The 17th Annual EMS STATE OF THE SCIENCE: Gathering of Eagles Conference, “Dedicated to the Men and Women of EMS Who Advocate Daily for the Sick and Injured” ended as it started, jam packed with topics, faculty and attendees ready to dive into, and learn about, the latest “State of the Science” in EMS, much of which was reported in the latest JEMS/Eagles State of the Science editorial supplement.
JEMS Coverage of 2015 Gathering of Eagles
Highlights: Part 1 | Part 2 | Part 3| Part 4
End of Another EMS “Deployment”
The end of the 2015 Gathering of Eagles EMS State of the Science Conference on Saturday, for me, a non-physician journalist, as well as the 60 men & women of “EAGLES” represents much more than a week of education. It represents the end of another EMS deployment.
The attendees at this year’s Eagles Conference were treated to their annual glimpse of clinical trends, big system progress and challenges and technological advances through 10-minute reports from the Eagle Flock.
The audience is aware of, and respects, that none of the 60 medical leaders traveling to Dallas are compensated for their time. They are also amazed that the five dozen Eagle physicians who all have a myriad of projects, problems and issues back home on their respective “battlefields” carve a week of their lives out annually to dive into the issues and walk away with an education of their own and re-energized to continue to put up the “good fight” and continue to change and advance EMS care to a population that not only needs it, but deserves it.
These incredible physicians, who travel from all across America, as well as from systems as far away as Canada, Great Britain, New Zealand and Australia, have to work on a daily with resistive hospital administrators, mayors, county councils and fire chiefs, as well as field providers frustrated with continual changes in clinical methods and messages, and unions that don’t want shifts from tradition, diversion from the members’ daily routines and functions to become engaged in areas like mobile integrated health care or the social or psychological medicine expansion.
But they come, participate and thrive on the energy that comes from one of the most prolific, powerful and well-educated group of fraternity brothers and sisters in the world, the Eagles coalition, a group that does not set standards nor lobby on Capital Hill.
Their power is in their camaraderie, their daily emails within their small “nest”, their cell phone calls to each other, and their ability to come to consensus on issues that take many large organizations and professional associations years to accomplish.
What you don’t get to see is a look inside the War Room where the Eagles, the true Field Generals of the clinical side of EMS, meet for two days before the annual conference.
Eagles Creek which occurs annually on the two days that precedes the Eagles Conference, is a closed retreat that consists of a rapidly moving marathon of high-level talks, debates on issues of great importance to the EMS community; program and personal reflections; good-natured sarcasm, and plenty of laughter behind closed doors at the conference hotel.
I am privileged to be a Sparrow among the majestic Eagles, able to synthesize and digest 20+ hours of breakfast gatherings, closed sessions and evening dinner meetings which allow me to then professionally present the powerful messages (often between the lines) to you, the foot soldiers of the EMS revolution.
Thoughts and sentiments of the Eagles Medical Directors was aptly summarized in a note to the group by James Augustine, MD, FACEP, Eagles archivist, as he departed Dallas on Sunday. He has allowed me to present it here:
I want each of you to know how much I appreciate the time learning from all of you, and the people who admire and work with you. We have a very special group of people, and as I get old and cranky and opinionated, I can’t imagine another group of 60 or so people that I could spend four days with.
And I look forward to it a little more each year. The audience is always amazed that we keep a patient-focused theme through all these years, and I really think that is one of the wonderful attributes that makes this meeting so different.
I have a list of about 40 items to try to accomplish when I get home, thanks to all of your ideas.
Coordinated by Dr Paul Pepe, this year’s Eagles conference focused a lot on new advances in resuscitation, significant discussion about termination of calls, pain medication and reduction of call volume through areas of mobile integrated health.
Perhaps one of the most interesting segment of this year’s Eagles conference was when Dr Pepe, while coordinating the traditional Gathering of Eagles on the stage, asked the senior Eagles to position themselves on either side of the stage invited medical directors from all over the country from smaller EMS system then the normal Eagles contingent, to take center stage and become involved in discussion with not just the audience but also the regular Eagles group.
It was amazing to see more than 40 Medical Directors, many with their own decades of experience, come up from the audience and participate on stage. For me it was a great moment and EMS to see that volume of medical directors, perhaps 100 and all, and attendance at a fast pace conference that has grown from a hundred to a hundred attendees and its 17 years of existence.
The other amazing observation that most attendees greatly appreciated was that even though each of the Eagles only present one or two lectures, in general, they all stay in the ballroom to listen to their colleagues and participate in the discussion.
The crowd at the Eagles conference really appreciate this involvement because it shows the sheer dedication of these positions were not compensated for spending 4 to 6 days of their time in participating in the closed Eagle Creek retreat and the two-day General Conference.
Eagle Creek this year was also very interesting because the Eagles reviewed issues of skill decay existing in systems with one two three thousand paramedics deployed on ambulances and engine companies, the implementation of mobile stroke unit, the predicament caused by increased resuscitation results as a as a result of improved CPR and at gym such as impedance threshold device (ITD), mechanical CPR devices, a more coordinated approach to resuscitation and rapid transport to cath labs.
With these resuscitation resulting in the return of ROSC after as long as 90 minutes, it is not as easy as it used to be to implement cessation of resuscitation and terminate cardiac arrest. More and more, patients are able to be taken to the cath lab, have their blockage removed and because it ate it, able to leave the hospital with no neurological deficit.
There was also significant discussion this year about the benefits of just basic BLS procedures versus the historic advanced life support approach to cardiac arrest. With epinephrine being shown to no longer be a crucial part of most resuscitation, and the need for uninterrupted compressions with continuous cardiac perfusion maintained as consistently as possible, the consensus appeared to be that EMS agencies should focus on solid basic life support and as much on intubation and other more advanced procedures.
Dr Michael Sayre, MD, Seattle MEDIC ONE Medical Director pointed out that his crews are now utilizing pediatric bag valve mask and a three finger ventilation technique during the resuscitation of adult patients. The Eagles noted that this made sense because there is less of the chance of over ventilation
Two of the most amazing presentations this year at the Eagle Creek private retreat by Keith Lurie, MD, creator of the impedance threshold device (ITD) and a clinical researcher, and the following day at the main conference by Paul Pepe, MD. Both noted a serendipitous discovery of increased cardiac perfusion and decreased intracranial pressure when animal subjects were elevated in a 30 degree head up position in the laboratory, it is now thought that this may be a major breakthrough and future resuscitation efforts.
Currently being observed in research an animal lab studies, what is occurring when the patient is elevated to a 30 degree position during normiostasis and during CPR, is that there is a noticeable drop and intracranial pressure which subsequently allows better perfusion of the brain by the improved cardiac output the results during continuous compressions. The audience was amazed to hear this observation and many attendees, after the session, told me that they were eager to watch for future progress in this area.
Several presentations by medical directors, particularly those from Seattle, Boston and Tucson, pointed out that it is more important to have quality paramedics then it is to have a high quantity of paramedics that get few opportunities to fully execute their required skills and remain proficient.
In some systems that deploy thousands of paramedics, the limited number of times when paramedics, not directly assigned to ambulances, are seeing and actively managing critical patient is shocking. This creates a dilemma for systems, not only in amount of skill review, re-training and remediation required, but also in the budgetary demands and drain to staff or back-staff engines that are not seeing a high volume of very sick or critically injured patients.
The last day of the Eagles conference featured the presentation of several prestigious awards by the Eagles:
Fionna P. Moore, M.D. received the Ron J. Anderson, M.D. Public Service Award, presented annually to “the EMS Physician who has implemented effective systems of care, education, and science in their EMS system. Fionna P. Moore, FRCS, FCEM, FIMC, RCS ed. is acting Chief Executive Officer and Medical Director of the London Ambulance Service, London, England, UK
The Michael K. Copass Award, awarded for excellence and contributions to the advancement of
Emergency Medical Services, was presented to John V. Gallagher, M.D. for his vision, leadership and mentorship for fellow Medical Directors of EMS systems.” Gallagher is EMS Medical Director for the City of Phoenix Fire Department; and Urban Search and Rescue medical director for Arizona Task Force One, Phoenix, AZ
The Corey M. Slovis Award for Excellence in Education was presented to Christopher B. Colwell, M.D., for incomparable educational achievement and the unique ability to facilitate substantive learning in emergency care. Colwell is medical director for Denver Paramedic Division and Denver Fire Department; Director of Emergency Medicine, Denver Health Professor and Vice Chair of the Department of Emergency Medicine at the University of Colorado School of Medicine, Denver, CO
Many of the Eagles will be presenting this week at the EMS TODAY Conference and Exposition in Baltimore, expanding on the details of their lectures and EMS programs presentations. Interested EMS personnel and medical directors and physicians can register for the conference on site at the Baltimore Convention Center.
