COVID-19.  The students in the dorm are quickly tested and two, including the sample donor are found to be positive for COVID 19 despite their asymptomatic state.  They are immediately quarantined and a large outbreak is likely averted.

The University of Arizona says it caught a dorm’s covid-19 outbreak before it started. Its secret weapon: Poop.

Sewage or wastewater testing is capable of picking up fragments of COVID that are released from the body in feces.  This type of testing can not only inform the public health community of the presence of COVID, it can track the prevalence, monitoring the rate of COVID in the community in close to real time, days before people start to show symptoms.

The increasing application of wastewater testing as well as the approval of cheap rapid testing are both encouraging signs in the battle against the spread of COVID-19.