Where in the World of EMS was A.J. Heightman?

Participating in an amazing educational EMS Conference in Pennsylvania

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I spent the weekend lecturing at the Education Made Simple 2016 EMS Conference held at the beautiful Desmond Hotel and Conference Center in Malvern Pennsylvania, Chester County, a suburban area outside of Philadelphia.

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The resort hotel and conference center was an amazing place to stay and lecture. I would recommend it to anyone, not just those attending an EMS Conference, but anyone who wanted to enjoy a wonderful and comfortable weekend away in this beautiful, historic part of Pennsylvania.

The rooms had a colonial look and feel, with amazingly comfortable king size beds, and a tiered conference facility that featured great audio and visual capabilities. It was perfect for both the attendees and the speakers.

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The conference served breakfast and snacks all day (Yum!) and treated us to a delicious catered lunch topped off with the best bread pudding I have ever eaten (and I’ve eaten a lot of it in my lifetime!)

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You might not think these comfort features are a big deal, but they are to me, having traveled all day and 3,000 miles the day before to get there, and for the attendees and I, who sat for eight hours of near non-stop lectures.

The conference, sponsored by Sponsored by the Good Fellowship Ambulance and EMS Training Institute; Paoli Hospital – Main Line Health and Chester County Hospital – Penn Medicine, featured lectures that were highly educational and enjoyable, presented by a great faculty from the region’s hospitals and specialty centers.

I really have to hand it to the planning committee, headed up by Bill Wells, Executive Director of the Good Fellowship Ambulance and Training Institute, for putting a faculty together that knocked it out of the park.

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Bill Wells, Executive Director of the Good Fellowship Ambulance and Training Center, served as the EMS Conference’s MC

Amazing Journey inside the Heart

Steven J. Weiss, M.D., MBA, Chief of Cardiac Surgery at Chester County Hospital and Clinical Assistant Professor of Surgery at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, presented a highly detailed lecture on heart valve disease and CHF, using amazing, high-definition echo cardiogram video clips.

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Most importantly, he addressed how helpful EMS personnel can be in calling valve problems to the attention of ED staff so they do not slip through the cracks and ensure that they get the surgical care that they need.

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Dr. Weiss was enthusiastic and proud of his life’s work on human hearts. He started with a great explanation of the heart’s anatomy, with special emphasis on the chamber and valves.

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His colorful visuals and detailed explanation of the blood flowing through the heart illustrated cardiac abnormalities amazed every attendee and gave us a real “inside look” into the actual hearts involved.

To top it off, this incredible surgeon showed videos that were shot from his headset camera during each operation as he repaired each heart valve with robotic surgical instruments and cleared clots that could cause a stroke of not removed (See photos below).

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Dr. Weiss took us on a journey into each patient’s body and each intricate, delicate heart chamber. It was a priceless experience; a level of education usually reserved for medical students. So it was a special treat for us all.

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Dr. Weiss started with a full explanation of each cardiac patient’s presenting symptoms. He then taught us how to assess and discern defective lung sounds and listen for the deadly symptoms of valvual heart disease – something that killed my beautiful grandmother long ago before such surgical repair and EMS assessment was possible.

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He showed the initial echo cardiogram video of the disruptive flow from each patient, such as one who suffered from a bad mitral valve (regurgitation).

He also showed us how he cross-clamped the aorta, stopped the patient’s heart and put the patient on the life sustaining cardiac bypass machine.

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Dr. Weiss then he took us deep inside each heart with him as he delicately and skillfully repaired most of the valves and heart structures without having to use replacement bovine or mechanical valves.

The techniques he showed us were amazing and described in great detailed to us, giving us a chance to fully understand each heart condition and its surgical repairs.

It was also pointed out how the excessive administration of nitroglycerin to some of these patients by EMS could result in the worsening or death of the patients.

The most interesting and educational fact to me was that his surgical repair procedures almost guaranteed the complete recovery and sustainability of the valve for the rest of the patient’s life – with no rejection.

To me, it was a “must have” lecture for the JEMS EMS TODAY 2017 Conference in Salt Lake City because I know the JEMS U.S. and International attendees would love it!

So, if you attend EMS TODAY, you will have the opportunity to experience this same ride into the heart with Dr. Weiss because he has agreed to make the trip to Salt Lake City Feb. 23-25 to present this topic twice. It is an experience I guarantee you will not get elsewhere and worth the cost of a Gold Passport all by itself.

 The Future of EMS and “ECMO”

I gave my vision for the future of EMS and had input into the wonderful advancements of ECMO [extracorporeal membrane oxygenation/Bypass] care from Dr. Weiss, who explained how the University of Pennsylvania and it helicopter program is pioneering in this area.

JEMS will be presenting this pioneering work and how U.S. and European systems are now performing ECMO via helicopter and ground outreach units at EMS Today 2017 in Salt Lake City.

Crush Injury Assessment and Treatment

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JEMS Medical Editor Ed Dickinson was on the faculty and presented a detailed lecture on Crush Injuries and how EMS personnel can make a big difference by their early/correct assessment and care – with high volume fluid delivery and the slow but methodical administration of calcium and bicarbonate soon after extrication and condition recognition.

Dr. Dickinson also explained how patient trapped in wet dirt or sand (even in normal outside temperature conditions) will sustain hypothermia and need to be treated with warmed IV fluids.

Dr. Dickinson, one if the country’s most respected EMS Medical Directors and lecturers and chairman of the JEMS Street Medicine Society is also Medical Director of the Hospital of the University of Pennsylvania Department of Emergency Medicine; Director of EMS Field Operations for Penn’s Department of Emergency Medicine; and Professor of Emergency Medicine at the Hospital of the University of Pennsylvania.

Another Journey inside the Body

Attendees took another trip inside the body with the presentation delivered by Kris Kaulback, MD, FACS, trauma program medical director at Paoli Hospital and assistant professor of surgery in the Department of Surgery, Division of Acute Care Surgery at Thomas Jefferson University Hospitals (TJUH) in Philadelphia. Dr. Kaulback showed us multiple patients with fractured or crushed spinal structures or cord injuries.

TJUH, a world-renowned spinal cord injury center, sees and treats 600 severely injured spinal cord injuries each year, so this surgeon was a top shelf lecturer whom I will also be inviting to present at EMS Today in Salt Lake City.

Dr. Kaulback showed us lots of data and position statements that documented and illustrated the reduced need and harm that can result from positioning patients on full back boards when there was no need to do so.

More importantly, Dr. Kaulback was well versed in past and current prehospital care spinal injury immobilization practices and procedures, and the new Pennsylvania statewide EMS immobilization protocols that now reduce the need for the complete immobilization of all back injuries.  (See PA ALS & BLS Protocol #261)

SPINAL CARE – PA STATEWIDE BLS PROTOCOL

Criteria:

 Excessive motion of the spine may worsen spine fractures or spinal cord injuries (especially in patients with altered consciousness who can’t restrict their own spinal motion), but immobilization on a long spine board may also cause pain, agitation, respiratory compromise, and pressure ulcers. Patients with the following symptoms or mechanisms of injury should be assessed to determine whether restriction of spinal motion is required:

  1. Symptoms of:
  2. Neck or back pain
  3. Extremity (upper or lower) weakness or numbness, even if symptoms have resolved.

 OR

Mechanism of injury consistent with possible spinal injury, including:

  1. Any fall from standing or sitting with evidence of striking head.
  2. Any fall from a height (above ground level).
  3. Any MVC
  4. Any trauma where victim was thrown (e.g. pedestrian accident or explosion).
  5. Any lightning or high voltage electrical injury.
  6. Any injury sustained while swimming/diving or near drowning where diving may have been  involved.

OR

Any unknown or possible mechanism of injury when the history from patient or bystanders does not exclude the possibility of a spine injury. 1 (See online protocol version / link – below)

This protocol also applies to assessment of patients before inter-facility transfer for injuries from a traumatic mechanism unless a medical command physician agrees that the patient may be transported without restriction of spinal motion.

Exclusion Criteria:

  1. No history or no mechanism of injury that would be consistent with spinal injury.
  2. Patients with penetrating trauma to the chest, abdomen, head, neck, or back. These patients may be harmed by immobilization on a spine board.
  3. Patients with gunshot wounds to the head do not require immobilization on a spine board.
  4. Patients with non-traumatic back or neck pain related to movement, position or heavy lifting.1

Pennsylvania Statewide BLS and ALS Protocols

See protocol page 261 – pages 2 of 4 to review a clearer copy of this nice flow chart for spinal assessment and spinal immobilization exclusion parameters

http://www.health.pa.gov/My%20Health/Emergency%20Medical%20Services/EMS%20Statewide%20Protocol/Pages/default.aspx#.VydwiKPn_Mo

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Burn Care Presented by a “Street Medicine” Physician

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I got a chance to induct Dr. Herbert N. Schiffer, D.O., into the JEMS “Street Medicine Society”, the elite Society of EMS physicians who started out on the street as EMTS and paramedics.

Dr. Schiffer, who served as a Malvern (PA) Fire Paramedic and paramedic at the Longwood (PA) Fire Company before going off to medical school, later returned to work at at Crozer Keystone Health System in Upland PA, as an EMS Physician, educator and EMS Medical Director, presented an informative and highly graphic review of burns, their assessment, calculation and care.

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Dr. Schiffer is also an accomplished pilot who does his time flying patients in need to far away specialty centers. He is a credit to our profession.

Addressing the Drug Overdose Epidemic in America

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David P. Neubert M.D., Deputy Regional EMS Medical Director for the Montgomery County Department of Public Safety; an ED physician at Lansdale Hospital, part of the Abington Health System; Medical Director and Educator with Tac-Med LLC and a JEMS and EMS Today contributor, closed out the day with a detailed and informative lecture on the latest street drugs and conditions being seen in the field and in the ED.

Using his amazing personality, humor and rapid delivery style, Dr. Neubert made a complex chemical imbalance subject both understandable and educational.

Wonderful Reunions

This conference was the type that Jim Page always enjoyed, the type that was so fast-paced and informative that it “made your brain hurt”!

It was also fun for me to be back in my home territory to lecture to, and be reunited with, many people that I knew and grew up with in EMS over the past 40+ years.

Jerry Peters, a long-time friend and judge for the JEMS Games Advance Clinical Competition, sponsored by Laerdal and held at EMS TODAY each year, invited me to participate in this wonderful conference at which I enjoyed several hours of solid continuing education.

JEMSHands On” Product Columnist, Fran Hildwine, (who lives and works in the region as a Simulation Guru and educator) attended the conference and joined us for a wonderful dinner at the historic General Warren Inne (See separate story below).

At dinner, we laughed and reflected on some of Fran’s epic “performances” as not just a judge at the JEMS Games, but as a lead “actor”/victim at the JEMS Games final competitions. Each year we use Fran in amazing patient or bystander rolls at the Games, with a one attendees attending specifically to watch and enjoy.

This year Fran was a stroke victim at a Rock Concert gone bad and was accompanied by Laerdal’s Staceyann Van Horne, who was a “hoot” herself, chiding competing teams who gave her beloved companion lower-priority care during the 20 minute MCI scenario.

One team that encountered Fran on the floor with his obvious stroke signs, ripped open his shirt without unbuttoned it – something I would probably do.  The disgusted look on Fran’s face and his whine of “they ripped the buttons off my shirt” was priceless.

We also laughed about how some of his adoring “fans”/”groupies” loved being the recipients of the buttons from his shirt after the event. To them it was like catching a drumstick from Metallica’s drummer!

Bob Reeder, Director of Crozer EMS, where I have presented several two-day MCI Management workshops, complimented me by pointing out how some of the tips and processes they learned in my MCI workshops helped them successfully manage a recent AMTRAC train crash in Chester PA and a carbon monoxide incident that involved 59 patients.

It was nice to hear from an old friend and colleague that my MCI education made an impact on their care and operations at these two recent MCIs.

Al Kalbach, a former paramedic colleague of mine at Bethlehem Twp. Volunteer Fire Department in the 80s, and now an accomplished paramedic/educator at Good Fellowship EMS, was on hand to film the conference. In addition to his EMS skills and educator talents, Al is a master videographer. Look for some of his work on JEMS.com.

I was surprised and pleased to have EMS luminary and critical care nurse Leo Scaccia travel all the way from my home city of Scranton PA in Northeastern PA, to Southeastern PA see me and hear my lectures on EMS and MCI management.

Leo, Director of Operations at Brandywine Hospital and an active member of several EMS services, is the younger brother of Diana Scaccia, a high school classmate of mine from the Class of ’71 in West Scranton.

Diane had called me 30+ years ago and asked me to advise her brother on the right patch into an EMS career. Leo listened to my recommendations and went on to become a great EMT, paramedic, EMS educator and Critical Care nurse.

People often ask me why I love EMS and still endure the many long flights and road trips in overcrowded planes, rental cars, and hotels after all these years?  Conferences and “reunions” like this are some of the reasons why I do.

Having a great and supportive JEMS and PennWell team who understand my quirks, passion and digital, distance editing and meetings, are the other reason.

I could not be on the road without their understanding and all of their great work and support in keeping JEMS and EMS Today as two of the premier institutions in EMS.

Others try to replicate what we do at JEMS/EMS TODAY and PennWell, but they cannot replicate the level of commitment and passion our team has for EMS. It is our pleasure (and commitment) to serve you.

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About the historic General Warren Inne

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Since 1745, the Historic General Warren Inne has been center stage for American history and a premier carriage stop for hungry travelers. The story of the Historic General Warren Inne can be followed through its name changes. The Inne was first named in 1745 as The Admiral Vernon Inne, in honor of the naval commander Admiral Edward Vernon. He led the 1739 attack and capture of Portobello, Panama.

In 1758, the name was changed to the Admiral Warren after the famed Admiral Peter Warren, a hero in defense of the American colony that year at Louisburg, (Cape Breton Island, Nova Scotia) during the French and Indian War.

During the revolution, the Inne was owned by John Penn of Philadelphia, loyalist and grandson of William Penn. Its key location on the main highway between Philadelphia and Lancaster had helped the Admiral Warren become a popular stage stop and a Tory stronghold. It was here that the Loyalists met, drew maps and plotted against the revolutionaries. Howe and Cornwallis use these maps to negotiate the great valley, the route to capture Philadelphia.

The infamous Paoli Massacre was planned and launched from The Admiral Warren Inne. Local folklore has it that on the night of September 20, 1777, the British, led by Lord Grey, captured the local blacksmith and tortured him on the third floor of the inn. Upon receiving the information that General “Mad Anthony” Wayne was camped one mile south of the Inne, the British attacked with bayonettes after midnight.

In 1786, John Penn sold the property to Casper Fahnestock, a German Seventh Day Adventist from Ephrata. During Fahnestock’s long ownership, the Inne once again thrived, attracting many Lancaster County Germans and other travelers along The Lancaster Turnpike because of its reputation for clean lodging and excellent food.

In 1825 an effort was made to make amends with the new nation, the Admiral Warren was renamed the General Warren, to honor the American hero of Bunker Hill. During the 1820’s, the height of turnpike travel was reached, and the General Warren became a relay stop for mail stages and a post office. Then in April of 1831, the Philadelphia and Columbia Railway opened for travel, and in May of 1834, the last regular stage went through. The new, faster and cheaper means of travel via the rails doomed the inn as traffic by-passed the property.

In the 1830’s the great grandson of the first Fahnestock turned the Inne into a Temperance Hotel, cutting down his apple orchard to prevent cider from being made. The lack of “spirits” doomed the hotel, and it closed within a few years. From that point into the early 20th Century, The General Warren Inne changed hands often, occasionally becoming a private residence. In the 1920’s, the inn reopened as a restaurant, with limited success over the next 60 years.

As area population and business grew in the mid 1980’s, the current owners made great strides to return the Inne to its 18th Century elegance. The upper floors were renovated into eight suites, the addition of a private dining room and all-weather heated patio for cocktail parties, outdoor dining and weddings.

In 2005, the latest improvements included the new Admiral Vernon Dining Room and the return of The Warren Tavern, a spacious bar for dining and spirits, relocated to the original spot of the old tavern from the 19th Century.

Today’s guest at The Historic General Warren Inne find the perfect blend of old world charm, excellence in continental cuisine, fine wines and delightful overnight accommodations.

 

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