Better Lifting for Better Care

Anyone who has been to a national EMS conference in the last few years has probably seen Rick Binder in the exhibit hall. If that name is not familiar, you may be more likely to remember his life-size teddy bear wearing a vinyl vest surrounded with brightly colored handles. While we are friends now, I have absolutely no financial interest to disclaim. In fact, I had initially avoided both him and the product that his dad had developed whenever I saw the booth at trade shows. Personally, I just didn�t see the need for it since I was a master with a hospital sheet and had acquired a wide repertoire in the many ways to use it. But there are times that peer pressure can be a good thing. Other teammates from my service had visited with him at EMS Today and appeared to be impressed. Curiosity got the better of me and I wanted to learn what I might have overlooked, so I took Rick up on his free offer to field test the device. It was because of my own experience with the Binder Lift that I was finally sold.

I have learned that there are many lifting situations where this device will be an incredible asset to me as well as my patients. The slogan, �because people don�t come with handles� initially led me to think that the use of the Binder Lift was directed primarily at the bariatric patient who requires only a simple lift assist to return them to an upright condition where they can sign my refusal form. While it is certainly useful in such cases, it is definitely not limited only to that situation.

In my first example of these many unique cases, the patient was over six-foot-tall and had been discovered unconscious, but breathing, on his front porch by a third-party caller. I had been to that address before and knew he had a history of stroke that had previously left him unable to drive. We had three responders available and knew we needed to get him to the hospital quickly. After a rapid initial assessment, the patient was rolled to his side so we could apply the Binder Lift. Once secured, one person grabbed his feet while my partner and I were able to grab different handles to balance our height difference and eased his lanky frame down the steps to our stretcher. This movement was much easier on our backs and proved safer for the patient compared to our other options that day.

The simplicity with which we were able to transport this patient made me think back to a previous visit here. I only wish I had had this device when this same patient had been helping his elderly father get to the bathroom toilet. I can only imagine the mishap that led to his naked father falling on top of him – pinning him to the bath tub wall. Then, whether it was due to the fall or just the wait for us to arrive, his dad had defecated quite a lot. The waste had eventually made its way over both of the men. Finding a firm handhold on the slippery gentleman was a challenge made even more difficult by his son being entrapped beneath him. The vinyl construction of the Binder Lift would have made the extrication job much easier to accomplish and also simpler to clean up afterwards. It may have even prevented the need to change my uniform that evening.

In another memorable example, it was about 2AM when the tones dropped for a fall with injury. The husband of a 62-year-old female found his wife on the ground in front of their porch. She had stumbled and fallen forward about a two-foot drop. Unfortunately, she had braced herself for the landing with a stiff arm before reaching the ground. Her primary complaint was pain in the right shoulder which, although closed, did exhibit deformation (a probable dislocation. She denied any other pain along her spine, but as a precaution against a distracting injury, we placed her in a cervical collar per protocol.) Getting the patient to a seated position was accomplished only with significant coaxing and some obvious pain. There was no option of lifting her from beneath her arms and her loose pajamas gave little hope of bearing the weight of her hips to lift her. So after placing her right arm in a sling, we were able to place the Binder Lift around her torso and helped her move her legs into a crouched position without any further aggravation. The patient was then easily lifted upright and the stretcher maneuvered behind her allowing her to simply sit down. The Binder Lift was also helpful in orienting her on the cot. Finally, the slick vinyl material of the vest and straps was easily removed to leave her comfortably in a high Fowler’s position on the stretcher.

In short, the Binder Lift allows for better body mechanics when lifting that not only help to raise the patient safely but can be effective in extending the careers of medics that might otherwise be forced into premature retirement due to back injury. If you don�t try a Binder Lift for your patients, at least do it for yourself. I still carry an extra hospital sheet for many situations, but it always lays right on top of my Binder Lift.

Learn more at http://binderlift.com.

Advertisement

EMS Today 2018 Highlights

The EMS Today conference is always filled with interesting content both in the classrooms as well as the show floor. My live Twitter feed during the conference referenced highlights of the educational sessions I attended ranging from the Operational category to Advanced practice and even some Basic courses. The complete experience shared by everyone is permanently archived with the official #EMSToday hashtag. 

I traveled the exhibit hall several times last month looking for innovative and practice-changing technology. There was plenty to be found and the “best” will always be subjective. While these are some that I felt were worth sharing, others may have found significant gems I missed. If you were also there, please feel free to use the comment section below to add your own impressions of what you see as important in changing the practice of our field of EMS. 

One of my favorite sessions at any national EMS conference is when you can find a gathering of even a small number of “Eagles” (the top Medical Directors from around the country.) The lightning round of “The Eagles Unplugged” presentations in Charlotte was on February 22, just a week before the huge international Gathering of Eagles in Dallas. One of the first topics requested by the audience was on “spinal immobilization” (or in deference to my friend Rommie Duckworth, the proper term should arguably be “spinal stabilization”.) There was certainly no love in that packed room for most techniques or devices currently in use. In fact, the emphatic consensus statement was that there is simply no literature that shows any benefit to current spinal motion restriction while there are plenty of documented complications. 

In regards to spinal stabilization, everyone in the room agreed that the long spine board is gone and immobilization currently consists of just a collar. However, there was no consensus on what that collar should look like while there was no shortage of complaints for what is currently on the market. One of the JEMS “Hot Products” from EMS Today in 2017, however, was the SIPQuik vacuum cervical splint from Care 2 Innovations which I only got to play with this year. Basically, it is a collar-shaped bag filled with tiny styrofoam beads and a generous velcro strap. It has several advantages in that it fits a wide variety of patients and will conform closely to the shape of the neck to provide gentle support in any position. Unlike rigid collars that require the head to be placed in the neutral position for stabilization, the SIPQuik can wrap around the neck and be secured comfortably snug with the strap before the collar is molded to support the head while the air is vacuumed from the collar. The beads are held tightly in place to provide support that minimizes the possibility of further injury. Removing the manual pump without locking the air tube will allow air to reinflate the collar for easy removal. 

Several sessions, and exhibitors, included discussions of safety for care providers while working on the road. In America, we tend to love the large square box we call the patient compartment in our Type I and Type III transport vehicles. The size of the box and position of supplies and equipment requires a significant range of motion and most providers roam about unrestrained. Traditional safety belts are already available in every seat, however, they are just too cumbersome to apply and too restrictive to be used. At least this was my thinking until I placed by arms into the new 6-point “Back Pack” belting system on the EVS2160BPB from Emergency Vehicle Seating, Ltd. Unfortunately, the Back Pack system is not advertised on their website yet, but if you are interested, they will know what you are asking about if you contact them. 

The shoulder straps were as easy to apply as simply slipping my arms through the loops.  But the range of motion was incredible and allowed me to stand up fully and reach clear across my imaginary patient to where I would expect cabinets to be on the other side of the room – while still wearing the shoulder straps and even the lap belt! As I return to the seat the straps automatically tighten and should the vehicle have an accident, the belts would immediately tighten to prevent my head from crashing into those same cabinets across my patient. This quick and easy seat belt access is certified to meet all safety standards of FMVSS and SAE while providing maximum flexibility for the care of my patient. Two EVS1790 captain’s style chairs in place of the typical bench seat also allows comfortable and safe crew seating or can be rotated and tilted forward to allow the transport of a second patient on the non-skid back surface of the seats. Clearly, EVS has been giving plenty of thought to where we put our butts.

Another one of the hottest topics in prehospital treatment of trauma has to be the use of tourniquets and binders. I really thought that the poplar military-style tourniquet had not changed significantly from the belt and windlass configuration of decades ago, but there have been innovations here as well.

The S.T.A.T. Tourniquet is probably the greatest revolution in design. It comes in both a pediatric and adult size, but immediately conjures up the ubiquitous zip tie. It is wrapped around the limb above the injury and the end is inserted and pulled as tight as needed (in 2mm increments) to easily adjust. Although it looks like a zip tie, it is anything but what you find in the hardware store however. It is a wider design to prevent cutting into the skin and the material is a stretchier rubber to hold fast and evenly to secure blood flow. It also has a simple timer that can be activated when applied to measure half hour increments up to a max of 2 hours. Like the common zip tie it resembles, it can be used in combination to create a larger band or used in a series for splinting too. One major difference from the traditional zip tie is that this model also has a release tab to remove the tension. The simple design and lower cost compared to a traditional windlass system makes it ideal for public use in an MCI situation as part of a hemorrhage control kit. S.T.A.T. Medical Devices even sells them preloaded on a carabiner in a quantity of 25 tear-off tourniquets.

 

In case that style of tourniquet design is just too revolutionary, the folks over at SAM Medical have evolved the traditional tourniquet design by adding TRUFORCE Buckle technology to auto-lock the tourniquet during application. Slack in the tourniquet is the main cause of application failure requiring extra time twisting the windlass or even restarting the application. The SAM XT is designed to

require 33 pounds of force to engage two pegs that hold the strap before it is Velcro-ed together and the windlass can be engaged to stop the bleeding. This makes application easier and quicker. They also have a junctional tourniquet to stop pelvic hemorrhage. And my favorite model is the SAM Pelvic Sling II to comfortably apply the correct force to stabilize pelvic fractures. The design looks similar to the SAM XT tourniquet, but uses a patented AUTOSTOP buckle instead that ensures that the optimal compressive force is reached to confirm correct application. It is more expensive than a hospital sheet, but it provides confidence and comfort in a professional design.

I was also impressed by the Water-Jel Burn Dressings which provides a cooling gel (that is water-based, bacteriostatic and biodegradable) that actually stops the burn progression by actively cooling the skin and relieving pain rather than simply covering the wound to protect against airborne contamination. These dressings come in several different sizes and have a shelf-life of 5 years. The other great feature of these dressing is that each dressing has a Total Body Surface Area (TBSA) icon that indicates approximate total body surface area covered with the use of that particular dressing to improve your estimates of the body area covered.

Finally, to reduce medication calculation errors in pediatric patients, CertaDose provides syringes printed with color bands that match the Broselow tape used with younger patients. These syringes are clinically proven to reduce critical dosing errors by labeling the correct dosage directed on syringes labeled by the medication to be administered. Simply select the correct drug, match the color zones according to the Broselow tape and draw up the correct dosage.

I should also mention StethoSafe as another highlight from the floor of the show because I rely on their product to protect my stethoscope, but I did a whole other blog on the StethoSafe earlier.

Leave a note about what you found most interesting.

 

 

Analyzing Routes and Response Times

This is a second preview chapter of a new book in the Primer series from Bradshaw Consulting Services to be titled “Closest Vehicle Dispatch: A Primer for Fire�? to be released in time for the FDIC 2017 at the end of April.

Whether you are held to the standards of NFPA 1710, which addresses predominately career fire department responses in the US, or NFPA 1720, which deals specifically with volunteer departments, the challenge of meeting these response time standards is increasingly difficult for many reasons. Higher demands on limited resources and increasing performance expectations from the public are just a couple of those forces opposing response efficiency. Another elementary factor that critically impacts our response times is the route we choose in order to arrive at an incident. In most cases, there is not always a single route that is consistently the best choice at all times of the day or week. These differences can also include seasonal variations or be complicated by special events which may be planned or unplanned (Demiryurek, 2010). The subjectivity of route selection is further complicated by dynamic characteristics such as traffic or weather in addition to the extent of the mental map we develop of a service area or what that map may be lacking in adjoining or mutual aid areas (Spencer, 2011).

Most of the considerations that we process as we consider a potential path of travel in an emergency vehicle are often made subconsciously through personal experience and knowledge. While there is no legitimate argument against knowing your service territory well, the question becomes do we have sufficient awareness to consistently make the best route choices?

According to U.S. Fire Administration statistics for 2005, responding to alarms accounted for 17 percent of firefighter on-duty fatalities (Response, 2007). Deaths in road vehicle crashes are often the second most frequent cause of on-duty firefighter fatalities. In 2014, this percentage dropped to only 10 percent with a total of just 7 fatalities. Although the change is positive, it is too early to consider this to be a trend since it is only the second lowest number of crash deaths over the past 30 years (Fahy, 2015). While these accidents are not all due to their route choice, it can be argued that there are times where crews were clearly in the wrong place at the wrong time. Furthermore, the shortest path is not always the quickest route, and the fastest one may not have the simplest directions either (Duckham, 2003). Given the technology and data available today, there is little doubt that we can make strong decisions provided that we understand how we make these choices and what information may improve them.

In selecting a route for any particular apparatus, we may consider the physical or geographic characteristics of the roadway that determine the maximum speed of travel based on the maneuverability and size of our apparatus. Similarly, we must consider the likelihood of traffic congestion and also the safety of our crews as well as the public. As we increasingly rely on algorithms for making driving decisions, it is important to appreciate the mechanics of how the technology components function together. The Global Positioning System (GPS) is often credited with providing guidance to vehicle operators, but this is not exactly true. The satellite constellation that makes up the American-operated GPS (and similarly the European GLONASS) simply sends accurate time signals by radio waves to our portable receivers who detect the length of time each signal has traveled through space and then triangulates a position based on the calculated distance from those man-made stars (Hurn, 1989). The accuracy of the position that your GPS unit determines is based on the quality of those signals received and the precision of the local clock used to compare the time encoded in the signals. These satellites have no concept of transportation networks or traffic congestion on earth. It is Geographic Information Systems (GIS) that model the street networks and also track the vehicles using them. Unlike the limited number of GPS-like constellations in space that help us derive our position, there are a multitude of GIS-based computer services that offer routing recommendations. Some of these services, like the consumer-based routing applications available on your smartphone, are located on “cloud servers�? (although they are quite terrestrial) while others may be hosted privately on local government networks and available only to “trusted client�? applications on your Mobile Data Terminal (MDT).

Each of these GIS services has unique embedded algorithms for recommending directions or to estimate arrival times (Keenan, 1998). As users of these systems, we become subject to the specific assumptions inherent within their design leaving them far from being equivalent to one another (Psaraftis, 1995). For instance, network models must account for the elevation differences of overpasses in relation to the roadway below in order to prevent suggesting that a vehicle take a turn off of the side of a bridge. The cost of that ill-fated maneuver would be insurmountable, but other legitimate turns have minor costs associated with them because the apparatus must slow down to navigate the curve safely. A traffic light, or oncoming vehicles, can add further to that turn delay. Accounting for these delays requires logic in the GIS routing algorithm as well as valid time estimates coded into the street network data at each intersection.

The most basic feature of any transportation network model, however, is the cost of movement along a road segment in either direction which is known as its “impedance.�? Many systems will assume the speed limit over the distance (impedance_time=speed/distance) between intersections to derive a similar “drive time” in both directions. Real world conditions (including traffic, terrain, and weather) will prove that speed limit-based assumption to be overly simplified and can lead to poor routing decisions because of unrealistic impedance values in the model (Elalouf, 2012). Crews will quickly recognize these failures and the lack of trust that these errors engender can compromise the entire routing program. Realistic impedances should be variable based on the time of day or day of the week in addition to the direction of travel.

More complex online routing services now offer near real-time traffic updates. While this traffic feedback can be invaluable to most drivers, its practicality to emergency vehicles appears limited in general. If our task was to deliver pizzas, we would be constrained by normal traffic regulations. Knowing where traffic congestion is at any given moment would allow us an opportunity to seek an alternative to bypass a congested intersection. This is a common type of need for drivers and therefore many consumer routing apps seek to address that specific function (Ruilin, 2016). But when our duty is to respond to the accident at that same intersection that is causing the delay for others, these typical consumer routing applications may fail our unique requirement. This objection is especially valid where emergency vehicles are not strictly constrained by the driving patterns of other vehicles on the roadway. In certain situations, it may be allowable for an apparatus to use the road shoulder for travel or even cross a median to use an on-coming traffic lane or to traverse a one-way street in the wrong direction (Harmes, 2007). The only reasonable exceptions to this generality are those dense urban areas where congestion is excessive and these “open” lanes or roadway shoulders simply do not exist to allow apparatus to circumvent that traffic. In a recent trip to New York City, I visited a fire station in downtown Manhattan. They received a call and exited the station with red lights and sirens blaring, but even the air horn was unable to move traffic. The engine sat at the traffic light behind the rest of the cars until the intersection cleared enough to allow drivers to create a path up to the next intersection.

In general, when we look to leverage technology for our unique demands in public safety, a system would ideally be able to learn our peculiar patterns of travel and record typical impedances based on how our own fleet resources travel. Additionally, these impedances will likely be different during certain hours of the day or on specific days of the week and vary even further seasonally based on whether school is in or out of session. These cyclical patterns will have a huge impact on actual drive times and any route recommendations must account for them accordingly. Current consumer routing applications are continually improving their ability to recognize and address the needs of passenger cars or ordinary delivery trucks, but this still does not necessarily translate to better routing of emergent public safety vehicles in most cases.

Finally, the last critical piece of route selection is a review after the call. Comparing the actual route traveled with the recommended path is an important feedback mechanism to both ensure that the system is operating as intended and to build confidence within your crews that encourage them to trust the system. This is not to suggest a blind obedience to technology, but constructing a learning process for everyone in developing tools that function to improve overall performance. No technology is perfect in the real world, just as no person has ultimate knowledge at all times. But cooperatively, we can learn to make improvements in either the computer or human systems as needed to enhance awareness in the other. The most successful implementations of routing assistance create cooperative relationships between responders and the GIS staff responsible for maintaining the data. Failures discovered in any system should not be used to condemn an otherwise useful technology, but seen as opportunities for improvements in either the algorithms behind it or the data that fuels it.

One of the critical outcomes of route selection, aside from arriving safely, is the total time of travel. No matter when the clock starts for measuring your response time, it is the minutes and seconds that the wheels are rolling that often consume the majority of it. The longer that time or distance, the higher the cost. A cost that can be measured both in actual vehicle operating expenses as well as the risks associated with its operation; not to mention the losses adding up on scene prior to your arrival. In general, the shorter the time (and distance) between dispatch and your safe arrival on scene, the better it is for everybody.

 

References:

Demiryurek, U., Banaei-Kashani, F., Shahabi, C. “A case for time-dependent shortest path computation in spatial networks.” GIS ’10 Proceedings of the 18th SIGSPATIAL International Conference on Advances in Geographic Information Systems. ACM, November, 2010; 474-477.

Duckworth, M., Kulik, L. “’Simplest’ Paths: Automated Route Selection for Navigation in Spatial Information Theory.” Foundations of Geographic Information Science. (2003) 169-185. Berlin: Springer-Verlag.

Elalouf, Amir. “Efficient Routing of Emergency Vehicles under Uncertain Urban Traffic Conditions.” Journal of Service Science and Management, (2012) 5, 241-248

Fahy, R. F., LeBlanc, P., Molis, J. Firefighter Fatalities in the United States-2014. NFPA No. FFD10, 2015. National Fire Protection Association, Quincy, MA.

Harmes, J. Guide to IAFC Model Policies and procedures for Emergency Vehicle Safety. 2007. IAFC: Fairfax, VA.

Hurn, Jeff. GPS: A Guide to the Next Utility. (1989) Sunnyvale: Trimble Navigation.

Keenan, Peter B. “Spatial Decision Support Systems for Vehicle Routing�?. Decision Support Systems. (1998);22(1):65-71. Elsevier, Salt Lake City.

Psaraftis, H.N. “Dynamic vehicle routing: Status and prospects.” Annals of Operations Research (1995) 61: 143.

“Response-Time Considerations.�? Fire Chiefs Online. ISO Properties, 2007. Web. 20 May 2016.

Ruilin, L., Hongzhang, L., Daehan, K. “Balanced traffic routing: Design, implementation, and evaluation.” Ad Hoc Networks. (2016);37(1):14-28. Elsevier, Salt Lake City.

Spencer, Laura. “Why the Shortest Route Isn’t Always the Best One.�? Freelance Folder, November 2011. Web. 7 December 2016.

EMS Today 2016 Review

It was my privilege to have been selected as the Official Blogger of the EMS Today conference for 2016. Like my predecessor, Tom Bouthillet at the EMS 12-Lead blog, I took that role very seriously and visited as many of the sessions, vendor exhibits, and even socials (they are definitely part of the experience) as I possibly could. Throughout the conference I posted my impressions live on Twitter through my @hp_ems account using the hashtag #EMSToday2016. But I know many people either couldn’t, or simply didn’t, watch that whole feed over the four days that I was tweeting live, so I felt a summary blog of the highlights was definitely in order. If you were there, I hope I saw you and that my remarks will echo your own experience. But I would also like to ask that you include your own impressions as comments at the end of this post. If you weren’t there, you missed a lot. And hopefully for you, this article can provide justification for you to make the trip to Salt Lake City next year for EMS Today 2017.

The very first time I attended an EMS Today conference, I arrived on the first day of the show only to discover that I was actually more than 24 hours late. By not arriving early, I had missed tons of great content presented during the pre-conference sessions the day before. While they definitely add an expense to attending the meeting, they also add anywhere from 4 to 8 hours of detailed content (as well as CEH) that you just won’t get in the faster paced 60-minute sessions of the rest of the conference. This year, I opted to attend an afternoon cadaver lab hosted by Teleflex. Training with manikins and simulators is great, but it can only take your skills so far. But flushing a proximal humerus IO access with the chest cavity open, allowed me to witness first-hand the short vascular distance from the infusion point to the heart compared with femoral access. In addition, we had plenty of time to practice ETI with various devices on many different patients. I also had the chance for my very first surgical cricothyroidotomy. While the practice of these skills was highly valuable, the opportunity to simply hold the lungs while they were ventilated and explore the chambers of the heart with my finger were enlightening beyond imagination. Nearby, was another very popular choice for a pre-conference class in the Active Shooter Simulation. It was unfortunate, but just the evening before this shooter simulation class was a vivid reminder of its importance to us in the form of a gunman who killed 3 and wounded 14 more in Hesston, Kansas. Violence leading to an MCI can clearly happen anywhere and we must all know how to respond. Thanks to this timely offering, many more EMS providers are now better prepared.

Moving quickly from the lab to change my clothes, I headed for the formal EMS10 awards ceremony. This invitation-only event hosted by Physio-Control was an opportunity to rub elbows will the people marking their mark to improve the level of care in EMS today. You can always read about the 2015 EMS10 recipients and their innovations, but by being here I was able to run into them several times throughout the conference and even had the chance to speak with some of them to learn their detailed stories.

The next day (which officially began the conference) started early with sessions beginning promptly at 8AM. I was given reasons to consider “Point of Care Testing” by Kevin Collopy who helped me better understand what we can, and cannot, do today based on federal CLIA regulations and why to consider accreditation. Next was Jonathan Washko discussing the success of community paramedicine at North Shore LIJ EMS. The best part of being at a conference with such notables is hearing comments that challenge your work. Jonathan asked “if you can’t manage yourself, or control your own emotions, how can you manage others” and reminded us that it is “the strongest leaders who ask for help.” Then from my virtual visit to NYC, it was on to a global view of self-regulation in paramedicine with Michael Nolan, Gary Wingrove, Becky Donelon, and Peter O’Meara. A couple of great lines prompted a shift in professional thinking, like when being told that “as paramedics it is time to ‘move out of mom and dad’s basement'” and as we argue over the universal meaning of “paramedic” (or “ambulance driver”), “the patient, the media, and your mother should all know what to call you!” Over in the room where Ray Barishansky spoke on “proactive professionalism,” it was crowed as he said “we as a profession have let ourselves down with our behaviors, low pay, and attitudes.” Ray also reminded us that it is “professional EMS providers who own their mistakes, are respectful, and are always advocates for the patient” and asked us to give further thought to the idea that “93% of how you’re judged is based on non-verbal data.”

Plenty of more data was presented at the Prehospital Care Research Forum session hosted by David Page where I am proud to say North Carolina was nicely represented. We also learned interesting tidbits in these lightning talks such as “volunteer EMS services are 27% more likely not to transport (also to accept refusals, or do ‘treat and release’) than paid services” and that the gender differences in the use of restraint (chemical or physical) is not about the sex of the patient, but more likely to happen with male providers even though female providers are the ones statistically more likely to be assaulted. Matt Zavadsky along with Rob Lawrence (filling in for Nick Nudell) also presented plenty of facts in their session on the Data Dichotomy of the current EMS payer landscape. All of these sessions were going on as the JEMS Games preliminary competitions were being held to see who could brag about being the best of the best in EMS. If you want to see how challenging these “games” can be, here is a quick view of the obstacles that participants face to prove they can handle the job.

It was the mid afternoon that the official opening of the conference was held with all of the pomp and circumstance (including fifes, drums, and bagpipes) that you expect at any public safety conference. There was a somber recognition of our brothers and sisters in EMS who have answered their last call due to LODD along with multiple awards and a stirring multi-media presentation by alpinist Brian O’Malley. The prestigious James O. Page award went to NEMSMA for this ground-breaking whitepaper aimed at preventing EMS provider suicide. There was also a brief visit from Maurice Davis to promote his tribute designed to raise awareness and remove the stigmatism that keeps EMS providers, the military, and many others silent and leading all to often to “The Wrong Goodbye“. The video depicting the impact of suicide is something we should all be sharing with our friends.

It is after the keynote presentation that the exhibit hall opens for a brief reception. If you didn’t get to see it, follow along with a bodycam highlight video of the exhibit hall from my friend Jeffery Armstrong. I must also recognize the generosity of Limmer Creative who donated several of their LCReady classes for me to give away during the conference for people who were able to find me and even opportunities for followers who retweeted my post about the contest. Being social is beneficial!

As my friend Bob Holloway put it, “Day 2 was packed with sessions on EMS innovation, MIH (Mobile Integrated Healthcare), and creating value.” And what better way to kick that off than with a cup of coffee and a lightning round called “Ask the Eagles”? If you aren’t similar with the Gathering of Eagles, it is also known less colloquially as the EMS State of the Sciences Conference. This year’s conference was held the previous week in Dallas and consequently the session at EMS Today (always a favorite of mine) is packed with the latest EMS Pearls that will hopefully one day make it into your local protocols. This is where you can hear progressive medical directors from around the country like Bryan Bledsoe busting dogma with comments like “less spinal movement with self extrication compared to backboard extrication.” Unfortunately, I missed it this year to interview Ferno in a video on their innovative iNTraxx system to promote safety, flexible modular design, and increased efficiency. Watch for the interview made in conjunction with my friends from EMTLife later this week.

Over lunch on Friday, I heard Dr. Keith Lurie, CTO of ZOLL Medical, discuss the changing perceptions of resuscitation through “active compression decompression” during CPR and his ResQPOD impedance threshold device that together can increase one-year survival after cardiac arrest by 49%. There was also discussion of heads-up CPR which can significantly decrease ICP during CPR ad many other tips to help us improve CPR survival rates. This discussion was followed up by another visit to the cadaver lab for some hands-on with real human patients. Practice such as this really makes the charts and figures come alive! But what had to be my favorite session of the whole conference had to be the experience of behavioral medicine with David Glendenning and Benjamin Currie. Far from a traditional PowerPoint presentation, we were invited to take a very different look at patients with behavioral issues by experimenting as a group with schizophrenia and delving into the taboo topic of viewing ourselves as potential patients. David suggested that “dealing with PTSD is NOT a rite of passage in EMS and we need to acknowledge it is a real physical condition and begin to talk openly about it.” The session closed with a thought-provoking David Foster Wallace video from a commencement speech explaining how “sometimes the hardest things to see are all around us.” I hope you will take about 9 minutes and watch it. I would also like to recognize the fine efforts of The Code Green Campaign in this same area (as JEMS/Penwell also did.)

Another awesome session well worth mentioning was early on Saturday morning, it was called “Creating a Social EMS Culture” with Carissa O’Brien and Steve Wirth. While there were several good quotes, it is most important to note that “your EMS agency has a legal interest in your use of social media just as you have a professional one.” There are several legal considerations that include the US Constitution, National Labor Relations, defamation laws, HIPAA, harassment laws, and more; but the end game is not “big brother” watching your networking. It must be understood that your agency has a responsibility in “building a culture that breeds responsible digital citizens.” Just as we develop our clinical skills, “we need to train EMS providers in social media just as we would with any other skill.” This discussion is one that can continue even after the conference by participating with the #socialEMS hashtag in your favorite forum.

For those who attended, you can access the conference proceedings with the username and password you received at registration. I also hope you will add your favorite memories below to give others a more accurate record of the whole conference.

I could go on about meeting the paramedics from Nightwatch, my childhood hero Johnny Gage (Randolph Mantooth), being able to sit in Squad 51, or see the original Heartmobile that played a significant role in the development of EMS in America, but I really think it would be best if you just went ahead and registered for your own journey and plan to attend the conference next year.

What You Need to Know for EMS Today

I know that some of you will be in Baltimore this week for EMS Today, while still others cannot join us. Regardless of which category you may fall into, I have some advice to help you make the most of this week.

First, if you are travelling, hopefully all your arrangements are complete. But even so, you still have an opportunity to save money during this trip. There are many transportation, parking, eating, drinking and shopping opportunities in the Baltimore area that are offering discounts to conference attendees. All you need to do is “Show Your Badge” for discounts at these participating merchants. To help you keep track of all the sessions (and any last minute changes) or just find your way through the exhibit hall, you should download the EMS Today app for your smart phone or mobile device. It is free for your Android phone from Google Play or for your Apple device from iTunes.

Whether you are physically at the conference or not, networking is what any conference experience is all about. And you can do it while you are here, at home, or even between calls. The key is to “be social” during the conference whether you are physically there in person or you can join us only in the virtual sense. Many attendees, including myself, will be active on social networks allowing you to connect with your peers and gain some insight of what is happening through the eyes and ears of others. If you are on Twitter use the #EMSToday2016 hashtag and follow the official @EMSTODAY account or join me, @hp_ems, for the latest updates, comments, and feedback on what is going on at, or even beyond, the sessions. Check out the latest posts on Facebook at the official EMS Today Conference & Expo page or join the conversations on various topics throughout the year at the High Performance EMS page. You can also learn from my own perspectives and the opinions of attendees that I talk with by reading my posts as this years official blogger of EMS Today 2016 at HighPerformanceEMS.com.

Being social can also win you prizes. There will be giveaways for visiting exhibitors in the Expo Hall, but also opportunities to find me at sessions where you can tell me about your favorite experience this week for an opportunity to win a prize from Limmer Creative who can not only help you pass the test, but retain the knowledge you need to succeed at the job. Just look for me, Dale Loberger, or find me by my backpack pictured here, and tell me what you love about this conference. I’ll make it easier to know where I will be by posting the sessions I will attend to my Twitter account at @hp_ems. If you won’t be at the conference, you can still have an opportunity to win by simply retweeting my contest post starting on Wednesday. Reposts of the full tweet will be counted through noon on Saturday in the drawing. Watch my account for more details!

Another EMS Today Winner

It may be Groundhog Day, but this is not a repeat post. We really do have another winner in the EMS Today Conference blogger promotion contest. Once again, it is my privilege to announce a winner who used the HPEMS promo code. PennWell Corporation, the sponsor of the Fire EMS Blogs network, has been kind enough to allow their bloggers to provide a promotional code offering discounts on Gold and Silver registrations for the EMS Today conference later this month. Using the code from any of the bloggers, gave the registrant an instant discount along with an opportunity to be entered in a monthly drawing. I announced the first winner here last month and now I have the privilege to congratulate Katherine Rodriguez as the final winner of an Apple iPad Mini that she can pick up at the PennWell booth during the conference. I have tried to contact her without any reply yet. So, if you know her, please extend the announcement to her.

There was another part to this contest, however, that I can now disclose and it was to choose the official EMS Today Conference Blogger. The email notification came yesterday, and I am excited to have been chosen to fill that position following in the footsteps of my friend Tom Bouthillet of EMS 12-Lead who performed that role last year. My plans are to attend the conference starting on Wednesday and I will post a blog each day highlighting the events that happened. Whether you attend the conference or not, I hope you will share this experience with me and check back each day in order to learn about what is happening there and how it may impact our industry. If you are in attendance, please watch for me. I typically sport the HP-EMS logo and I would love to meet you and hear about your impressions of the conference.

Travel safe (whether you will be in Baltimore or not), Dale

EMSToday Earlybird Winner

Planning ahead pays off. At least it did for Christopher Clarkin of OMFD! He didn’t win the billion dollar lottery, but having a brand new iPad Mini for the EMS Today conference in Baltimore later next month is pretty sweet. Christopher registered during December for the conference using the promo code HPEMS which earned him $100 off his Gold or Silver registration along with the winning entry for an iPad Mini. 

If you haven’t registered for the conference yet, its not too late. You can still register today using the HPEMS promo code to receive a discount and your own entry for this month’s drawing of another iPad Mini. Not everyone will win the next drawing (however, your odds are much better than this past lottery drawing) but you will benefit from unparalleled networking and learning opportunities at the premier EMS conference of the year. Highlights include Leadership tracks, clinical tracks, JEMS games, Dynamic & Active Threats training, Expo hall, and so much more.

You can also still vote on the winning caption for the Paul Combs “Drawn by Fire” official 2016 conference t-shirt design at this special link through January 22.

Christopher, you can pick up your prize at the PennWell Booth any time at EMS Today conference in Baltimore. I hope to see you there!

Black Friday Sales for EMS

You never hear a paramedic yell “yeah, its a holiday weekend!” Holidays simply don’t have the same meaning to the people who work in EMS than they do to the rest of humanity. But, hey, we are human too. To paraphrase Shakespeare in Act 3 of The ‘Medic’ of Venice, “if you lacerate us, do we not hemorrhage?”

Besides bleeding, one of the other things we have in common with the rest of the public is that we love a good deal. However, many of us will be working at some point during this Thursday’s celebration of gratitude for the things we have (and the day after which celebrates bargains on the things we don’t yet have.) So, I have searched for a few of the specials that you can grab this week even if you are working “on the bus” this Friday.

Dixie EMS Supply is having a Tactical Black Friday Sale on lots of fun things like tourniquets, bandages, shears and more. Chief Supply is offering discounts all week on boots, gloves, and duty gear. But most importantly, JEMS is offering an unprecedented discount on training, knowledge, and networking with your peers. Until midnight on Sunday, November 29, you can save an additional $75 on top of the Early Bird Discount of $100 for either a GOLD or SILVER pass to the EMS Today conference. The event for this coming year will be held in Baltimore on February 25-27.  You don’t even need to leave your house (or ambulance post) to save money with this deal. Simply register for the conference and enter the promo code: BLACKFRIDAY.

If you miss the Sunday deadline, don’t worry, you can still save $100 through January and also be registered for a monthly drawing during November and December for an iPad Mini – but only if you register by using the promo code: HPEMS.

I hope to meet you in Baltimore! But if you know of any further deals offered this week that would be of interest to medics, feel free to add it in the comments below. Enjoy the holidays!

On the Shoulders of Giants

As we go about our routine business each shift, it can be easy to forget that we are involved in a field of healthcare that is still relatively young. Our history as a unique discipline has only recently been documented through the efforts of  the National EMS Museum, which is itself just in its infancy. It is also interesting to me to that many current practitioners still remember using equipment that is featured as historic innovations in the museum’s new mobile app. Additionally, the television show that inspired many of us to enter the field of emergency paramedicine, called Emergency!, which lasted seven seasons starting in 1972, is still available in reruns on antenna television.

The unfortunate side of all of this recent history is that some of the pioneers who were instrumental in forming our field are passing away. Just last month, Dr. Walter Graf, a cardiologist who founded the Daniel Freeman paramedic training program in Los Angeles and personally outfitted a “mobile critical care unit” in a 1969 Chevy van, died at the age of 98.

However, there is also a positive aspect of our current period of growth and development. That fortunate side is that we still have instrumental players with us that can, and should, be recognized for their contributions. These are the folks who can probably quote Sir Isaac Newtown in saying that, “If I have seen further, it is by standing on the shoulders of giants.” These men and women are transforming our work to include the scheduling of preemptive visits known as Community Paramedicine, or Mobile Integrated Healthcare. They are introducing new protocols and tools to prevent further injury to our patients and recognizing the extent of medical conditions even earlier during our interventions. They are working toward alternate endpoints or definitive treatments in the prehospital setting. They will be recognized with awards such as the  EMS 10: Innovators in EMS or with the prestigious James O. Page Award at the EMS Today conference in Baltimore early next year. But who are they? Well, that is where you can have an impact. Nominations are open through the end of this month for all of these awards and you can play a role in ensuring that these innovators are properly recognized by sending their stories to the nominating committees. This is your chance to help make history and recognize those who are making our future a reality.

High Speed Education Where Eagles Gather

Dallas is the place to gather today and tomorrow if you are like me and actually enjoy the most current thinking on pre-hospital medical practice coming at you like a fire hose from the very “eagles�? of our business. Unfortunately, I am not there. Instead, I was standing a thousand miles away this morning in a dim light hallway peering into a bedroom where a large chested man had been pulled from his bed onto the floor and was surrounded by a team of EMS professionals efficiently working to bring him back to life. The call was a mutual-aid assistance request from a neighboring district and I was one of a handful of “trained providers�? simply waiting my turn to begin compressions. We haven’t justified the money in my county for mechanical CPR devices.

At the Gathering of Eagles conference in Dallas, the first lightning round of topics for this morning was scheduled as “Resuscitating Resuscitation: New Technologies and Approaches for Achieving ROSC�?. I wished desperately that I could have been walking down a hallway in that Texas hotel instead of standing in that local house between a husband and his wife.

Still, no matter where I am, I try to take in all the information I can and learn something from it. Here, I was limited to watching each fresh new rescuer dutifully assume the position for compressing our patient’s chest. Why is the room always so small? The bed is always so close and the personal effects of a lifetime are always stacked neatly in the way. Worst of all, the patient never seems to resemble the size of the mannequins we use in practice. But what struck me most vividly this morning was watching the inconsistencies between each of these well-meaning rescuers. I even started a checklist in my mind of the failures I saw. It was that attitude that led to the most important failure, it was the fact that I could almost viscerally feel a lack of hope in that room.

Also lacking in the setting was anything to keep cadence for the compressions or the rescue breaths. The eagles were about to tell me that without a metronome, providers typically compress too fast. I saw exactly what they discovered, that rescuers could routinely hit a rate as high as 140 compressions per minute even though we know we need to stay in the range of 115 to 120. The idea that “more is not better�? is quite clear here and we need to build better muscle memory. I knew we were being good about limiting the pauses, but I would soon be reminded that our enemy is not that “we suck�?, but that we are satisfied that we are doing “good enough.�? I learned from the Resuscitation Academy at EMS Today last year of the importance of going into every OHCA with the attitude that “everyone survives.�? However, my faith somehow still gets robbed.

In just a few hours, I would be reading notes from attendees in Dallas promoting the virtue of consistency in providing “world-class manual CPR.�? But at that moment, I didn’t feel surrounded by “eagles.�? The Eagles would tell us about places like Oklahoma City and Tulsa that use the “pit crew�? approach so everyone knows what they are doing. We’ve got that in place here when it comes to pushing drugs and managing airways, but the prevailing opinion here is still that compressions are just a brute force task to manually maintain circulation through the heart. I would also hear that Memphis, where each ambulance is equipped with a LUCAS device, is getting ROSC in 30% of arrests compared to 21% of arrests employing manual CPR. Probably the same type of CPR that we were performing today.

What we needed to hear was more than just advice to minimize compression pauses, to slow them down, maintain compressions even while the AED is charging, and always remember the fundamentals! We needed the advice that helps us recognize that PEA is a health hazard when it is distracting us from focusing on compressions by spending too much time looking for that elusive pulse. I needed to know that only 15% of pulse checks are accurate when done within the AHA guideline of 10 seconds or that if you don’t have VF, even the AED can be a health hazard due to prolonged compression pauses for rhythm analysis.

We all need to be convinced that with the advent of LUCAS/ITD and easily applied ECMO/LVAD, we may not need to care as much about the condition of the heart as we should be concerned over the resuscitation of the brain. The Eagles are further suggesting that traditional “supine CPR�? should soon become a thing of the past in favor of a 30-degree “heads-up” Gravity-Assisted CPR that promises to improve patient outcomes. As they explained today, standard CPR increases ICP and facilitates only low cerebral perfusion pressure. A trend which is reversed by elevating the patient’s head up 30 degrees. We can also hope that someday we can be using ultrasound in the prehospital setting to determine optimal position of chest compressions. And it’s not just compressions that need our attention, but to understand that positive pressure assisted ventilation actually decrease the coronary perfusion pressure.

What I learned today in both of the settings where I found myself is that there is no “silver bullet.” There is still much to learn and understand and it is only hard work and an interest to do better that will ultimately ensure a future where everyone will have a better chance at survival!