Forty medical directors from some of the largest population and call volume EMS systems in the U.S. and other countries—representing a cumulative 450+ years of medical direction experience—attended the Eagles‘ annual Eagle Creek closed retreat in Dallas Texas. The group conducted a lively roundtable of issues being confronted in their systems.
Exact details and discussions are restricted to attendees, but we can say that the following topics were reviewed and considered for future action.
Roundtable of EMS Issues
- Airway management
- Proper management of patient refusal
- Unsafe driving practices
- Transporting to free-standing clinics or suburban EDs with no inpatient beds
- Management, restraint and transport of psychiatric patients
- Rise in demand/call volume
- Delays in hospital turnover of patients
- Chronic staff vacancies
- Increasing costs of Narcan (naloxone)
- Rise in opiate overdoses, especially fentanyl
- A need to change the way we perform cardiac arrest resuscitation
- Budget restraints limiting the purchase of new equipment
- Provider stress
- Dual paramedics (with one weak provider) and how we can assist them in getting better
- System abusers (repeated callers for assistance)
- Medication mistakes in the field
- Provider credentialing issues (missing lapses and remedial action needed)
- Putting trauma kits in areas of mass gatherings
- Recruiting medical directors in suburban and rural areas
- How can we increase self-reporting
- Innovative ways to provide continuing education
- Staffing of shifts
- Pay level for personnel
- At what point do we stop codes during long transports?
- Keeping quality EMS as a top priority in fire departments
- Convincing top service leaders to spend money on EMS training
- Increasing number of high-acuity calls due to an aging population
- Redirection/diversion policies
- Downgrading poor performaning paramedics to the EMT level of care and responsibility
- Double sequential defibrillation
- Getting the right patient to the right hospital (especially when hospitals go on diversion)
- Motivating some paramedics to stay certified and involved at the ALS level
- Cost involved in throwing out expired items
- Keeping providers refreshed in high difficulty/low frequency skills
- Encouraging bystander CPR
- Integrating critical care nurses into in-ambulance care
- Getting data back from receiving hospitals
- Convincing hospitals to start ECMO starting during cardiac arrest
- “Blue Flu” —When crews don’t want to work overtime or extra shifts/events.
- What is the acceptable dispatch error rate (miss-categorizing high acuity calls)?
- Need for police K-9 officers to carry naloxone for dogs that collapse from sniffing drugs
- Placing “Stop the Bleed” kits in police vehicles and at special event venues
Follow jems.com for more detailed information from A.J. Heightman at the Eagles Conference in Dallas as it continues through Feb. 20.
Eagles in attendance on day one of the Eagles (Eagle Creek) closed retreat were:
Peter Antevy, medical director, Miami, Fla.
Glenn Asaeda, chief medical director, New York, N.Y.
Stein Bronsky, medical director, Colorado Springs, Colo.
Chuck Burnell, chief medical officer, Acadian Companies
Jose Cabanas, medical director, Raleigh, N.C.
Libby Char, medical director, Honolulu, Hawaii
Thomas Collins, medical director, Cleveland, Ohio
Kevin McVaney, medical director, Denver, Colo.
Marc Conterato, medical director, Minneapolis, Minn.
Eric Cortez, associate medical director, Columbus, Ohio
James Dunford, medical director, San Diego, Calif.
Sophia Dyer, medical director, Boston, Mass.
Marc Eckstein, medical director, Los Angeles, Calif.
Craig Ellis, medical director, St. John, New Zealand
Ray Fowler, regional medical director, Dallas, Texas
John M. Gallagher, medical director, Wichita, Kansas
Scott Gilmore, medical director, St. Louis, Mo.
Jeff Goodloe, medical director, Oklahoma City and Tulsa, Okla.
Andrew Harrell, medical director, Albuquerque, N.M.
Joe Holley, medical director, Memphis, Tenn.
Jon Jui, medical director, Portland, Ore.
David Keseg, medical director, Columbus, Ohio
Michael Levy, medical director, Anchorage, Alaska
Don Locasto, medical director, Cincinnati, Ohio
Craig Manifold, ACEP liaison, San Antonio, Texas
Chuck Mason, medical director, Little Rock, Ark.
Crawford Mechem, medical director, Philadelphia, Pa.
Fionna Moore, former chief executive, London, U.K.
Neha Puppala, associate medical director, Washington, D.C.
Paul Pepe, medical director, Dallas, Texas
David Persse, medical director, Houston, Texas
Jay Reich, medical director, Kansas City, Mo.
Neal Richmond, medical director, Fort Worth, Texas
Ron Roth, medical director, Pittsburgh, Pa.
Michael Sayre, medical director, Seattle, Wash.
Ken Scheppke, medical director, Palm Beach, Fla.
Terry Valenzuela, medical director, Tucson, Ariz.
Joe Weber, medical director, Chicago, Ill.
Jeff Williams, deputy medical director, Raleigh, N.C.
Arthur Yancy II, medical director, Atlanta, Ga.