Next year the Gathering of Eagles will celebrate its 19th rendition. And you should be there.
The Gathering of Eagles isn't like the academic conferences many of the Eagles' faculty present at. Nor is it like smaller state-level conferences many in the audience attend. And it definitely isn't like the larger EMS conferences such as EMS World Expo. It's a different breed entirely.
The Gathering started as a way for the medical directors of some of the busiest services in the U.S. (and the world) to come together and trade methodologies, techniques, science and stories. It has since exploded into a large—yet strangely intimate—gathering of those same medical directors sharing what they know with other medical directors, clinicians and even the occasional researcher from across the globe.
Given the number of presentations, the variety of topics covered was significant. However some topics stood out.
Provider and Patient Safety
The book on whether or not provider and patient safety in EMS is a real issue is closed. Marc Conterato, MD, medical director for North Memorial Ambulance Service and Air Care in Minneapolis, presented some of the most convincing evidence that provider safety is no longer a problem to be ignored. He cited a new study from the American Journal of Industrial Medicine that showed paramedics were over 14 times more likely to be injured by a patient than firefighters. At the end of his presentation, Dr. Conterato listed three recommendations for EMS:
The adoption of a national reporting system for incidents;
Encouraging uniform language and penalties across states regarding violence against EMS providers;
Establishing policies within law enforcement that ensure EMS is never left without assistance during the care and transport of a potentially violent patient.
Also of note was the presentation by Jay Reich, MD, medical director for Kansas City, MO, on the new EMS Forward report. This report was originally developed by the Center for Patient Safety and “strives to increase awareness, open dialogue, and promote actions to improve patient and provider safety in EMS.”1 Some of the topics in the report are clinical in nature like airway management, pediatric patients assessment and medication errors, but most relate to the culture and operations of EMS agencies such as crashes, transitions of care and second victim interventions.
The Uncertain Pathway to Professionalization
One of the funniest presentations of the conference was a debate between two of the most senior Eagles, Drs. Fowler and Valenzuela, on the utility of the new EMS board certification exam. The significance of this exam is that it has allowed physicians specializing in emergency medicine to take an exam in order to sub-specialize in emergency medical services. While each Eagle took an opposing view, both advocated from the stance that their position was better for the advancement of the industry.
Although the direct effects of EMS becoming a subspecialty will take time to realize, the level of advocacy for EMS as a profession was lost on no one. The Eagles recognize that EMS had long been the red-headed stepchild and are more willing than ever to fight for the resources and recognition this industry deserves.
Integration with Public Health
Ebola, the zika virus, and even chicken gunya received references during this year’s conference. But perhaps more significant was the realization that drug overdoses are a much larger threat to public health. Cities like Anchorage and Chicago are both dealing with respective epidemics, and each has a unique way of handling the influx of patients.
In Anchorage synthetic cannabinoids (aka “spice”) had resulted in an average of 7.1 transports per day, or almost 13% of their call volume. The city was able drop this number to 4.6 transports a day or about 8.5% of their call volume by updating an existing ordinance, but the strain on the system has continued. Providers in the area have become experts at recognizing the signs, symptoms, and natural history of these drugs in order to better understand the needs of their patients.
In Chicago, a batch of fentanyl-laced heroin resulted in a three-day spike of overdoses that would not have been as quickly identified without the help of EMS providers. The epidemic was so severe; Dr. Weber activated the city-wide crisis plan, something never done before. This provided access to resources across the public health, public safety and healthcare spectrum. A decision he would not hesitate to make again.
Next Year’s Wish List
Advanced Research Methods
The presentations at the Gathering are likely some of the most highly scrutinized in the industry. Prior to the actual conference the Eagles gather to discuss each presentation, vetting the information, and fine-tuning it such that the facts being presented are as accurate as possible. Although the analytic methods used in most of the research are well respected, the reality is that these methods are relatively simplistic. Perhaps that’s because the EMS profession as a whole accepts descriptive statistics and logistic regressions as the norm, but EMS should consider embracing more advanced methodologies. They provide an additional resource for improving the science behind EMS systems.
The Eagles on stage have earned their spots. They are respected medical professionals that have undergone at least a decade of training to reach their current positions. Some have been Eagles since the Gatherings started. Although they cracked jokes about the number of grey hairs on stage, there were a solid number of younger faces among their ranks. What the current cohort lacks is a diversity of gender and race. Making up for this deficit will both require interest from the underrepresented, as well as backing from those in a position to support them as they advance within the industry.
Catherine R. Counts is a doctoral candidate in the department of Global Health Management and Policy at Tulane University School of Public Health and Tropical Medicine where she also previously earned her Master of Health Administration. Counts has research interests in domestic health care policy, quality and patient safety, organizational culture and prehospital emergency medicine.