ECHO 2017 Annual Conference

October 27th - 29th 2017 Thomas Jefferson University

Philadelphia, Pa

Pre-Conference Workshops October 27th

SurgicalAirwayLab(0800-1000)JeffSTATeducationcenterroom9101Theinabilitytomaintainoxygenationbynon-invasivemeansisoneofthemostpressingemergenciesinprehospitalcare.Topreventhypoxicbraindamageanddeathina“cannotintubate,cannotoxygenate”scenario,emergencysurgicalairwayaccessmustbeperformedimmediately.Eventhoughthisemergencyisrare,everyprehospitalpractitionershouldbeprepared,comfortable,andcapableofperformingthisprocedure,asthesituationwilloftenariseunexpectedly.Clearknowledgeoftheanatomyandinsertiontechnique,andrepeatedskilltrainingareessentialtoensurecompletionofthisprocedurerapidlyandsuccessfully.Varioustechniqueshavebeendescribedforemergencyoxygenationandseveralcommercialemergencycricothyrotomysetsareavailable.TransportECMOLab(0800-1000)JeffSTATeducationcenterroom9103ECMOisanextremelypowerfultoolthathasbeguntogainpopularityinthetreatmentofpatientswhowouldhaveotherwiseneverhavesurvived.AsECMOgainspopularityapushtoofferthislifesavingmodalitytoalargerpopulationfollows.AsaresultofthismanyHEMSprogramsarebeingcalledupontotransportpatientsonECMOoraretakingteamstodoECMOrescue.JointheJeffersonECMOserviceandJeffSTATcrewsastheydiscussthislifesavingmodalityandhowtheygoabouttransportingtheseuniquepatients.Theworkshopwillcovereverythingfrompatientselectiontothelogisticsofloadingthepatientandequipmentinahelicopterandanambulance.SuctionAssistedLaryngoscopicAndAirwayDecontamination(1030-1230)JeffSTATeducationcenterroom9101ExistingairwaytrainersfocusonbasicssuchasBMV,placementofNPO,OPA,LMAinsertionandlaryngoscopymanyhavethecapabilitytosimulatevomit,butthisisrarelyused.Moreoversuchsystemsrelyon‘singledose’bolusofcontaminantviasyringeintotheesophagusJamesDuCantohaspioneeredamodelfor‘suctionassistedlaryngoscopicairwaydecontamination’(SALAD),whichteachestechniquestobothdecontaminatetheoropharynxfromblood/vomitinastaticfashion...andtoperformlaryngoscopyandsuctionsimultaneouslyinthefaceofcontinuingcontaminationoftheoropharynx(eg:GIbleed,epistaxisetc..)WorkingwithJamesforthelasttwoyearsIhaveworkedonrefininganintroductorytrainingsessionaimedattheParamedic/PreHospitalmarket.InteractiveCaseStudiesinCriticalCareTransport(1030-1230)JeffSTATeducationcenterroom9103Wouldyouliketosharpenyouredgeonthoseubersickinterfacilitytransfersorhaveyoupersonallyhadaconfoundingcaserecentlythatyou'dliketodiscuss?Thisisanopportunitytogooversomereallyhighacuitycases,deepdiveintothemandhaveasuperinteractive1on1discussionwithanintensivistandflightNP.Thissessioncanbewhateveryouwantittobetoandhelpyoutowalkoutwithsomerealpearlstoimproveyourcriticalcaredelivery.

Pre-Conference Workshops October 27th

EMSPOCUSWorkshop(1330-1730)JeffSTATeducationcenterroom9103POCUS(pointofcareultrasound)isaseverelyunderutilizedtoolintheprehospitalandretrievalenvironment.Discoverhowthisdiagnosticmodalitycanbeimplementedtopositivelyimpactpatientcareinbigways.Topicsincludeovercomingdeploymentandtrainingissues,vascularaccessandmedicalindications,suchasdifferentiatingoccultcausesofshockandtheutilizationofPOCUSincardiacarrestforbothtreatmentandprognosticationwithahinttothepossiblefutureofEMScareinstrokesandpreventativemedicine.AdvancedMechanicalVentilationLab(1400-1600)JeffSTATeducationcenterroom9101Inpartnershipwithsomeofourventilatorsponsors,wewillbeofferingareviewofmechanicalventilationfrombasicstraightforwardventmanagementthroughthemanagementofthesicklungwithARDS.Thelabutilizespiglungstoillustratetheeffectsofthedifferentmodesandstylesofventilationonthelung.Thislabwillyougiveyouawholenewperspectiveonventmanagementandhowitismorethanjustblowingairinandout.

2017 Annual Conference October 28th

0800-0900 RegistrationandBreakfast

0900-0915

OpeningRoom109

0915-1015

Don'tcallmeasurvivor:Oneyearafterthe

NorthMemorialHelicoptercrashMilesandBrookeWeske

Room109

1015-1030

FASTTeamRoom109

1030-1100 Break/VendorVisits Room109 Room628

1100-1200 KickingtheassofacidosisDanRauh-UCAirCare

Safety from the customer’s point of view –Developing an SMS

Jeff White- HealthNet

1200-1330 Lunch Room109 Room628

1330-1400

HowtoPreventFlyingthroughtheGlotticOpeningviaAutorotationand

IFRDr.BenLawner–AlleghenyLifeFlight

"FitforDuty"JamesBoomhower-BostonMedFlight

1400-1430BurnCair:CriticalCareBurnManagementforHEMSMattRandall-Erlanger

ToosickfortransportVaheEnder-BostonMedFlight

1430-1500AirwayPressureReleaseVentilation

(APRV);TheBasicsJoeHylton–MedCenterAir

StateoftheMarketGuyBarber-JeffSTAT

1500-1530 Break/VendorVisits Room109 Room628

1530-1700

Trauma/CriticalCarePanelDr.DaveGaieskiDrDanHaaseDrBenLawnerDanRauh

FlyingSpecialNeedsPopulations:I’mDeafNowTalkToMe

ShelbyNero-FairfaxCountyPublicSchools

TBD

2017 Annual Conference October 29th

0900-1000Comingback–Recoveringfromtheworstnightofyourcareer

BenSummerandErinLester–LifeLinkIIIRoom109

1000-1030 Break/VendorVisits

Room109 Room628

1030-1130 Pre-HospitalSepsisDr.DavidGaieski–TJU

10thingsyourIntensivistwantsyoutoknow

DanRauh-UCAircare

1130-1300 Lunch

1300-1400Attitudetoaccident–connectingthedots

DanFoulds-AMRMTrainingSolutionsRoom109

1400-1430 Break/VendorVisits Room109 Room628

1430-1500 NASWISARResponsetoEA-18GMishap

HM2JohnSiedler-NASWISAR

AdvancedCriticalBurnCareDr.WilliamB.Hughes

1500-1530PrehospitalOB:“Whenthe$^!#hits

thefan”JessicaArno

1530-1600 Break/VendorVisits Room109 Room628

1600-1630

Fightingintheshade-cognitivereadinessinHEMS-preparation,

training,andperformanceJohnVonrosenburg-WakeMed

PrehospitalHocusPOCUS?Dr.BenLawner–AlleghenyLifeFlight

1630-1700

ATaleofTwoAirwaysRobertGirardeau-JeffSTAT

TamingtheClinicStarfishofDeathandothersignsofaverybaddayJacobMiller–ClevelandClinic

PresentationDescriptions

October28thDon'tcallmeasurvivor:OneyearaftertheNorthMemorialHelicoptercrashHowdoesaflightcrewfamily,awifewhoisaflightnurseandhusbandwhoisaflightmedic,endureahelicoptercrashthatoneofthemisinvolvedin?ListenasBrookeandMilestelltheirstoryfortheveryfirsttime.KickingtheassofacidosisDothewordsacidbasebalanceandmetabolicacidosisleavingyoucontemplatingifyourQTccan tolerate an 8 mg dose of Zofran? It doesn't have to!! If you understand 3 or 4 basicprinciplesyoucantrulyseparateyourselffromthemajorityofcriticalcareprovidersthatthinkSodiumBicarbonateistheanswertothismetabolicderangement.SafetyfromthecustomerperspectiveThispresentationwilldiscuss the increaseddesirebyCAMTS fororganizationstohave theirownSMS that integrates into theiroperators largerSMS.Thispresentationwill coverqualitymetrics,whichwillgiveyoudatatodrivesafetyprocessesandassistwithbusinessdecisions.WewilldiscusstheSMSassessmentprocessandhowitcanbeusedtobuildyourSMSfromthegroundup.WewilldiscusshowJustCultureplaysapartintheoverallsafetycultureandhowreportingisincreasedinaJustCultureenvironmentimprovingyourinternalinvestigationstofindthetruerootcauseofanevent.HowtoPreventFlyingthroughtheGlotticOpeningviaAutorotationandIFRRapidSequenceIntubation(RSI)hasevolvedsinceitwasfirstperformedoutsidetheoperatingroom.Manyvariablesareinvolvedinasuccessfulintubation,andtheprocedureisperformedin accordancewith varying protocols. Review the evidence supportingRSI and integrate thelatestinformationintoacomprehensiveemergencyairwayplan.BurnCair:CriticalCareBurnManagementforHEMSBurnrelatedinjuryanddeathcontinuetobealowfrequency,highacuitypatientpopulationforcriticalcareHEMSproviders.Thislecturewilltakeanindepthlookatthecriticalcareapproachtoburnpatientmanagement.Wewilltreatmentsoftotalbodysurfaceareaburns,highvoltageburns,pre-hospitalsurgicalproceduresforburnpatients,smokeinhalationinjuries,ventmanagement,aswellasareviewthecurrentliteratureonaggressivepre-hospitalantibiotictreatmentofburnpatients,additionallywewilldiscussnebulizedanti-coagulationtherapyinsmokeinhalationinjuries,andidentificationandtreatmentofthemajorhypoxiaassociatedwithburninjuries.AirwayPressureReleaseVentilation(APRV);TheBasicsCriticalcaretransportteamsareincreasinglybeingrequestedtotransferpatientsthatarebeingventilatedwithAPRV.ThispresentationwillreinforcethephysiologybehindAPRV,aswellasrecommendingappropriateinitiationsettingsandbasictroubleshooting.Thispresentationwillbefollowedbyahands-onworkshopduringthebreak.

"FitforDuty”In"FitforDuty"IwilldiscussthefundamentaldifferencesbetweencumulativestressdisorderandPTSD."FitforDuty"willtellthestoryofanewHEMSproviderandanincrediblychallengingcallforhim,hispatientandhisteam.UsingthisframeworkalongwithahealthybitofhumorIaimtoensureallmembersoftheHEMSandaviationteamunderstandtheimportanceoftreatingourmentalhealthnodifferentlythanthephysicalhealthofourpatients.Takingstockofthesymptoms,seeingthesignsandensuringthatweareallFitforDuty.TooSickForTransfer:OurFailureandOurFallacyWeexplorethefallacyofinstabilityasanexclusionfortransportandexploreourresponsibilityanddutywhichwehavetowardsourmostcriticallyillandinjuredpatients.Iwilldiscussorganizationalandpersonalapproachestodealingwiththispatientsetandultimatelypushustoadvocateforourpatientswhennooneelseis.It’smyhopethatthistalkinspiresprovidersandhospitalstafftoreframehowtheyperceivethecriticallyill,peri-arrestpatient.Trauma/CriticalCarePanelThepanelwillbeachancetopickthebrainsofsubjectmatterexpertsinthefieldofcriticalcareandresuscitationmedicine.TopicsinthepasthaveincludedECMO,ARDS,Sepsis,heartfailure,massivetransfusion,TBIandairwaymanagement.Thistimearoundthepanelwillbepresentedwithcasessubmittedbyattendeesandmembers.Ifyouareinterestedinofferingupacasetobediscussedcheckoursocialmediaprofilestofindthedetails.FlyingSpecialNeedsPopulations:I’mDeafNowTalkToMeWhatifyourmedevacpatientorpatientfamilywasdeaf?Doyoujustwritethingsdowninpostitnotesandthatisyourbestformofcommunication?Thispresentationwillbeleadbyaspecialneedsteacheranddiscusseffectiveemergencycommunicationskills.October29thComingback–RecoveringfromtheworstnightofyourcareerFollowingthecrashofanairmedicalhelicopternearourairport,werespondedtothehospitaltocareforthevictims.Wetransportedthemostcriticallyinjuredofthecrew.Thistalkwillencompassourmentalrecoveryfromthatnightandhowourcompanysupportedusthroughit.Pre-HospitalSepsisThispresentationwilldiscussthestateofsepsiscarein2017,addressingongoingproblemsofearlyrecognitionandappropriatelyaggressiveearlytreatment.ThepresentationwilltracetheevolutionofmodernsepsiscarefromthelandmarkRivers’EGDTtrialtothemorerecenttrioofprotocolizedsepsistrials(ProCESS,ProMISE,ARISE).Wewilldiscusssepsisepidemiology,SIRSvs.qSOFA,the2016sepsisdefinitions,earlyantibiotics,protocolizedcare,regionalizationofsepsiscare,andlong-termconsequencesofsepsisincludingneurocognitivedeclineandreadmissions.Theseissueswillalsobediscussedinthecontextofprehospitalcareandthepossibleinterventionsavailabletoprehospitalproviders.

10thingsyourIntensivistwantsyoutoknowLet'sfaceit.....sceneflightsarefunbutcriticalcaretransfersarewhereyouneedtomakethemostefficientuseofyourhighercorticalstructures.Letstalkabout10criticalcaredilemmasthatyourintensivistreallywantsyoutounderstand...whenishyponatremiaabigdeal,whatlabsmatterandwhatcanyoudowithTHEIRultrasoundprobethatwillmakeadifferenceforYOURpatient,justtonameafew.Attitudetoaccident–connectingthedotsWewillidentifythehazardousattitudesthathavebeenlinkedtoHEMScrashes,andwilldiscussareal-worldexampleofeachH.A.linkedtoacrash.NASWISARResponsetoEA-18GMishapDiscussiononthemissionandcapabilitiesoftheNavySearchandRescueMedicalTechnicianandNavalAirStationWhidbeyIslandSAR,specificallyinregardstoamissionoccurringon16Dec2016.ThemissionthatoccurredinvolvedtheexplosionofthecockpitonanEA-18GGrowlerAircraft,resultingintwopatients-onewithasignificanttraumaticbraininjuryandthesecondreceivingmassivebarotraumaresultingintwotensionpneumothoracesandaruptureddiaphragm.Iwillbeperformingmission/responsereconstruction;descriptionsofthetreatmentrenderedonthegroundandin-flight,aswellasprovidesomefollowuponthein-hospitaltreatmentofbothpatients.PrehospitalOB:“Whenthe$^!#hitsthefan”OBpatientsaresomeofthemostdreadedpatientsinallofPre-hospitalandEmergencyMedicine.InthispresentationIwillcoverthreeofthescariest:breechandshoulderdystociadeliveriesinafieldsettingandpostpartumhemorrhage.AttheendofmypresentationstudentswillbebetterequippedtohandletheseHOLY$^!#situations.PrehospitalHocusPOCUS?Ultrasoundtechnologyhasbecomeincreasinglymoresimpleandportable.Severalprehospitalprogramshaveincorporatedultrasoundintotheirassessmentalgorithms.Prehospitalproviderscanbetrainedtoperformdiagnosticscans,butcantheuseofultrasoundaffectpatientoutcome?Istheultrasoundprobejustanothershinyobjectorausefultoolforprehospitalassessment?Discussthefutureofprehospitalprotocolsandultrasoundassistedpatientassessment.TamingtheStarfishofDeathandothersignsofaverybaddayAcuteneurologicemergenciesareacommonreasonforcriticalcaretransport.Thispresentationwillreviewflightteammanagementofcommonneurocriticalcarecomplaints,withafocusonacuteintracranialhemorrhage.