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" There is no more honored sterward than he who compassionately serves; not out of subjugation, but moral obligation."

First Responder, Pt II

Medical Emergencies: "Club Drugs"

    I was listening to my subscription to the Medic Cast, a podcast for emergency medical responders this week, the show topic being Club/party drugs. I think weve all come in contact with somebody hopped up or doped out on something homemade and elicit. These folks are often dangerously lethargic, but can also be unpredictable and volatile. 

    From personal experience, I highly recommend you subscribe to this feed for your own benefit. Each episode is less than an hour, and you get tons of information. Even if you have no medical training, the Paramedic hosting the show is very thorough and will point out numerous helpful tips you can implement in the future. Check out the hyperlink above.

    For official and most up to date info, check out the National Institute on Drug Abuse.  Below is the data they have posted, but I encourage you to read up on their page, as it is much more extensive than I have room here for....

    MDMA (ecstasy), Rohypnol, GHB, and Ketamine are among the drugs used by teens and young adults who are part of a nightclub, bar, rave, or trance scene. Raves and trance events are generally night-long dances, often held in warehouses. Many who attend raves and trances do not use club drugs, but those who do may be attracted to their generally low cost, and to the intoxicating highs that are said to deepen the rave or trance experience. For the third and fourth quarters of 2003, hospital emergency department mentions were estimated at 2,221 for MDMA use, 990 for GHB, and 73 for ketamine.*

MDMA (Ecstasy)

    MDMA (3-4 methylenedioxymethamphetamine) is a synthetic, psychoactive drug chemically similar to the stimulant methamphetamine and the hallucinogen mescaline. Street names for MDMA include "ecstasy," "XTC," and "hug drug." In high doses, MDMA can interfere with the body’s ability to regulate temperature. On rare but unpredictable occasions, this can lead to a sharp increase in body temperature (hyperthermia), resulting in liver, kidney, and cardiovascular system failure, and death. Because MDMA can interfere with its own metabolism (breakdown within the body), potentially harmful levels can be reached by repeated drug use within short intervals.

    Research in animals links MDMA exposure to long-term damage to serotonin neurons. A study in nonhuman primates showed that exposure to MDMA for only 4 days caused damage of serotonin nerve terminals that was evident 6 to 7 years later. While similar neurotoxicity has not been definitively shown in humans, the wealth of animal research indicating MDMA’s damaging properties suggests that MDMA is not a safe drug for human consumption. 

    According to the Monitoring the Future** (MTF) survey, NIDA’s annual survey of drug use and associated attitudes among the Nation’s 8th-, 10th-, and 12th-graders, 12th-graders reported significant declines in lifetime*** MDMA use and perceived availability of the drug in 2005. Perceived harmfulness in occasional MDMA use declined significantly among 8th-graders, from 65.1 percent in 2004 to 60.8 percent in 2005.

    Another national survey, the National Survey on Drug Use and Health,**** reported 450,000 current ecstasy users in 2004, which is similar to the number reported in 2003. Past year ecstasy use declined from 3.7 percent in 2003 to 3.1 percent in 2004 among young adults aged 18 to 25. Approximately 607,000 Americans used ecstasy for the first time in 2004. The majority of these new users were 18 or older, and the average age was 19.5 years.

GHB, Ketamine, and Rohypnol

    GHB and Rohypnol are predominantly central nervous system depressants. Because they are often colorless, tasteless, and odorless, they can be added to beverages and ingested unknowingly.

    These drugs emerged several years ago as "date rape" drugs.***** Because of concern about their abuse, Congress passed the "Drug-Induced Rape Prevention and Punishment Act of 1996" in October 1996. This legislation increased Federal penalties for use of any controlled substance to aid in sexual assault.

GHB
    Since about 1990, GHB (gamma hydroxybutyrate) has been used in the U.S. for its euphoric, sedative, and anabolic (body building) effects. It is a central nervous system depressant that was widely available over-the-counter in health food stores during the 1980s and until 1992. It was purchased largely by body builders to aid in fat reduction and muscle building. Street names include "liquid ecstasy," "soap," "easy lay," "vita-G," and "Georgia home boy." 

    Coma and seizures can occur following use of GHB. Combining use with other drugs such as alcohol can result in nausea and breathing difficulties. GHB may also produce withdrawal effects, including insomnia, anxiety, tremors, and sweating. GHB and two of its precursors, gamma butyrolactone (GBL) and 1,4 butanediol (BD), have been involved in poisonings, overdoses, date rapes, and deaths.

Ketamine
    Ketamine is an anesthetic that has been approved for both human and animal use in medical settings since 1970; about 90 percent of the ketamine legally sold is intended for veterinary use. It can be injected or snorted. Ketamine is also known as "special K" or "vitamin K."

    Certain doses of ketamine can cause dream-like states and hallucinations. In high doses, ketamine can cause delirium, amnesia, impaired motor function, high blood pressure, depression, and potentially fatal respiratory problems.

Rohypnol
    Rohypnol, a trade name for flunitrazepam, belongs to a class of drugs known as benzodiazepines. When mixed with alcohol, Rohypnol can incapacitate victims and prevent them from resisting sexual assault. It can produce "anterograde amnesia," which means individuals may not remember events they experienced while under the effects of the drug. Also, Rohypnol may be lethal when mixed with alcohol and/or other depressants.

    Rohypnol is not approved for use in the United States, and its importation is banned. Illicit use of Rohypnol started appearing in the United States in the early 1990s, where it became known as "rophies," "roofies," "roach," and "rope." 

    Abuse of two other similar drugs appears to have replaced Rohypnol abuse in some regions of the country. These are clonazepam, marketed in the U.S. as Klonopin and in Mexico as Rivotril, and alprazolam, marketed as Xanax.

    And for a visual reference, here’s a Youtube cinematic / musical montage of the use and effects of the four main ’party drugs,’ amphetamine, ecstasy, cocaine and LSD. http://www.youtube.com/watch?v=HZr9LvrREH0

 

 

And Just In Case.... if you (or somebody you know) needs help with an addiction... 

Need a treatment referral?
Call 1-800-662-HELP or visit
findtreatment.samhsa.gov

 

Your friendly neighborhood superhero: HAZMAT

    Ever wonder what the diamond-shaped signs on tanker trucks are? Or what the combination of numbers and colors signify?

    Hazardous materials are shipped by every conventional method these days. Land, sea, air. For the purpose of this blog, I'm going to discuss the one you will primarily come across in normal day to day- on land (namely trucks or trains).

    The Department of Transportation (DOT) has set up a system of classifying dangerous substances as well as the methods of reacting to their release into the environment. Your best available resource is the North American Emergency Response Guide. Newer editions come out every few years. If you can get a copy, do so. They're chocked full of data regarding what to do when accidental/intentional spills or emissions... including the heath risks of thousands of chemical, isolation distances, first aid , and what can occur if on fire. Trust me when I say, if you actually knew half of what was being transported through your neighborhood it'd surprise the hell out of you.

    UN/NA numbers (the four digit number) found on bulk placards refer to specific chemicals or groups of chemicals and are assigned by the United Nations and/or the United States Department of Transportation. An online USDOT 2004 Emergency Response Guidebook will help you find out what the four digit numbers you see on placards mean.  Speaking of which, get a pair of binoculars to read the placards. By law, there should be one on every side, just in case. Read the 4 digit number, look up the corresponding page and follow the directions.

    And when all else fails, follow The Rule of Thumb: Hold up your arm outstretched, thumb upward and cover the entire scene of the accident with it. If your thumb doesn't obscure the site, RUN LIKE HELL!     YOU ARE TOO CLOSE!

    Proximity to a hazardous material, the amount, length of exposure and the route it enters your body are all incredible risks to your health, with serious long-term ramifications. Maintain your distance. Hat Mat Technicians take HUNDREDS of hours of training in order qualify for a team with a fire department or emergency services. Do the right thing and turn tail and get out of that situation post haste!

There are several classifications, each with their own subcategories, and they all go from most volatile to least.

1. Explosives
2. Compressed gasses
3. Flammable liquids
4. Flammable solids
5. Oxidizers
6. Poisons
7. Radioactive
8. Corrosive liquids
9. Misc

See this site here for all the subcategory classifications:

http://environmentalchemistry.com/yogi/hazmat/placards/

     Random facts that no one should care about:

    A trailer is not placarded unless it carries 1,001 lbs. of a product. However, trailers are required to be placard for carrying Inhalable Poisons (Class 2), dangerous when wet (class 4), certain oxidizers (like a 5.2) and all other Poisons in a certain subcategory (like a class 6.1). Also, most trailers will not have food mixed with poisons. Although the DOT requirement is that food is four feet away. Some trailers might load all of their Hazmat in the end of the trailer.

    Most LTL carriers will not take explosives or radioactive material. Fireworks and some small explosives may also qualify as a class 4.1 so that will be shipped. All drivers are required by law to have the correct placards on their trailers. It is an out of pocket 20 to 50 grand if they do not. The company they work for will not pay for it.

Responding to motor vehicle collisions & accidents.

    Ok, this is a huge topic. There’s so much I can talk about with this subject covering everything from fire department point of view or emergency medical treatment. But since there's prolly only a few here on the boards trained in emergency response, I’m going to set this up with a First Responder angle.

First responders are usually ordinary citizens with basic first aid and emergency training, for example life guards or volunteer firefighters. Their role is to provide a 1st link in the chain of events immediately following an incident.

Here’s how it usually plays out:
1. emergency occurs
2. EMS activated
3. Services dispatched
4. First responders arrive, render care
5. Additional personnel (fire & EMS)
6. Transport to ER

    I know I mentioned it before in other blogs, but nothing is more important than SAFETY! I cannot over-emphasize this point. Public safety workers get injured on the scene of an MVA (motor vehicle accident) or MVC (collision) depending on your regions' vernacular. Vehicles, especially newer ones, can have a ton of hazards. i.e.: air bags, hydraulic rods in hatches, or car bumpers. Emergency crews have been known to be struck by vehicles while working on the scene of an accident. As a matter of fact, my lieutenant was hit a year or so ago when responding to a call. She was thrown underneath the fire engine. Luckily she survived without permanent injury, but some are not so lucky, even those who are the most prepared. Personal protective gear is key

    Let’s describe a scenario, and walk through it. We’ll also assume that, even at night, fire/law enforcement/ EMS respond usually in less than 10 minutes depending on distance and traffic.

You’re at a corner coffee shop and you hear a crash.

1. Locate the scene, and make a quick assessment. Quickly locate:
-hazards
-number of patients

2. Designate someone to call for help

3. If you can, gain access to the vehicle occupants. You may need a variety of tools; seatbelt cutter, glass punch, etc. For inexpensive MVA rescue tools:
http://www.galls.com/category2.html?assort=general_catalog&cat=2681

    If your patient complains of neck pain, make sure they stay put; this is a strong indicator of spinal injury.

    If there is significant danger such as fire, or the victim is in traffic and risk of being struck, remove as quickly as possible. We have extensive protocols regarding the extrication of a patient, HOWEVER, LIFE OVER LIMB. Almost every time you have a collision, the PT (patient) needs to be collared, back boarded, and assessed by trained emergency crews. But this goes out the window if the patient cannot remain in dangerous conditions.

4. If you are able to enter the vehicle, begin by approaching from a side the patient can see you. Don’t come up from the rear because a sudden turn of their head could cause permanent damage if they have a spinal injury. Identify yourself & inform them you are there to assist. Insist that they stay seated in their chair. Maintain stability in their cervical spine (neck bones) and don’t allow them to turn the head.

5. If you cannot gain access because the car is wedged, or pinned, try the handle. I know it sounds dumb, but professional firefighters will literally tear the door off with the Jaws of Life or break glass, without ever thinking of checking the door handle. If you have to, you can go through the trunk and then the backseat. Rear windows are large and accommodating. Bust them out and sit behind them while holding their head upright against the bucket seats' headrests.

  *breaking glass!!!* There are 2 types of glass involved in this situation. 
    LAMINATED: the windshield is made of layers with a laminated layer between. This is in the event of an accident; the glass remains mostly intact as a shattered sheet. 
    SAFETY GLASS: this will shatter into thousands of tiny crumbled cubes, instead of angular shards. Use a window punch like this one, sold in combination with a belt cutter:

Photobucket 

Phantom Zero also sent me a link to a site with a bunch of cool pocket rescue tools. http://freeper.the-hobbit-hole.net/

6. Most people will not want to sit still for you, especially as some random stranger, or even somebody in uniform. It’s weird but you will occasionally get people in denial, or will flat out refuse treatment. You cannot force treatment on them. Not unless they are unconscious. (see my good Samaritan law blog)

7. if you have the time or ability, try and get vital signs.
-identify pulse, breath rate, signs of bleeding,
(my post on bleeding)

8 if necessary provide care such as CPR (yet another of my blogs)

    For scene safety, there’s a few factors to consider. with downed power lines, the rule of thumb is to place yourself at least ONE WHOLE SPAN BETWEEN YOU AND THE LINE (in all directions). a span being equal to the distance between utility poles. unless you are a lineman, you can't be sure which the cable, phone or power line is once they're on the ground. even if the line is not on wet ground, the electricity can pass through the ground into you within a certain distance from contact. this is known as "ground gradient", and is certainly fatal.

    Also something to consider, look for leaking fuel or the possibility of vapors if the vehicle in question is a tanker truck. This creates a whole other problem of hazmat emergency. see here for my blog on HAZMAT  

    Low laying areas can accumulate heavier than air flammable vapors like liquid propane gas. they will sink & follow the contour of the ground and WILL find an ignition source, unless dispersed by some sort of breeze. keep away any personal vehicles and, for God's sake, DO NOT LIGHT A FLARE. Always be on the upwind side. If you are responding in your own vehicle instead of on foot, same thing applies. Park far back, and engage your hazard lights, pointing your car away from the accident. The reason for this is in case your car is struck by another vehicle because the drive isn't paying attention, they will not plow your car on top of you.

Be safe out there guys

(OvO)  Knight Owl

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