Friday, June 19, 2020

A New Team of Professional Crisis Workers

 The mayor of Hartford Luke Bronin is proposing “a new team of professional crisis workers who would respond instead of or alongside police to calls involving mental illness, emotional distress, trauma and addiction.”

Hartford mayor commits to creating civilian crisis response team to handle certain emergency calls instead of police

As he says in the article in the Hartford Courant, "police should not be the first or only ones to respond to some calls for help."

Hmmm.

How about EMS?

No, wait, we already do it.

He just didn’t know because of our special powers of invisibility.

Now, to be truthful, here’s how it works in Hartford.

Resources are dispatched depending on the way the call comes in.

Let’s talk about these categories.  EDP (Emotionally disturbed person).  Violent EDP, Overdose, Shooting, Stabbing, Assault.

Many years ago when I started in Hartford, we were sent to these calls and we just went.  In time, we started to do something called staging.  We respond, but wait for the police at a safe distance.  Today, a nonviolent normal EDP, we don’t stage.    We stage for a violent EDP.  We stage for shootings and stabbings.  Sometimes we stage for an assault and sometimes we stage for an overdose.  I understand why they have us stage for a some assaults in case the assailant is still there, and I can see us staging when we are sent for an overdose when the overdose is a large muscled man on PCP climbing naked on cars.  I don’t understand why sometimes they have us stage for an apneic heroin victim, but staging for such calls is rare.

Let’s say the call is a violent EDP.  The police enter and we wait for them to call us in.  Sometimes, they bring the patient out in handcuffs, sometimes they come out and say misunderstanding, but most times we go in, talk to the patient and convince them to come with us to the hospital.  We often do a good guy bad guy routine.  They want to get away from the cops so they go with us.  Sometimes, they are holding the patient down, and we sedate them, and then they help us get them on the stretcher and follow us to the hospital.  Usually, when I sedate a violent EDP, they are snoring by the time we get to the hospital.

On the heroin overdoses, sometimes the cops show up and try to force the patient to go to the hospital when they refuse.  I once had a cop say, “Either you are a victim of a medical illness, in which case you are going to the hospital, or you are a criminal, in which case you are going to jail.”  I am against these forced transports.  If a patient is alert and oriented, I will take a refusal after giving them a full discussion of where they can get help and how to stay safe.  For the most part, the cops will defer to whatever EMS decides is right for the patient.

I have noticed on some overdoses lately harm reduction people have shown up on scenes, often getting there before us.  (They listen to scanners).  They are helpful and never in the way.  I can see how dispatching them formally would be a good thing.  I am also not opposed to mental health professionals going.  This has happened sometimes in the past.  They can be helpful, but they can also just make things worse.  I have waited on scene for extended periods while they have conducted their assessments.  I prefer that we say to the patient, how about we give you a ride to the hospital and you can talk to someone there who can here you out?  That usually works.

I am all for keeping the cops on calls where they are most needed.  Sending them for a violent eight-year old or an apneic heroin overdose or a fifty-year old who told her friend she doesn't want to live anymore might not be the best use, but they do certainly need to still go to the shootings, stabbings and crazed people on PCP.

Dribble for Justice, Dribble for Change

 

Tonight I participated in Dribble for Justice.  Dribble for Change.   I made a top score of 279 (trying five times and worked up quite a sweat).

It is a part of a basketball training App called Home Court special BLACK LIVES MATTER activity.

As part of the event, I also made a donation to the Equal Justice Initiative in memory of Kevin Andrews.

The Equal Justice Initiative is committed to ending mass incarceration and excessive punishment in the United States, to challenging racial and economic injustice, and to protecting basic human rights for the most vulnerable people in American society.

We can make our world a better place for all!

 

Thursday, June 18, 2020

Reopening

 Connecticut reopened its gyms and swimming pools today along with indoor dining.  Unfortunately, neither my pool or the two gyms I go to reopened.  Nor word yet when they will.  Bummer.

I had no desire to celebrate the phase two opening by going to a restaurant to dine indoors, so tonight i am in my backyard grilling hamburgers and in a little bit I will get in my small hot tub that I just paid $600 to get the leaks fixed in and a new motor after a few years of unuse,  I will also likely have a couple of hard seltzers even though I find they interfere with my sleep.

Connecticut has been doing great as evidenced by the map below.  We are one of the few states in green, meaning we are a state making progress in our battle against COVID.  Part of the reason we are in green is we were hit so hard in the first wave that made its biggest initial impact in our neighboring New York, spreading into New Jersey to the south and Connecticut to the north.  Our state made some good choices early on and for the most part people have followed physical distancing protocols.  I use the term physical distancing now because that is really what it is all about.  We should never socially distance.

 

 

How We Reopen Safely

While the reopening and the fact that today Connecticut has less than 200 people hospitalized with COVID down from a peak of over 2,000 in April, is cause to celebrate, the more I read, the more realistic I realize I and we all need to be about the future.

The interview below with Dr. Michael Osterholm, noted epidemiologist and author of Deadliest Enemy: Our War Against Killer Germs, a great book that is clear-eyed in its appraisal of what we face.

COVID-19: Straight Answers from Top Epidemiologist Who Predicted the Pandemic

Only 5% of our population has been infected.

Covid-19 has no reason to disappear.

Unless we have a vaccine, which is no sure thing, COVID will burn until 60-70%of our population is infected, and will likely kill 800,000 to 2 million american in the next two years.

Chances of a successful vaccine that prevents COVID are not good.

Our darkest days he says are still ahead of us.

He recommends avoiding prolonged contact with others in indoor spaces with poor ventilation and cautions that cloth masks offer only limited protection in such situations.

What  we must do is find the safest ways we can to live the life closest to what we have loved about our society, and if we have strong leadership that speaks the truth to us, we will get through it.

Please read the interview, and if you are looking for a good read, try the book.  It in nonfiction, but reads like an adventure story.  It covers everything from Ebola to the flu.

Be safe out there.

Wednesday, June 17, 2020

Harm Reduction

 Connecticut's harm reduction workers are out on the street everyday trying to make the world safer for those caught in substance use.  This is particularly important in this time of COVID-19.  I am often questioned whether or not harm reduction - syringe services, community naloxone, overdose prevention sites, drop-in centers-- are not just enabling users.

The video below offers a great explanation of the benefits and role of harm reduction.

https://youtu.be/w7vptIKGOKo



 

 

Monday, June 15, 2020

Kevin Andrews

 With all that is going on these days, I thought of Kevin Andrews, one of my first partners in EMS.

I first posted this in January of 2011.

***

In EMS, we cannot help but be shaped by our earliest partners. They are the ones who show us the way. I was lucky in that regard.

Kevin Andrews was one of my first partners. This was back in 1989. I was a spanking new EMT — so fresh I didn’t even have my certification yet. Due to an EMT shortage I was working on a waiver that let EMT class graduates work pending the outcome of their state exams. I even wore a “whop kit” – one of those pouches that attach to your belt and hold your tools of the trade. Mine was small and conservative by some standards. I had a penlight, trauma shears, bandage scissors, and a window-punch.

We worked for Eastern Ambulance, a mom and pop ambulance company in Springfield Mass that had the 911 contracts for three suburban towns in addition to backing up calls in the city and doing transfers. On a good day we only had five ambulances on the road. On most we had three. Some of the ambulances had brown bondo on the sides and in one, you could see the road through a hole in the floorboards. On Fridays, we use to all race down to the bank to try to cash our checks. The last to get there often found theirs would bounce. We didn’t have paramedics, just basics and intermediates. We didn’t even have defibrillators then. But we were a close-knit group, and there was more to the job than money.

Kevin was an EMT, but he was respected as any of the intermediates. He’d tried to take the EMT-I exam a couple times, but kept just missing it. He was very street smart, but had trouble overthinking the tests. I, on the other hand was book-smart, but had no clue about the street. With the wrong partner, my life at work could have been made miserable. I was always glad to find myself working with Kevin.

We were both thirty then, but our backgrounds couldn’t have been more different. He grew up in a large family in Springfield in a neighborhood where the drug trade flourished. I was from an upper middle class suburban family and my most recent job was working for a United States Senator until his loss had send me on this personal quest to learn how to help people in person rather than from behind a policy desk.

Kevin was a big strong man with a shaved head who a instructor and black belt in karate. Still he was gentle and soft-spoken, with a ready smile. I never saw him raise his voice or become excited on a scene. He had that calm about him that for all the occupations I have worked in, I have only ever really seen in certain EMS responders — an unperturbed always in control manner that seemed to deescalate any panic around him from patients, bystanders or partner. He always knew what to do, and if he didn’t, he never let that on.

Sometimes we used to stop at his mother’s house where she always made sandwiches for us and we would visit with his youngest brothers and sisters before heading back on the road. He was their clear pride. Out on the street, Kevin would point out to me the drug houses and dealers. What I might have thought was an innocent boy of twelve on a bike, was instead a drug-dealer’s lookout. It was a new world for me.

My clearest recollection of a call with Kevin was on a cold sleety morning in winter when we responded for a woman who had slipped on the ice on the top steps of a church. I could tell right away her arm was broken. I palpated it through her coat and it felt almost as if it were in two separate pieces. I had my trauma shears out in a jiffy, but before I could make my first cut, Kevin had a soft but strong grip on my arm. “This might be the only coat she owns,” he said quietly. “Let’s see if we can ease her arm out of it.” Which is what he did, taking his time not to cause any pain. The woman’s winter coat was preserved and her arm was carefully splinted and he talked to her in a reassuring way that caused me to feel only awe at what I was witnessing. It made me see that EMS wasn’t really about blood and guts and bad car wrecks and doing CPR. It was about taking care of people.

The company went bankrupt a couple years later. By that time I was only working one overnight shift a week. I was back behind the policy desk as the ex-Senator after a year in exile had run for Governor and won. Despite the full-time government job I was not only hooked on EMS and had to get my weekly fix, but I felt like I was a part of a family at Eastern Ambulance and I didn’t want to lose that connection. I hated to see Eastern close. Kevin and most of the others we worked with went to work for another ambulance company in Springfield while I joined a volunteer service in Connecticut.

I saw Kevin periodically over the years. We had a few Eastern get-togethers. Another time he and his girlfriend brought their kids down for a picnic at the condo in Connecticut I shared with my own girlfriend at the time. I visited him in the hospital when he got a bad infection and had to get IV antibiotics. We’d talk on the phone sometimes and get caught up on how all the people we worked with at Eastern were doing. He told me he was honored when I mentioned him in my first book. I was honored to be able to write about him. Whenever he’d call, even if we hadn’t talked to each other for a couple years I’d say “Kevin” recognizing him at the first sound of his voice.

The last time I talked to him was three years ago right around the birth of my daughter. He’d mentioned there was going to be a new get together of some of the old people we knew. I wrote his number down, but in the confusion of the time, misplaced it. I have always been somewhat of a recluse. I work all the time and I’m not the best about keeping in touch.

A month ago I talked to a woman who’d also worked ambulance up in Springfield, starting shortly after I had left the area. When I mentioned I had worked for Eastern, Kevin’s name came up. She said she knew him and that he was helping teach basic EMTs at the college where she also taught. I said to say hello. Later in a New Year’s Day phone call, she told me she had talked to him and that he had been excited to hear she had spoken with me. He told her about the good times we’d had as partners. She’d given him my cell phone number and he’d said he was going to call me. She wanted to know if he had ever gotten a hold of me. He hadn’t. And now he won’t be. The reason for the call was to tell me he had passed away suddenly. She didn’t know the details. The rest of the conversation was a fog. I kept thinking. What do you mean? He passed away?

I have always found it hard to believe people I have known are gone. I have to see the obituary in the paper. I found it and there is was in print. Kevin Andrews, 52.

I am not one who believes in heaven or an afterlife. I believe when you are dead, you are dead. There is no place where you go to sit with others or wander among the clouds. Your conciousness is no more.

But what I do believe in is memory. I can close my eyes and see Kevin sitting right next to me in the ambulance, telling me a story. I can see him standing there in his mother’s house smiling watching his brothers and sisters play, and then years later, sitting on the back deck watching his own children play in my yard. I can see the true friendship in his eyes and feel his warm handshake when he says “Keep in touch.”

And I can still see him taking care of that old woman on the church steps as clear as if I were still there. I watch his hands and I want my hands to be able to soothe someone as his do.

***

Kevin shaped me as a caregiver and as a person. He helped make me the paramedic I am today. If I am gentle toward a patient, than Kevin’s spirit is in me, Kevin’s touch is in my hands. If watching the way those of us who were influenced by Kevin treat their patients, others are now gentler with the sick and injured, then Kevin’s hands and heart are also in them. His breadth widens. This is what becomes of him. This is how Kevin is passed on, from one caregiver to the next. Let this be how he is remembered.

The great church doors open to the icy weather. Outside on the cold steps, an EMT caring for a patient.