# EMT Held Against His Will in Maine



## MMiz (Jul 9, 2013)

*EMT Held Against His Will in Maine*

ROCKLAND, Maine — A 27-year-old Rockland man suspected of being under the influence of bath salts was arrested Friday afternoon and charged with holding a Rockland emergency medical technician against his will.

*Read more!*

Are bath salts still big?


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## shfd739 (Jul 9, 2013)

Thankfully the outcome was positive and apparently quick for the EMT. 

Bath salts/K2/Spice are still big here. I've had 2 patients in the last 3 weeks that used it. Cheap way to get high.


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## Medic Tim (Jul 9, 2013)

bath salts are Still a big problem in Maine.


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## JPINFV (Jul 9, 2013)

shfd739 said:


> Bath salts/K2/Spice are still big here.



Just a quick note. Bath salts are a form of meth while K2 and Spice are forms of synthetic marijuana. They are not the same thing.


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## shfd739 (Jul 9, 2013)

JPINFV said:


> Just a quick note. Bath salts are a form of meth while K2 and Spice are forms of synthetic marijuana. They are not the same thing.



Im aware they arent the same. I was more mentioning that we are seeing alot of these nontraditional drugs still.


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## TransportJockey (Jul 10, 2013)

JPINFV said:


> Just a quick note. Bath salts are a form of meth while K2 and Spice are forms of synthetic marijuana. They are not the same thing.



BUt I see a lot of meth like symptoms w/ spice... IT's kinda odd. I keep telling my spice patients I'd much prefer them to smoke the real stuff.


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## shfd739 (Jul 10, 2013)

TransportJockey said:


> BUt I see a lot of meth like symptoms w/ spice... IT's kinda odd. I keep telling my spice patients I'd much prefer them to smoke the real stuff.


Same here. 

Had a patient 2 weeks ago that used spice and was acting like a meth ingestion. I'd much rather they use the real stuff- we know what to expect with the real stuff


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## chaz90 (Jul 10, 2013)

I'd imagine a lot of this is because we don't know what kind of adulterants or "extras" are in these random batches of K2 or spice. It seems to vary tremendously patient to patient.


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## DrParasite (Jul 11, 2013)

MMiz said:


> Are bath salts still big?


absolutely.  I attended the EMSworld conference in DC, and one of the presenters (a toxicologist from one of the Va hospitals) gave an hour long presentation on them.

Also of interest was how he (as an ER attending and toxicologist) wanted bath salts cases handled in the field vs how we typically handle them in the field


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## Walter Sobchak (Jul 11, 2013)

Maine is the last state (as far as i know ) where "bath salts" are legal.  also, north west Maine is akin to the hollows of WV/KY......serious hill billy/white trash enclave.


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## EpiEMS (Jul 11, 2013)

DrParasite said:


> Also of interest was how he (as an ER attending and toxicologist) wanted bath salts cases handled in the field vs how we typically handle them in the field



What were his recommendations?


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## DrParasite (Jul 12, 2013)

pretty much if you get a violent EDP who you suspect is on bath salts (or PCP since the signs were very similar), they should immediately get RSIed in the field.  The justification is that's what they will be doing in the ER, before they get admitted to the ICU for specialized monitoring (especially when you learn the long term effects on the brain of bath salts, scary stuff).  

Since we currently have the cops tackle said violent offender, handcuff him, and then handcuff said kicking and fighting individual to the stretcher, and transport him to the ER with a BLS crew, it was definitely a different way of thinking.


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## Victoria (Sep 6, 2013)

Wow that's crazy.


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## Brandon O (Sep 9, 2013)

Bath salt capital of the country, or so they say.


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## EMT B (Sep 18, 2013)

What do they expect you to do when you can't get the tube in after pushing your succs and versed (or whatever cocktail you use)?


Also anything north of Agusta is "hick land" in Maine.


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## Medic Tim (Sep 18, 2013)

EMT B said:


> What do they expect you to do when you can't get the tube in after pushing your succs and versed (or whatever cocktail you use)?
> 
> 
> Also anything north of Agusta is "hick land" in Maine.



I have had a number of bath salts pts. In Maine we don't have RSI we sedate them with versed. In my last PHTLS class in Bangor a few weeks ago... we were told the intubation success rate in Maine was like 70%... scary stuff

And anything north of Bangor = here be dragons


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## Brandon O (Sep 18, 2013)

Medic Tim said:


> Anything north of Bangor = here be dragons



North of Portland.


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## EMT B (Sep 18, 2013)

Medic Tim said:


> I have had a number of bath salts pts. In Maine we don't have RSI we sedate them with versed. In my last PHTLS class in Bangor a few weeks ago... we were told the intubation success rate in Maine was like 70%... scary stuff
> 
> And anything north of Bangor = here be dragons



I understand we dont have RSI in Maine. Im not really a fan of RSI. im just making the point of what are you going to do if you cant get the tube? Cric in a non sterile environment?


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## NomadicMedic (Sep 18, 2013)

EMT B said:


> I understand we dont have RSI in Maine. Im not really a fan of RSI. im just making the point of what are you going to do if you cant get the tube? Cric in a non sterile environment?



If I'm going to Cric somebody, it's typically a non sterile environment. :/ And why aren't you a fan of RSI? When the program is administered correctly with stringent QA/QI, it's not an issue. Although, with a statewide 70% success rate I'd not be keen on RSI either.


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## EMT B (Sep 18, 2013)

DEmedic said:


> If I'm going to Cric somebody, it's typically a non sterile environment. :/ And why aren't you a fan of RSI? When the program is administered correctly with stringent QA/QI, it's not an issue. Although, with a statewide 70% success rate I'd not be keen on RSI either.



That's my point. They are sedated and paralyzed and because you can't get the tube you have very few options in terms of airway management.


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## NomadicMedic (Sep 18, 2013)

EMT B said:


> That's my point. They are sedated and paralyzed and because you can't get the tube you have very few options in terms of airway management.



Well, that's not really the case. How about an LMA, combitube or King. Pick an SGA that your medical director likes and go to it quickly when you cant get the tube. OPA/NPA and a BVM or that much feared and much maligned Surgical airway. 

There are always options, unless you're in a true CICV scenario. 

We typically use Versed to sedate our bath salt ingesters. We rarely field RSI them, but they almost always end up buying a tube in the ED.


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## EMT B (Sep 18, 2013)

If there is a more bls way to manage the airway like a king or a combitube then why not use that instead of jumping right to the big guns. If the ED is gonna do it, let the ED do it in a more stable environment with someone who does it more often like a CRNA. 

Even better, if the old method of restraints and bls works, why not just use that? Your trying to fix something that isn't broken by taking away the respiratory drive of a patient that can breathe fine on their own.


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## CFal (Sep 18, 2013)

I spent the summer living and working almost 3 hours north of Bangor


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## EMT B (Sep 18, 2013)

im sorry :lol:


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## Tigger (Sep 18, 2013)

EMT B said:


> If there is a more bls way to manage the airway like a king or a combitube then why not use that instead of jumping right to the big guns. If the ED is gonna do it, let the ED do it in a more stable environment with someone who does it more often like a CRNA.
> 
> Even better, if the old method of restraints and bls works, why not just use that? Your trying to fix something that isn't broken by taking away the respiratory drive of a patient that can breathe fine on their own.



Did you read the part about the ED physician stating that he was pretty much going to immediately RSI these patients? It has nothing to with respiratory drive, it has to do with the total management of the patient, which in this case the physician believes is best done with the patient RSIed. You can't BLS they're airway since they don't actually have any respiratory compromise. The issue has nothing to do with airway but everything to do with an extremely combative patient.

Also RSI is not the "big guns." It's a procedure that has indications and can certainly be done appropriately by paramedics given proper system design.


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## EMT B (Sep 18, 2013)

I did read that. Then like i said let the ED Physician or the CRNA do the RSI in the hospital. If your worried that the patient is going to become combative and cause harm to you, soft restraints and a versed/benadryl combo will certainly make them sleepy without having to take away the patients respiratory drive.

I also certainly agree that it has its indications, but I feel as though there are medics out there that will RSI any difficulty breathing patient to "protect their airway" just so they can play with their flashy cool toy. My opinion is that it should not be used unless the patient is going to loose their airway and respiratory drive anyway.


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## Aprz (Sep 18, 2013)

EMT B said:


> If there is a more bls way to manage the airway like a king or a combitube then why not use that ... let the ED do it in a more stable environment with someone who does it more often ....
> 
> Even better, if the old method of restraints and bls works, why not just use that? Your trying to fix something that isn't broken....


You've been listening to wanna be progressive paramedics who talk about all the bleeding edge stuff in paramedicine, or you are making the same mistake as them.

BLS before ALS is a lie.

Intubation has recently been discouraged because interrupted chest compressions during cardiac arrest, just poor chest compressions in general, poor ventilation (rapid large breaths causing hyperoxyemia, mild arterioconstriction, but hypotension from increased intrathoracic pressure), and failure to recognize a failed airway.

Intubation still has it's place. I believe it really is the gold standard for airway management because it prevents aspiration. As long as you focus on good quality chest compressions without interruption (including for intubation attempts), that attempts aren't prolonged or tried more than three times, that you change how you are doing it if you failed the previous try, and to recognize a difficult airway where it may not be worthwhile to attempt intubation. Under those conditions, I think intubation is good to do still.

** I'd type more, but my brother is nagging me for lunch. I'll comment more later maybe.


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## NomadicMedic (Sep 18, 2013)

EMT B said:


> I did read that. Then like i said let the ED Physician or the CRNA do the RSI in the hospital. If your worried that the patient is going to become combative and cause harm to you, soft restraints and a versed/benadryl combo will certainly make them sleepy without having to take away the patients respiratory drive.
> 
> I also certainly agree that it has its indications, but I feel as though there are medics out there that will RSI any difficulty breathing patient to "protect their airway" just so they can play with their flashy cool toy. My opinion is that it should not be used unless the patient is going to loose their airway and respiratory drive anyway.



I think you're misunderstanding what RSI is for. Responsible paramedics RSI their patients BEFORE they're behind the 8 ball on airway management. I've never considered RSI a "flashy new toy" and I think you'll find most medics who've been trained and vetted by medical directors to perform RSI take the decision to perform the procedure seriously. 

As I mentioned, we usually simply sedate our Bath Salts/excited delirium patients, but I wouldn't hesitate to RSI one of these patients if I felt that I may encounter airway management issues during my contact. 

You should know that "BLS measures" like an LMA or King work only on deeply unresponsive patients or dead people. If you've got a patient fighting you, he's got a gag and last time I looked that was a contraindications to an SGA. 

And as a point of note, paramedics in my system perform far more RSI and airway management procedures than the ED docs.


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## Brandon O (Sep 18, 2013)

DEmedic said:


> And as a point of note, paramedics in my system perform far more RSI and airway management procedures than the ED docs.



Why do you think that is?


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## EMT B (Sep 18, 2013)

DEmedic said:


> I think you're misunderstanding what RSI is for. Responsible paramedics RSI their patients BEFORE they're behind the 8 ball on airway management.



Yes, RSI is to prevent getting behind on your airway management. But what is the real benefit to RSIing the bath salts patient that has been managed by more basic methods before?

Maybe I should just give up, as it appears I am missing something..


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## chaz90 (Sep 18, 2013)

EMT B said:


> Yes, RSI is to prevent getting behind on your airway management. But what is the real benefit to RSIing the bath salts patient that has been managed by more basic methods before?
> 
> Maybe I should just give up, as it appears I am missing something..



It's not an airway issue. It's management of the patient overall. If the patient is in such a great danger of hurting themselves or others and can't be safely restrained by other means, RSI allows complete control. Not all bath salts patients will need it, but it's something to keep in mind.


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## NomadicMedic (Sep 18, 2013)

Brandon O said:


> Why do you think that is?



Because we fly the majority of head trauma patients and intubate most of them. Because we are a small system that sees a fair number of sick and critically injured patients that require emergent airway management and we are proactive in managing the airways of patients that may become unstable during a long transport. The same as any other service that practices true RSI and doesn't just half *** it by trying to tube somebody with versed and brutane. 

Also, many of the ED docs simply don't intubate enough patents to stay competent, by their own admission. 

Trust me, an "unnecessary RSI" would be immediately flagged in QI.


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## Brandon O (Sep 18, 2013)

Makes sense to me.


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## NomadicMedic (Sep 18, 2013)

EMT B said:


> Maybe I should just give up, as it appears I am missing something..



Probably a good choice.


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## Carlos Danger (Sep 18, 2013)

Aprz said:


> You've been listening to wanna be progressive paramedics who talk about all the bleeding edge stuff in paramedicine, or you are making the same mistake as them.
> 
> BLS before ALS is a lie.
> 
> ...



I strongly disagree that "BLS before ALS is a lie", or that advocates of BLS management are "wannabe progressive paramedics". That doesn't even make sense. Many times I've seen paramedics make serious mistakes that could have been avoided or saved by reverting to good BLS management. 90% of airway problems alone could be avoided if paramedics simply had stronger BLS airway skills.

Prehospital intubation has been increasingly questioned because it often leads to adverse outcomes. Even in systems that have good success rates, it is often impossible to demonstrate that it improves outcomes.

It has actually never been proven that ETI is "the gold standard" in prehospital airway management, and frankly I think the "ETI prevents aspiration" thing is waaaay overblown. I would be willing to bet that prehospital ETI has caused more harm than it has saved by preventing aspiration. 

I think it still has its place, but only in select systems. IMO most prehospital advanced airway management should be SGA only.




EMT B said:


> Maybe I should just give up, as it appears I am missing something..



I don't think you are missing anything; in fact I think your point of view is quite valid. It is just more conservative than many want to hear.


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