Where in the World is A.J.?

University of Cincinnati EMS Midwest Conference

On Friday and Saturday, JEMS Editor-in-Chief, A.J. Heightman joined a stellar faculty at the
EMS Midwest 2014 Conference, sponsored by the University of Cincinnati and Cincinnati Children’s Hospital at the beautiful Great Wolf Lodge in Mason Ohio. Cincinnati EMS Medical Director, Don Locasto, MD and staff from the University of Cincinnati organized the two-day conference.

Interior of 1973 HORTON van ambulance Photo A.J. Heightman

A.J. opened the conference on Friday with a keynote address on the History of EMS, from the American Civil War to the present. He was followed by Anderson Twp. (Ohio) Fire Chief Mark Ober who presented The Back of the Ambulance: From the Hearse to the Harness, a review of the development of the ambulance patient compartment and safety issues involved in EMS today.

Cincinnati Fire Chief Richard Braun then outlined fire service involvement if EMS in his lecture: How Did the Fire Service get into the EMS Game?

Staff from the University of Cincinnati , College of Medicine, Cincinnati Children’s Hospital Medical Center and University of Cincinnati Air Care presented exceptional lectures on: trauma in pregnancy; pediatric trauma, triage and transfer; the role of the EMS physician in the field; pediatric burns and electrical injuries ; critical care patient management; adult & pediatric patient toxicology issues; needle cricothyrotomy and surgical airways; geriatric challenges; cardiology; the use of simulators and simulation; and MCI Management from the field through the hospital (a detailed review of a Greyhound Bus Accident on I-75 in Liberty Twp. on 9/14/13).

A.J. Heightman’s keynote presentation on Saturday, What’s on the Horizon for EMS, was a fast-paced review of EMS concerns, protocols and equipment that were discussed at the February Gathering of Eagles Conference presented by medical director members of the Major Metropolitan Medical Directors Coalition and other innovations, issues, processes and procedures A.J. said he felt will change the way EMS crews respond and operate in the future.

A.J.’s keynote presentation focused on: new models being implemented by fire and EMS services to deploy their crews, including use of smaller, two-person, Rapid Response Fire Units in place of large engines; use of Narcan (Naloxone) and Epi-Pens by the public, law enforcement, BLS and fire first responders crews (including the positive and negative aspects involved with each); CPAP and other, previously ALS procedures, that are now being performed by BLS crews in the United States;  Pit Crew Resuscitation approaches being used successfully in may EMS Systems with increased ROSC being realized; ); the merits of delivery UPSTROKE Ventilations after every 10th compression and use of Mechanical CPR Devices such as the LUCAS 2 (Physio-Control) and AutoPulse (ZOLL) units in place of manual compressions, citing positive results being experienced by many systems deploying the devices; the need to continue resuscitations for more than 20 minutes before terminating codes (because there is now evidence that patients can be resuscitated after more than 90 minutes, particularly when mechanical compression devices are utilized); the use of capnography to detect septic shock; the transitioning of EMS crews into the Warm Zone at Active Shooter incidents; the need for EMS and police responders to carry and use wound clot dressings, chest seals and tourniquets (citing the need for all emergency response units to carry at least four (4) tourniquets per vehicle because of the probability of multiple amputations after an IED explosion and at mass casualty incidents.

A.J. also reviewed new technology and equipment being used in the field, such as: oxygen tissue saturation (StO2) devices; the iTClamp for hemorrhage that cannot be controlled by tourniquets and other conventional means; the ResQPod that increases intra-thoracic pressure during resuscitations; the ResQGUARD mask/valve that increases blood pressure in a non-invasive manner; ECMO (Extracorporeal membrane oxygenation) in hospital centers of excellence for acute respiratory conditions heretofore used primarily on newborns; the use of the REEL Splint System (used extensively by the U.S. Military) to rapidly immobilize fractures and dislocations in the field; and, the use of vacuum mattresses and splints in place of long spine boards; use of 3 needles for plural decompressions and simple thoracostomy procedures now being used in some systems.

He concluded his presentation with a compelling review of the potential harm responders can do if they inappropriately apply cervical collars and stretch the spinal cord of their patients.

A highlight of the two-day conference was the display of ambulances and a helicopter from the region, dozens of historic EMS equipment items and a beautifully restored 1973 Dodge HORTON van ambulance.

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