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Anecdotally I can say I've only ever had to sedate one overdose patient after administering naloxone in the last 7 1/2 years. As we later discovered this particular patient had a long standing history of violent/aggressive behaviour directed toward LEOs and Paramedics. In my own experience the key to preventing violence and aggression with these patients is to correct hypoxia prior to bringing them up. This however does beg the question as to whether or not a lay person should be administering naloxone. Lay people won't be providing ventilation or oxygen prior to administration.
We lose too many too early. If it isn't shift work related or worsened illness it's PTSD. You will be missed Island. I knew you only through your contributions here, but based on what I've read over the years I'm certain your passing has left a giant hole in the hearts of your loved ones. Your shift has ended. Just leave us the keys mate. We'll take it from here. Ed
I expect the Edmonton unit may have more of a positive effect than some of the other similar units because of the deployment plan. AHS plans to send this unit to intercept potential hot strokes coming in from rural areas which could make the difference for a number of patients (two units travelling toward each other at 100km/hr would equate to one unit running toward the stroke centre at 200km/hr).
I can't speak for other programs but CAMATA was included in my ACP program at SAIT. I suspect the best thing would be to approach the local schools directly and offer the ride along/practicum space for students on final practicum. Perhaps it could be an additional two tours/blocks at the end of a successful students practicum?
Intuitively the reported results make sense. In my own experience with enough epi and bicarb you can get ROSC out of a rock. That doesn't mean the person will have survival to discharge.
At this point it appears that epi is more beneficial than harmful in cardiac arrest. I would expect the next logical step regarding epi will be dosage determination. Is 1mg IV q 3-5 minutes the ideal dose? Should it be more? Less? An infusion instead of bolus dosing?
If you're starting entirely from scratch I would suggest finding a CAMATA course to put your people through. The course is fairly old and certainly due for an update but it's the best primer I know of without putting them through a full Critical Care Paramedic program (The 1-2 year Canadian version of the CCP I mean).
A lot of it will come down to the basics. Teach Loading/unloading using whatever system the aircraft is equipped with; flight physiology and how you can expect it to affect you and your patients. Racking equipment for the flight environment; Modified patient assessment for the flight environment. It doesn't sound like you'll be flying any vented patients so that should make things a little easier. If you're flying psych patients BC actually has a fair amount of experience with this and a well developed sedation policy. It's a policy that has come under some heat over the years but is strongly backed by a record of zero patient harm incidents.
Island I am sorry for your loss. Preventing the drugs from ever landing on home soil is certainly a valid avenue to try and prevent addiction all together. I was speaking in reference to treatment cost reduction for those who are already addicted.
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"Supervised shooting galleries" as you refer to them do not really assist anyone in getting off drugs. What safe injection sites do is reduce the amount these people drain out of the public system (remember Canada, and in fact most of the developed world, has some form of publicly funded health care). Safe injection sites reduce 911 responses for overdose, they reduce infection due to the sharing of dirty needles, and for a very small number they provide access to rehab facilities.
From a study in Quebec looking at the cost of caring for septic patients (a frequently occurring malady amongst the IVDU population). "The mean cost for all patients abstracted was $11,474 per episode of care ($1,064/day). The survivors had a mean cost for their treatment of $16,228 per episode of care ($877/day). The total cost per episode was $7,584 per nonsurvivor ($1,724/day). An average cost of $27,481 for survivors after day 28 through 1 year was calculated. The burden of severe sepsis was estimated to be $36.4 to $72.9 million per year, but higher if costs beyond day 28 are included."
From the CDC regarding the cost of HIV treatment "The most recent published estimate of lifetime HIV treatment costs was $367,134 (in 2009 dollars; $379,668 in 2010 dollars)."
In a country with a publicly funded hospital system the tax paying public is on the hook for Sepsis and HIV treatment cost. In the end I don't support safe injection sites because I think they help people get off the drugs. I support safe injection sites because I'm a responsible tax payer who likes seeing the impact of junkies on the public purse reduced as much as ethically possible.