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Katrina & the Future of Prehospital Care: Topics of Discussion at EMS Today 2006

Approximately 3,500 EMTs, paramedics, nurses and medical directors from more than 20 countries and 44 states, as well as more than 230 exhibitors, gathered in Baltimore March 21Ï25 for the 24th annual EMS Today Conference & Exposition. With more than 100 classes and 85 speakers, the educational program represented a thorough snapshot of the most urgent and relevant issues to the EMS community. The exhibit hall had a buzz, excitement and overall energy that everyone felt.

Reflection was a common theme of many sessions, particularly those with a focus on mass casualty incidents. As with any large-scale disaster, Hurricane Katrina and its tragic aftermath provided a number of lessons, painfully learned, and a special evening session on Wednesday, March 22, focused on the specific lessons that came out of the emergency response to Katrina.„

˙EMS Lessons Learned from Hurricane KatrinaÓ was presented by Kenneth Bouvier, a Louisiana fire chief and special events coordinator for New Orleans EMS; Mark Reis, deputy director of New Orleans EMS; and Julette Saussy, MD, New Orleans EMS medical director. Together, they painted a vivid picture of the chaotic days following Katrina_s initial impact. Many of the stories were familiar, but colorfully presented here by those directly involved. The speakers described the specific challenges they faced in dealing with the hordes of affected flood victims ƒ while acknowledging that they themselves were also victims. They relayed stories of first responders tirelessly working to help others while their own lives and families were in danger, using whatever materials they had available to them to fashion makeshift rafts and transport patients.

Bouvier said he had anticipated that Katrina would be bad, but he never imagined it would be as devastating as it ultimately was. He described the feeling of dread when he heard the levies had broken, knowing full well how the city would be affected and the challenges first responders would face.

The speakers identified several key areas of concern highlighted by the frenzied Katrina relief efforts. As with many previous MCIs, one of the biggest issues was communication. Dr. Saussy discussed the complete lack of communications with other crews around the city: ˙No radios, no cell phonesƒnothing.Ó It was nearly impossible to coordinate with other groups, which left many first responders alone to deal with hordes of confused people in need of aid and care.

Dr. Saussy also talked about the difficulties in dealing with FEMA and military workers, whose reaction to her suggestions and complaints ranged from indifference to hostility.

Despite the difficulties and chaos of the Katrina response, the speakers highlightedƒto great fanfare from attendeesƒthe fact that all New Orleans EMS personnel showed up for work, a remarkable achievement in light of the much-publicized defections in some other public safety agencies.

The show_s opening keynote on Thursday, March 23, also focused on the Katrina aftermath. Dr. Norman McSwain, director of trauma for Tulane University Medical Center (TUMC), spent five days trapped in a flooded hospital with his staff and patients after Katrina hit. The situation was bleak, and Dr. McSwain and staff were forced to be extremely resourceful in caring for their existingƒand legions of incomingƒpatients without basic needs like electricity, water and food.

Dr. McSwain described a nightmarish environment in which chaos had to be carefully managed. With flood victims looking for shelter clamoring for admittance to the medical center, TUMC staff had to turn away all but those needing immediate medical attentionƒand prepare themselves for angry, frustrated responses.„

He shared an amusing, if sobering, anecdote about a Marine sharpshooterƒthe extent of the military force assigned to TUMC. The sharpshooter spent several sleepless days roaming the perimeter of the hospital, making deadpan observations about the sorry state of things.„

In addition to the various educational sessions and exhibit hall, EMS Today 2006 was marked by the acknowledgement of many great achievements in the profession.„

The men and women of Acadian Ambulance Service in Lousiana were honored with the 2006 James O. Page/JEMS Award. The award encourages EMS personnel and agencies to deliver quality service, gain the respect of their colleagues in the field and fight to do what_s in the best interest of patient care and EMS in their community. This year, the men and women of Acadian Ambulance Service are being collectively honored for their heroic efforts under some of the worst conditions in U.S. history as a result of Hurricanes Katrina and Rita.„

The review committee recognized the personal and professional sacrifices by Acadian_s staff, such as the fact that Acadian_s administration offered without hesitation all of its resources for the unprecedented medical evacuation efforts, not knowing if they would ever be reimbursed, and that Acadian_s employees, many of whom lost their homes and all of their personal possessions, put in more than 43,000 hours of overtime in the first five weeks immediately following Hurricane Katrina.

Most importantly, under the criteria of the James O. Page/JEMS Award, Acadian Ambulance employee-owners_ actions resulted in EMS system operational changes that cut through bureaucratic red tape and significantly improved the delivery of care and patient evacuation during Hurricanes Katrina and Rita.

This year's winner of the 2006 Nicholas Rosecrans Award for Excellence in Injury Prevention is Gary Gustafson from Marquette County, Michigan. A certified child passenger safety technician and program coordinator, he has been actively involved in pedestrian safety, stranger safety, home safety and bicycle safety programs. A strong injury prevention advocate, he was instrumental in starting Camp 911, a weekend program for sixth graders that focuses on safety awareness, injury prevention and first aid skills. For more information on Camp 911 and other injury-prevention programs, look for an article in a coming issue of„JEMS.

Finally, the Prehospital Care Research Forum (PCRF) award for Best Research went to Dawson Brian, MS-IV, John E. Gough, MD, and Kori L. Brewer, PhD, for their study, ˙ED Visits & Hospital Admission Rates Following EMS No-Transport Calls.Ó The PCRF award for Best Oral Presentation went to Kurt Kainsinger, MPH, EMT-B, for his study, ˙Provider Attitudes & Perceived Barriers to Prehospital Pain Management.Ó These abstracts and other EMS studies can be read in ˙The Prehospital Care Research Forum Presents ...,Ó in the March 2006„JEMS.

EMS Today finished up appropriately with a look toward the future of medical care in a March 25 closing keynote from William Atkinson, PhD, president and CEO of North Carolina_s WakeMed Health & Hospitals health-care system, and the 2003 James O. Page/JEMS Award winner. In his speech, ˙Advances in Clinical Care & Delivery: Changes Coming to EMS over the Horizon,Ó Dr. Atkinson highlighted some of the many new technologies that promise to revolutionize emergency care.

Dr. Atkinson discussed the pace at which advances in science, medicine and technology are occurring, and the impact they_re having on some of the more advanced research centers and hospitals. This impact, Dr. Atkinson said, will extend to prehospital care settings and systems in the very near future.

He addressed such specific technologies as inventive non-invasive surgery devices and stent technology that promises to greatly reduce the chance of complications following the clearing of arterial blockages, as well as some advances a little further down the road. Atkinson hinted at a future in which more under-funded facilities will benefit from new technologies and be able to provide better patient care to all ƒ a goal shared by everyone who attended the 2006 EMS Today Conference.

Editor_s note: EMS needs an increasing body of knowledge to advance the profession. That_s why„JEMS joins PCRF in encouraging you to make prehospital care research a priority in your career. The future of EMS depends on it. To help EMS providers fulfill that mission,„JEMS is offering a $2,500 research grant for a study on one of the following topics: 1) the impact of implementing one of the revised performance techniques, medication delivery or other change in the updated AHA Cardiac Care Guidelines, or 2) the impact of a change in response time targets, staffing or other EMS system change. To download a grant application,„click here. The deadline to submit an application is May 1, 2006, and the winner will be announced in July.


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