Wednesday, November 22

This post is about fentanyl so you shouldn't read it, you'll OD

The newest EMS urban legend is first responders ODing on fentanyl.  The tales start usually with a cop on a drug bust or a traffic stop who suddenly falls ill, fentanyl being the culprit.  That cop didn't have symptoms of opiod use, but the legend doesn't need facts to spread.  The anchors talk about their day when it was all over the place and the new guys are freaking out about how dangerous this job is.

The rest of us are just shaking our heads and wondering how they all manage to dress themselves in the morning.

Let's start with the obvious: Fentanyl is an opiod.  It's basically legal heroin for treating severe pain, or so say the little cards used to sell the pills to your Doctor.  Totally legal with a prescription there's a good chance that within 20 feet of you right now is enough fentanyl to put down a horse.

Yet you're still alive.


Then there are those less than reputable folks using fentanyl as a replacement for heroin.  They add a little fentanyl and a lot less heroin and can still give their customers that same high (or low, if you prefer).  More concentrated dosing can pose a threat to rescuers except for one thing:

It's outside your blood stream.

No rescuer is going to OD on fentanyl, carfentanyl or any other opiod or substance on the scene of an incident.  If medics respond to a CO poisoning, go in with no masks, then get sick, did they OD on CO?  Of course not.


Exposure is the word you're looking for.  Same as exposure to blood, feces or anything else on scene we have all the tools we need to not let something on the outside get inside.

Trouble is, when there isn't blood or something else nasty readily visible many in our ranks seem to let their guard down.  Using gloves with the clipboard, not having a drop pen, even driving with gloves on shows a lack of understanding of how things can transfer.  I've been seen touching patients without gloves on while they're poking out of my back pocket!  The horror!  But when I don't know everything, the gloves are on.  I even carry an N95 in that back pocket at all times, because you never really know.

We all need to take a deep breath and remember that while fentanyl is a white powder, we don't need to activate the HazMat team every time we think we see it.

Step 1:  Don't touch it.

Step 2: If you do touch it, rinse your gloves off.

Step 3: Don't rub your eyes, use your pen from your shirt, handle everything in the rig, then get surprised when you start to feel drowsy.


The urban legends came to life when an ambulance operator fell ill when driving to the hospital.  A quick thinking partner in the back was able to give him some Narcan and he improved, but that's a sign of accidental exposure, not an OD as was reported and shared online.  I don't have the details, but I understand how this powder works and how the skin and mucous membranes work and I can guarantee you there was a lapse in good isolation technique.


At a nasty choking recently, the intern got his gloves dirty and went to change them.  He took them off wrong, got vomit on his hands, then wiped his pant leg before learning the hard lesson that gloves don't go on wet hands.  His preceptor never taught him to double glove or to simply add a layer.  It's that kind of lack of basics that leads to an exposure.


Get back to basics before the fentanyl monster jumps up from across the room and dives down your throat and makes you OD.

Saturday, November 18

Off-duty: Intervene or Be a Witness?

The Crossover Show - 132

In this episode, HM and MC discuss off-duty actions. What are their (and more importantly, your) requirements/policies/moral obligations for acting during a given scenario.

Also…what about Worker’s Comp should you decide to take action and sustain some kind of injury? Are you in your jurisdiction? Are you considered on-duty?

*Disclaimer: As per usual, review and adhere to your department policies. Take the things these two knuckleheads say with a grain of salt.


#MICC is #Done!!

The Slow Fix by Carl Honoré

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Source: the Crossover Show

Friday, November 10

Mass Shootings in a Small Town: What are Your Resources?

The Crossover Show - 131

In this episode, MC and HM talk about the shooting in Texas that left over 2 dozen dead and as many more wounded.

The guys dive into what little is known about the Three Disciplines in the area and compare that to the Las Vegas shooting in October.

As always the conversation evolves (or devolves) and they’re back talking about what they’re reading and planning for the week.


Sonoma Pride

Building a StoryBrand by Donald Miller

The Slow Fix by Carl Honoré

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Source: the Crossover Show

Sunday, November 5

#TapTapTime: The Latest Trending Topic

The Crossover Show - 130

In this episode, MC and HM create a new hashtag:


Sure, there’s other things they talk about, but to be honest…#TapTapTime is the best part of the whole damn show.

They’re overly proud of it.

The guys talk about trying to get out of jury duty, shooting at actors, and getting FM transmissions over your phone.

They’re all connected. Promise(-ish).


Secret drinks at CA Adventure’s Cove Bar

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Source: the Crossover Show

Friday, November 3

Police Responsible for Ambulance Bills on College Campus?

Boy should they be.

Here's the story we're talking about and I can tell you this is a topic too often visited upon those who find themselves looking from a Police Officer to an Ambulance and wondering why either of them is there.

University Police at GW seem to think a policy they have overrides the rights of a Student and the authority of a duly licensed ET or Paramedic.

Adorable, I know.


Students have come forward challenging ambulance charges when they were found to have been suspected to have ingested alcohol and UPD forced them to the hospital, citing their policy.  Even students who passed field sobriety tests and gave breathalyzer readings below those required to operate a motor vehicle were still forced, using authority, to be taken somewhere they did not wish to go.

There's a word for that.  We've discussed it before and how so many EMS agencies don't understand it.

If the students are violating policy and are speaking clearly, able to walk and understand the risks of not seeking a physician evaluation (which pretty much consists of "you OK?") law enforcement can not coerce or force them to hospital unless they are taken into custody.

Otherwise this is cut and dry...


kidnapping by force.

Don't think so?  Local laws are usually vague, and even though the Officers may not be seeking ransom, guess who operates the Ambulance?  The University.  The policy is written to increase billable transports of the parent organization.  I'd argue that's enough, but include that the ambulance takes the person to a place where they may be harmed and I'd say we have a decent argument.  Far better then the policy to transport anyone who had a couple Bud Ice at a dorm party.  You can't force them to the hospital!  Give them a stern lecture?  Fine them at tuition time?

Or cite them.  Or arrest them, but you can't force them into the hospital.

So there's a simple bow on the UPD policy.  Took me 2 minutes.  Each and every student should file charges and demand UPD cover all ambulance and hospital charges relating to the forced relocation.  If campus drinking is such a problem, why not try some police work and prevent the drinking, or perhaps focus on those who over-imbibe and might actually need an ambulance?

Too much effort and paperwork?  I know.  Imagine the paperwork and effort you just forced all those healthcare professionals to waste, not to mention taking an ambulance out of service and clogging a hospital bed for 15 minutes.


You are liable for the events you created and you created one hell of a mess.  Drop the policy and pay the bills.


To any students seeking to challenge UPD or the university policy, I'm available as an Emergency Medical Services Subject Matter Expert for deposition in your case.  No fee.