NAEMSP: Small Agency Makes Big, Deadly Find

One day the two men had been in a minor crash and refused transport. The next, unexpectedly, both abruptly became critically ill, with altered levels of consciousness. “I think we might have a problem,” a lieutenant at New Mexico’s Laguna Pueblo Fire Rescue told medical director Chelsea White, MD, NRP, FAEMS, FACEP, on that second day in 2020.

The first patient was now en route to the hospital. The second had gone to a small Indian Health Service hospital and was being flown on to Albuquerque. Both were extremely sick. The crash records were pulled but offered no clues, White recounted Friday at the National Association of EMS Physicians’ annual show in San Diego.

The culprit, it turned out, was hand sanitizer.

Turned out as part of its COVID mitigation measures during that initial wave in 2020, the government of New Mexico had closed the reservation’s borders. Alcohol consumption subsequently increased, and alcohol-use disorders were significantly exacerbated. When roadblocks brought prohibition, people turned to other sources of intoxication—and hand sanitizer was everywhere.

Both patients had dangerously high levels of methanol, having apparently consumed it after their accident. The first went into cardiac arrest in transit; his crew achieved ROSC, White said, but he was extremely dire when left at the ED, and both later died.

When White and his team realized the men had been poisoned, they contacted police, who found the bottle the men had consumed. The New Mexico Department of Health subsequently investigated possible bootleg sanitizers and tainted production processes. An online search for brands disapproved by the FDA turned up many from manufacturer Blumen—the name on the responsible bottle in this case.

There had been other deaths from drinking hand sanitizer in New Mexico as well as neighboring Arizona, so authorities provided education and warned users against methanol products. It was an exciting and high-profile catch for a small department, White said, and showed the importance of even small-scale quality improvement efforts—here a regular chasing down of repeat calls became a public health surveillance tool.

—John Erich, Senior Editor

Abo Goes Inside Fla. Condo Collapse

Ben Abo, DO, PMD, FAWM, one of the nation’s leading USAR physicians and Miami-Dade’s Florida Task Force 1 USAR physician, gave the Friday NAEMSP opening session on the June 24, 2021 Surfside apartment building collapse. The incident started as a partial wall collapse/water-flow alarm that soon escalated to a massive structural collapse that cost 100 lives. It was the third-largest single building disaster in U.S. history.

Abo showed compelling Ring camera video from one apartment that allowed the NAEMSP audience to hear the sound of the snapping rebar as rescuers continued evacuations, the rebar started to fail, and the entire structure started to collapse.

He also played video that showed why the USAR team and other rescuers has to occasionally stop “sloshing” in the lower collapse/parking deck area so they could listen for the sounds of trapped survivors.

The stress of not being able to reach all trapped survivors was sobering. Abo reported counseling rescuers to take comfort that one trapped female victim they communicated with but could not reach before she died “knew we [they] were attempting to get to her.”

Abo thanked fellow NAEMSP speaker Joe Holley, MD, and his wife Kim, both Tennessee Task Force 1 members, for deploying to this tragic incident.

—A.J. Heightman, MPA, EMT-P

A Mnemonic for Post-ROSC Care

Delaware state EMS medical director Robert Rosenbaum, MD, FACEP, FAEMS, outlined some simple adjustments made by his state’s New Castle County EMS—and a simple mnemonic to remember them—to boost cardiac arrest results.

Concerned by a 2018 downturn in survival, leaders formed a performance improvement work group that reviewed cases and delved into cases with field supervisors, looking for patterns. One area it identified to improve were things done in the first five minutes post-ROSC. When they got a pulse back, Rosenbaum said, many providers just chose to head for the hospital. Instead, they now perform a few basic measures on scene first, summarized by the mnemonic SAVE A LIFE.

• Stabilize: Stay on scene instead of rapidly departing to help ensure ROSC is sustained.
• Airway: Compressions, airway management.
• Vascular access/vitals: Get at least one IV if only IO access; change monitor to q3 for increased frequency of vitals.
• External cooling: Ice packs.
• Amiodarone: A second dose after ROSC was sometimes neglected.
• Levophed/LUCAS: Focus on cerebral perfusion pressure, with a goal MAP of more than 80.
• Internal cooling: With chilled saline.
• Follow-up vitals: Check stability before departure.
• EKG: Prefer delayed for accuracy.

The changes began in 2019, with ongoing education and other support. Results were positive, with norepinephrine admin rates topping 90%, more patients reaching the goal MAP, and all 2021 survivors with CPC scores of 1.

—John Erich, Senior Editor