Behind the Scenes: Q&A with Paul Pepe from the Gathering of Eagles

The man behind the wildly successful Gathering of Eagles conference discusses what makes this event so unique and popular

   Following a 13-year tradition, nearly 1,000 EMS educators, medical directors, chiefs and paramedics from across the country converged on Dallas at the end of February for a weekend of lively discussions and the occasional debate about the state of EMS and critical issues facing prehospital care. EMS World recently spoke with legendary emergency physician Paul Pepe, MD, MPH, FCCM, FACEP, who is largely responsible for organizing the annual event known formally as the EMS State of the Sciences Conference, or more familiarly as A Gathering of Eagles.

What makes this event so unique and popular?

   Part of what makes it fun is that we actually don't know what's on the program until everyone gets here. It's not advertised-it's strictly word of mouth-but it's become the place to be. We start off with a history of Eagles, since about a third of the audience is new each year, and then Corey Slovis, MD, from Nashville opens with a funny video and presentation of what he calls "The Pentagon Papers: The Five Most Important Publications of the Past Year." That sets the tone for the rest of the meeting.

What were some of the highlights this year?

   We started off with results of the North American multicenter ITD trial on resuscitation outcomes presented by Tom Aufderheide, who was the principal investigator. That was followed by a paper on the ResQPOD compression/decompression pump trial from R.J. Frascone from St. Paul. Following that, Kathleen Schrank from Miami looked at the new ACLS guidelines and which of them she would and would not follow. Craig Manifold looked at early intraosseous administration of epinephrine and noted that in San Antonio they've seen improved outcomes by getting the IO in right away and not waiting to start an IV.

   Jullette Saussy reported on an interesting development in New Orleans where they're using two defibrillators simultaneously on patients they can't get out of VF after the first shock or two. Paul Hinchey of Austin then picked up on something I've been doing for years called the "pit crew approach" to cardiac arrest where everyone on scene knows exactly what his or her job is when they get to the patient-just like a pit crew.

   Some other issues touched on included end-tidal CO2 as a gold standard for airway management and how it is useful in sepsis; comparison of military and 9-1-1 use of tourniquets for trauma; and the pros and cons of collar use and how putting on a collar incorrectly or unnecessarily can actually make a neck injury worse. ACEP President Sandra Schneider predicted that paramedics will be used more frequently for home visits and checks.

Explain the lightning rounds.

   That's when all the Eagles come up on stage and people in the audience ask questions that require rapid-fire answers. Then we do reverse lightning rounds where members of the audience come up and answer questions about the problems they're facing in their own EMS systems.

How does the future look for Eagles?

   We had to turn away a lot of vendors and attendees for this meeting because we sold out so rapidly. It's clear we'll have to expand somehow so more people will be able to attend. But there are two things you can count on: It still won't be advertised, and you won't know what's on the agenda until you show up. Even as we grow, there's still a certain intimacy to the meeting. At most conferences, faculty come in, give their talk, and they're out of there. With Eagles, they all stay through the entire meeting and attendees get to interface with them, including during lunch breaks.

   For information on the 2012 EMS State of the Sciences Conference, visit