Summaries of important EMS clinical information presented at the 2014 Gathering of Eagles in Dallas on Friday, February 28, 2014. (Presentations will be made available for download at www.gatheringofeagles.us following the conference.)
The Pentagon Papers: The Five Most Important Publications of the Past Year
Presented by Corey M. Slovis, MD (Nashville, Tenn.)
- It’s hard to show a benefit with Epinephrine
- Epinephrine versus Epi + Vasopressin + one bolus of Steroids WORKS and produces three times (3X) the survival!
2. The peri-shock pause — REDUCE IT
- 30% of our patients are shown to have a peri-shock pause >10 seconds
- The message: Reduce the Pause.
3. Prehospital ECGs
- How often does the rhythm change en route?
- 12.5% abnormal ECGs changed from time of first arrival to hospital arrival.
4. Prehospital Hypothermia
Cooling works, but:
- Prehospital therapeutic is not being shown to make a significant difference
- You do not need to DEEP COOL all patients 32-33 degrees. A little cooling is just as good.
5. Is Oxygen Dangerous?
It is shown that it can be:
- Hemorrhagic Shock
The New Normals for O2 Saturation:
- 89-92% saturation is the new normal for COPD.
- Keep your patients at around the 92-94% SpO2.
Trash Talk! Five Papers You Can Take Out of the Recycle Bin–and Toss into the Garbage
Presented by Kathleen S. Schrank, MD (Miami)
Kathleen Schrank presented five research studies that were either flawed or did not look at the right areas regarding prehospital care. Her message:
- Look at the bottom line.
- DIG DEEPER!
- Learn how to read the literature.
- Don’t fall for the HYPE!
- Ask: Is this “Ready for primetime” in our system?
Focus Area: Traumatic Circumstances: 2014 Ways of Dealing with Multiple Casualties
Presented by K. Sophia Dyer, MD (Boston)
The April 2013 Boston Marathon Bombings:
- Two seperate bombs 13 seconds apart and in two different areas.
- The Marathon attracts 500,000+ spectators and 20,000 runners
- Boston is only 48.2 square miles (in other words, it’s a crowded city).
- Patients were rapidly distributed to 10 hospitals.
- Marathon EMS resources: 9 BLS and 4 ALS units with multiple pre-staged tents.
- 600 patients had been seen by the time of the bombing.
1. Pre-planning is critical; be ready for the worst at all times.
2. Use the ICS system at all times.
3. Have staging in place and be in control of it.
4. Use a standard MCI plan and triage tags.
5. Stay calm at all times.
6. Keep your radio traffic clear and use to a minimum.
7. Use “alert tones” when presenting critical information to get the attention of your personnel.
8. Have your personnel hold their positions and await assignment.
9. Move patients off to hospital as soon as possible.
10. Use the same radio system.
11. Make sure all your personnel have personal protective equipment.
12. A lot of people will show up during the event.
13. Carry four (4) tourniquets on all EMS units.
Three Days Later: Explosive Sequelae in West, Texas on April 17, 2013
Presented by Emily G. Kidd, MD (San Antonio)
- 12 responders will killed.
- A nursing home was destroyed.
- Initial reports were that there were 600 injuries.
- The public responders were key to success.
- 60% went by private vehicles and police vehicles.
- Patents were transported to 5 hospitals.
- The local EMS agency was devastated.
- Ambulances buses were helpful; use them routinely.
- Get to know your emergency management partners.
- Know all your MCI and emergency management plans.
- Drill! — Drill! — Drill!
- Know what Public Health department does and can do for you.
- Learn from other incidents and change your plans and operations accordingly.