This week, I traveled to Topeka, Kansas, and joined Brad Matzke, RN, CFRN, a Flight Nurse/Marketing Director for Life Star of Kansas, on Monday and Tuesday, March 24 & 25, for a series of educational roadshows in western Kansas. The two educational forums were offered by Life Star for services located in two of the rural regions they serve.
A Near-Death Experience on the Way to Maryville
On Monday night, as Brad and I drove west on two-lane I-70 rural highway for an hour and 45 minutes to get to Marysville, Kansas, 110 miles away. On the long drive we talked about the changes and advances that had occurred over the past 22 years, such as front and side airbags that almost eliminated those long, difficult extrications that occurred after grinding head on collisions; adult introsseous/EZ-IO drills; ventilators and other devices important to the resuscitation of trauma patients.
I then joked with Brad, a 22-year aeromedical flight crew veteran, that we should've been flown by Life Star helicopter to get there.
He said, “Be careful what you wish for, we’d have to be critical trauma patients to get that ride!”
I laughed and said, “No thanks."
Then, all of a sudden, we both saw a situation occurring ahead of us that didn't look good. There was a tractor trailer traveling in the opposite direction, about 100 yards away from Brad’s car, and a car trying to pass the truck—in our lane. All the vehicles were traveling at 70+ mph, so everything was happening very fast.
We both suddenly realized that the truck was not allowing the car to get past him, and the car was not leaving his position – in our lane. He was headed directly for us.
Brad stayed his course, hoping the car would slow down and duck in behind the tractor trailer. But he didn't.
It looked like it was going to hit us head on. I must admit that my initial thought was, “Oh boy; Is this how my life is going to end?”
Then, with only a few seconds before impact, the driver of the car bearing down on us swerved to his left, onto the shoulder of the road on our side, and both vehicles flew by us in a flash; the tractor trailer on our left and the vehicle that was headed for us—on our right.
It happened in seconds, like a scene in an action movie. Brad and I both took a big breath (and I called out a few choice words that the driver couldn’t hear), then we each expressed disbelief that we weren't in a high-speed, head-on collision. I’ll never joke about wanting a ride in a Life Star helicopter again!
We then continued to Marysville and I presented three hours of educational lectures: Challenging Your Clinical Boundaries; Diabetes, Morbid Obesity, Hypertension and All Medical Conditions Made Easy to Understand; and Undercover Assignment: Assessing and Care for Abdominal Trauma Victims.
My presentation, Challenging Your Clinical Boundaries, reviewed my take on innovations, issues, processes and procedures I feel will change the way EMS crews respond and operate in the future.
I addressed the following areas with the predominantly BLS audience, which also consisted of ED physicians and nurses from the community’s hospital: New models for fire first response with limited resources; use of Narcan (naloxone) and Epi-Pens by the public, law enforcement, BLS and fire first responders crews; BLS use of CPAP and other, previously ALS procedures; the importance of using a “pit crew” approach to resuscitation; the merits of delivery “upstroke ventilations” after every 10th compression; and use of mechanical CPR devices such as the LUCAS 2 (Physio-Control) and AutoPulse (ZOLL) units in place of manual compressions, citing positive results being experienced by many systems deploying the devices; the need to continue resuscitations for more than 20 minutes before terminating codes (because there's now evidence that patients can be resuscitated after more than 90 minutes, particularly when mechanical compression devices are utilized); the use of capnography to detect septic shock; the transitioning of EMS crews into the "warm zone" at active shooter incidents; the need for EMS and police responders to carry and use wound clot dressings, chest seals and tourniquets (citing the need for all emergency response units to carry at least four (4) tourniquets per vehicle because of the probability of multiple amputations after an IED explosion and at mass casualty incidents.
I also reviewed new technology and equipment being used in the field, such as: oxygen tissue saturation (StO2) devices; the iTClamp for hemorrhage that cannot be controlled by tourniquets and other conventional means; the ResQPod that increases intra-thoracic pressure during resuscitations; the ResQGUARD mask/valve that increases blood pressure in a non-invasive manner; ECMO (extracorporeal membrane oxygenation) in hospital centers of excellence for acute respiratory conditions heretofore used primarily on newborns; the use of the REEL Splint System (used extensively by the U.S. Military) to rapidly immobilize fractures and dislocations in the field; and the use of vacuum mattresses and splints in place of long spine boards,
I concluded by stressing the need for the services to start carrying tourniquets, wound clot dressings and begin using CPAP, a pit-crew approach to CPR, continuous compression CPR, Upstroke Ventilations (one quick breath after every 10th compression) and epi-pens at the BLS level – just as they are all across the United States with great results.
I also encouraged the ED staff to begin using a mechanical CPR compression device—a trend I believe is on the horizon as more and more systems (and EDs) show signification ROSC because of the consistency of these devices.
As I did at a recent presentation in Cincinnati, I presented an important and compelling segment that reviewed the potential harm responders can do if they inappropriately apply cervical collars and stretch the spinal cord of their patients. To view a more detailed presentation on this important issue, first presented by Houston Fire Dept. EMS Medical Director David Persse, MD, and physician researcher, Peleg Ben-Galim, MD, at “Eagles” conferences in Dallas, in 2010 & 2011, go to:
2010 detailed presentation
Day 2: Off to Junction City, Kansas
Tuesday night, Brad and I, undaunted by our near-miss experience the night before, traveled 65 miles from Topeka to Junction City, Kansas, a quaint, rural town 65 miles northwest of Topeka.
We arrived early so I got a chance to tour the Junction City Fire and EMS Headquarters, located a block from the town’s Opera House where I was scheduled to speak to EMS folks and ED staff.
As Junction City Fire Chief Kevin Royse gave me a tour of his station and their state-of-the art rigs and equipment, I noticed that a photo of their old headquarters on the wall in the lobby looked like the Opera House we just left.
He then told me that the Opera House had originally been the town’s fire headquarters back in the day of horse-drawn engines. I took some photos to share with you because the rare images show firefighters preparing to hitch the horses to the steam engine via harnesses that were lowered down from the ceiling. It was an amazing collection of historic images I wanted to share with you. So we are presenting them here for you on a JEMS.com photo gallery.
I presented three lectures in Maryville to EMS services from throughout Northwestern Kansas: MCI Management: Critical Actions Necessary in the First 30 Minutes; Chest Trauma: The Silent Killer; and Diabetes, Morbid Obesity, Hypertension and All Medical Conditions Made Easy to Understand. The attendees at this educational forum also included EMS responders as well as ED physicians and nurses from the community’s hospital.
About Life Star of Kansas
Life Star of Kansas is a not-for-profit corporation owned by Stormont-Vail HealthCare and St. Francis Medical Center, both of Topeka, Kansas. Life Star’s administrative operations—communications center, billing office and administration services are located at Forbes Field in Topeka.
The program started operation in late 1987. It received accreditation by the Commission on Accreditation of Medical Transport Systems (CAMTS) in 1996, the first air-medical program in their four-state region to do so and one of the first in the country. (Accreditation requires a voluntary review of all aspects of the operation—aviation, clinical and operational—to outside experts every three years. Current practices are assessed against the high standards of accreditation, and Life Star has successfully reaccredited with each survey.)
Life Star has a 24 hour “west” base in Junction City, Kansas, 70 miles west of Topeka, located at Freeman Field in Junction City and operates 24-hours per day, seven days per week.
Life Star also operates a 24-hour “east” base in Lawrence, Kansas at the Lawrence Municipal Airport.
Life Star of Kansas has flown a number of different types of aircraft throughout its history. Starting in a Bell 206 L1 Long Ranger, the service has flown BK 117s, one BO 105 and one AS 350 B3.
Life Star of Kansas now utilizes two AS 350 B2s and one AW 119 Kaola. They select their aircraft based on safety of aviation operations, speed and patient care capabilities. All Life Star pilots receive factory training on the aircraft they fly, along with annual refresher training and quarterly check rides.