In an ongoing effort to advance the knowledge and skills of emergency medical special operations personnel, the New York City Fire Department (FDNY), in partnership with the FDNY Foundation, invites first responders to attend the third annual Medical Special Operations Conference (MSOC) to kick off EMS Week.
MSOC will take place at FDNY’s expansive academy on Randall’s Island on Saturday, May 16, and Sunday, May 17. According to FDNY Deputy Medical Director in the Office of Medical Affairs Douglas Isaacs, MD, one of the key developers of the event, this year’s conference will offer workshops, lectures, panel discussions, hands-on skills opportunities and a vendor area that features the latest medical and rescue special operations equipment and products.The conference provides an opportunity for specialists to experience some of the more complex and challenging areas of emergency medical response.
The goal of the MSOC is to provide a venue to discuss, illustrate and practice the best medical approaches to complex incidents, and improve the morbidity and mortality of patients in an austere environment previously unavailable outside of an actual event.
An optional one-day preconference workshop on May 15 will feature a hands-on bioskills cadaver lab and workshops on canine critical care, casualty air evacuation and special boat operations, concluding with a visit to the World Trade Center (WTC) Memorial for a special tour hosted by FDNY.
Rave Reviews for Last Year’s Conference
Last year’s participants told JEMS reporter Annamarie Robertone the FDNY MSOC should be mandatory for anyone operating in the medical special operations environment, a testament to the content and instructors featured at this unique conference.
Robertone attended last year’s conference and found not only the content to be a unique opportunity and experience for attendees, but also the FDNY facility to be a superb venue for emergency personnel to learn important aspects of medical special operations in a realistic training environment.
Attendees included EMTs, paramedics, physicians, medical specialists, educators and leadership from some of the country’s top urban search and rescue (USAR) teams, as well as the military, fire and EMS communities. The day concluded with a 9/11 remembrance ceremony at the WTC site and a meet-and-greet reception with the fire commissioner and chief of EMS at the New York City Fire Museum.
The two-day event featured lectures from some of the country’s top USAR teams, as well as hands-on skill and scenario workshops consisting of patient packaging in a subway simulator, confined space maneuvers in a collapsed structure, medical scenarios with high-fidelity manikins simulating entrapped patients, and ultrasound examination using live models utilizing the extended focused assessment with sonography for trauma method.
Subject matter experts shared past disaster experiences, which revealed strategy, equipment, technology and skills that have been utilized to improve patient care. Robertone’s report follows, presenting some key learning points from just a few of the lectures presented at the MSOC.
Katie Roberts, EMT-P, with Federal Emergency Management Agency (FEMA) USAR California Task Force 3, noted USAR members have learned that hazardous materials (hazmat) operations and concerns have to be considered at terrorist incidents, citing how past deployments have shown emergency operators are always working in an environment that contains contaminants or hazmat such as concrete dust, particulates, carbon monoxide and hydrogen sulfide. Areas that need to be considered in these environments, in addition to proper personal protection equipment (PPE), include air monitors, radiation detection equipment and chemical-protective clothing.
Roberts stressed that not protecting airways from the dust and particulates, often present at collapses like the WTC, can cause life- and career-altering medical issues, as can carbon monoxide from gas-powered equipment.
Mike Kurtz, EMT-P, medical coordinator for FEMA USAR Pennsylvania Task Force 1, discussed common issues at various deployments.
Medical issues that will be encountered at earthquakes:
>>Dehydration should be your No. 1 priority;
>>Be ready to treat hand injuries, simple lacerations and strains; and
>>Be alert to stress and aftershocks.
Medical issues that will be encountered at hurricanes include: dehydration, feet pain and blusters, rashes, puncture wounds, and abrasions.
Christopher Ho, MD, of FEMA USAR California Task Force 8, presented important bariatric patient care strategies that should be used when assessing obese patients:
>>Check lung sounds at the border of the scapula because there’s less adipose tissue;
>>Listen for heart sounds (laying the patient on their left side);
>>Use the tip of the nose and ear lobes for pulse oximeter placement;
>>Oxygenate by using combinations of nasal cannula, non-rebreather and continuous positive airway pressure;
>>Patients shouldn’t be laid flat because it causes the chin to tip forward, occluding the airway. Instead you should build a wedge by using layers beginning at the point of the scapula up to the head to open the airway; and
>> If one airway is good, three are better: place nasopharyngeal airways in both nostrils in addition to an oral airway.
Jorge N. Hernandez, MD, of FEMA USAR Florida Task Force 2, presented important pediatric pearls:
>>Placing a 1″ pad on a backboard at the level of the shoulders puts the spine in alignment and opens the airway;
>>Until age 8, pediatric nasopharyngeal structures are narrow;
>>Pediatric tracheas are short, their tongues are large, and their tracheas are prone to collapse;
>>Classically, because the necks of pediatric patients are so short during their early years of development, you won’t see jugular vein distention;
>>Intraosseous access should be considered early in the treatment algorithm; and
>>Crews should always watch for airway obstruction and pneumothorax in pediatric patients.
Dario Gonzalez, MD, FACEP, of FEMA USAR New York Task Force 1, noted special considerations in medical monitoring and supervision of personnel:
>>Criteria for team physical requirements must be established and followed;
>>The baseline physical assessment should include: vital signs, past medical history, present medical history and medications currently being taken;
>>There needs to be an ongoing evaluation of a responder’s fit for duty status to make the determination if rescuers is are “good to go”; and
>>After effects of each incident on the responder needs to be assessed and there should be a structured support system in place for personnel.
Jennifer Brown, DVM, of FEMA USAR Florida Task Force 2, presented important considerations for USAR canine care:
>>Know the canine “partner” from head to toe, perform a physical assessment and take canine vital signs every morning the dog is on the job;
>>Watch for limping, elevation of the head or flinching by the canine when you compress or palpate a hurt or injured paw or leg;
>>Learn to recognize what’s normal for each dog;
>>Check the mouth for symmetry and assess capillary refill (should be less than 2 seconds);
>>Check breathing patterns—the normal range for canines is 6–20 bpm, up to 40 with exertion/exercise;
>>Lung sounds should be clear, there shouldn’t be crackles or wheezes
>>The average working dog (60–100 lbs.) will have a resting heart rate of 60–100 bpm; up to 120–140 bpm with exertion/exercise; and
>>Operators should know how their canine behaves at different times throughout the day, including how the dog responds to food and other stimuli.
Joseph Holley, MD, medical director for FEMA USAR Tennessee Task Force 1, reviewed seldom-used cache drugs medical operators must be knowledgeable about and discussed medications in the current USAR cache. These included sedatives, paralytics, veterinary and topical medications. He also pointed out how ketamine can and should be utilized during USAR medical care.
Anthony Macintyre, MD, medical director for FEMA USAR Virginia Task Force 1, presented case summaries from USAR rescue experiences and noted that:
>>Basic elements provided in training developed by Joseph A. Barbera, MD, over the past two decades still hold true, and advanced procedures are usually less useful in these unique situations; and
>>The unique aspects of USAR mandate that multidisciplinary coordination occur to affect safe patient extrication.
A field limb amputation workshop conducted at the North Shore LIJ Bioskills Education Center featured a lecture discussing the historical background of field limb amputation, followed by a review of the necessary supplies and equipment, as well as some alternative equipment options. Instructors pointed out the indication and superior clinical judgment required to make the decision to perform a field limb amputation and the complexities surrounding the actual procedure including coordination between rescue, structure and medical teams required to safely extricate a patient.
Following the lecture, participants received hands-on experience and practiced the steps of performing a field limb amputation in the bioskills lab with experienced trauma and emergency medicine physicians. They also had the opportunity to learn how to obtain humeral and sternal intraosseous access as well as a chance to hone their airway management skills using advanced techniques and equipment.
Registration for MSOC