On Saturday, Feb. 27, 2021, the National Collegiate EMS Foundation (NCEMSF) held its 28th annual conference as a virtual experience. Clinical programming, breakout sessions and awards were delivered to an audience primarily comprised of EMS providers working for campus-based agencies.
Below are highlights of the conference.
Fifteen-minute mini-lectures comprised the “Medical Hour” portion of the conference.
Ben Abo, DO, EMT-P, an EMS physician, paramedic, and wilderness medicine expert, discussed asthma and reactive airway disease—the most common chronic childhood disease, responsible for over 600,000 visits to the emergency department every year. This is a chronic inflammatory process, Abo said, adding that wheezing is not an indicator of disease severity. “If I hear no breath sounds, I get worried. I want to hear clear breath sounds,” he said. One important modality for this condition is steroids, but less than 10% of pediatric cases are given steroids by EMS providers. Mainstay treatments include bronchodilators, corticosteroids, epinephrine and magnesium sulfate. To become proficient at identifying abnormal breath sounds, listen to as many “normal” sounds as you can, advised Abo.
Gerard Carroll, MD, FAAEM, paramedic and EMS fellowship director at Cooper University Hospital in Camden, NJ, delivered the presentation “EMS and the Opioid Crisis.” Opioids are a big problem in Carroll’s home city. “On any given day we do a number of overdoses,” he said. It is a problem for EMS providers as treating the same patients for addiction issues can lead to them getting burned out, experiencing compassion fatigue, and feeling powerless to help. This is a medical condition, not a life choice, stressed Carroll. Rehabilitation and detox centers don’t have high long-term success rates. Medication-assisted treatment (MAT) via methadone and buprenorphine is the only medicine proven to address the core addiction. “You are the first access of these patients,” Carroll told his audience. Offer patients your time and protect their dignity.
Kate Kasen, MBA, BSN, RN, CEN, administrative coordinator/emergency response medical educator at the University of Virginia, and northern New England Regional Coordinator for NCEMSF, delivered “The So-What of Normal” to wrap up Medical Hour. “Normal” is a set of baseline numbers such as blood pressure, heart rate, and oxygen saturation, Kasen said. It gives providers a nice place to start an assessment, but not all normals fall within set criteria (i.e. systolic BP >90; oxygen saturation >94% etc.) For example, athletes, older patients on beta blockers and COPD patients will present widely varying “normal” baselines. Ask your patient (or caregiver) about their history, pre-existing conditions and what’s normal for them. Has there been a recent change in vital signs from baseline? What is the trend, is it expected, and is it moving in the right direction?
The next series of lightning-round lectures focused on trauma.
Ben Lawner, DO, EMT-P, medical director for Maryland ExpressCare Critical Care Transport and medical director for the Baltimore City Fire Department, discussed a need to rethink many prehospital trauma protocols currently in existence. It makes no sense to compress a heart that has no blood, Lawner began—closed chest massage has inferior survival rates in trauma cases. Likewise, there is little benefit to epinephrine in these circumstances. Don’t lose sight of what’s lifesaving, stressed Lawner—hemorrhage control, airway management, pelvic binding and chest decompression, in addition to medication such as TXA and the utility of stopping the bleed with tourniquets and hemostatic gauze. If you don’t have the ability to pack gauze, trauma protocols are quite inferior, he said. Manage the airway—in general the least invasive strategy is preferred, but airway management can be escalated if there is failure to oxygenate and/or ventilate. Lawner concluded his segment with a discussion of IV fluids. The evidence is clear that the standard of care for blood loss is to replace the blood, he said. There is a minimal role for saline infusions. Don’t make things worse by diluting your patient’s blood further. Finally, stop “stabbing patients in the chest” with needle decompression. “In terms of making patient less likely to die, there is not a lot of evidence in support of needle decompression,” he said.
William Hughes, MD, covered initial management of burn injuries and what to do when EMS first arrives at the scene (scene safety, stop the burning process and ABCs.) Hughes covered first-, second- and third-degree burns and their characteristics. Protect yourself first, he advised. Wear isolation gear and decrease your risk of exposure to infection and contamination. When you perform your primary survey, ignore the burn—focus on your ABCs. Get the patient history, look for soot or singed nasal hairs, listen and verify breath sounds and administer high-flow oxygen. Monitor blood pressure, establish IV access and establish IV fluids and monitor peripheral pulses. Is your patient awake and alert? Do they respond to verbal or painful stimuli? Most burn patients are initially alert and oriented. If they are not, consider associated injuries, carbon monoxide poisoning, substance abuse, hypoxia or a pre-existing condition. Remove all clothing and jewelry, examine for associated trauma, ensure a warm environment and use clean, dry blankets. It’s acceptable to use lukewarm water to clean and stop the burning, but don’t use ice. During your secondary survey, include the patient’s pre-burn weight and history of the injury (type of burn, when, where and how did it occur, and duration of the exposure.) Do a head-to-toe exam and determine the size and depth of the injury (i.e. the Rule of Nines).
Sam Galvagno, DO, PhD, professor at the R. Adams Cowley Shock Trauma Center in Baltimore, stressed that failure to manage the airway is a major cause of preventable death in the prehospital setting. Galvagno’s discussion covered seven premises of EMS airway management: If you need an airway, you need an airway; your first try is your best try; if it isn’t 3 feet in front of you, it might as well be on Mars; if we can bag we’re going to go, if we can’t bag, we’re going to go; muscle relaxation provides the best conditions for intubation but may become permanent; anesthesia is optional, an airway is not; and the surgeon is your friend. Galvagno also listed his four most common airway mistakes: no airway “management,” ineffective BVM use; inability to open the mouth, and incorrect grip on the laryngoscope. Final pearls from his talk were that airway assessment is imperative; laryngosocopy and mask ventilation may be challenging if not impossible; prepare for a cricothyrotomy; and allow patients to assume a position of comfort when safe to do so.
Visit www.ncemsf.org for more information about the foundation and to access conference materials.