Compressions

The first day of the conference. We all gather in a big ballroom.

I arrive just as they are doing a presentation about the EMS Memorial. They do a slide show of the 26 EMS people who lost their lives in 2005. It is very moving. You see these photos show the people smiling proudly in their uniforms(as music plays). They could be the person next to you. They clearly have no idea of what their fates would be, certainly not expecting to be a part of this slide show.

Here are their names:

Tommy Allen Allred of American Ambulance Service, Cullman, AL who died in the line of duty on August 18, 2005 of injuries received in a motor vehicle collision while on duty.

Bridgett Nicole Autry of Herring Volunteer Fire & Medic Department, Clinton, NC who died in the line of duty on June 13, 2002 of injuries received in a motor vehicle collision while on duty.

Heidi Jean Behr of Riverhead Volunteer Ambulance Corp Inc, Riverhead, NY who died in the line of duty on May 3, 2005 of injuries received in a motor vehicle collision while on duty.

Timothy Russell Benway of Yampa Valley Medical Center, Steamboat Springs, CO who died in the line of duty on January 11, 2005 of injuries received in an aeromedical aviation accident.

Christopher Dale Clingan of Pafford EMS, Hope, AR who died in the line of duty on February 19, 2005 of injuries received in a motor vehicle collision while on duty.

Gaylette Drummond of Midwood Ambulance, Brooklyn, NY who died in the line of duty on July 13, 2001 of injuries received in a motor vehicle collision while on duty.

Jeffery Scott Ferrand of Pafford EMS, Hope, AR who died in the line of duty on February 19, 2005 of injuries received in a motor vehicle collision while on duty.

Felix Hernandez Jr. of New York City Fire Department EMS, Brooklyn, NY who died in the line of duty on October 23, 2005 of complications from toxic exposure suffered while on duty at the scene of the 9/11 terrorist attacks.

Phillip H. Herring of LifeNet of the Heartland, Norfolk, NE who died in the line of duty on June 21, 2002 of injuries received in an aeromedical aviation accident.

Courtney Hilton of Highlands Ambulance Service, Lebanon, VA who died in the line of duty on June 4, 2005 of injuries received during an assault while on duty.

Scott David Hyslop of TriState CareFlight, Durango, CO who died in the line of duty on June 30, 2005 of injuries received in an aeromedical aviation accident.

Timothy Patrick Keller of New York City Fire Department EMS, Brooklyn, NY who died in the line of duty on June 23, 2005 of complications from toxic exposure suffered while on duty at the scene of the 9/11 terrorist attacks.

David B. Linner II of Yampa Valley Medical Center, Steamboat Springs, CO who died in the line of duty on January 11, 2005 of injuries received in an aeromedical aviation accident.

Chastity Hope Miller of American Ambulance Service, Cullman, AL who died in the line of duty on August 18, 2005 of injuries received in a motor vehicle collision while on duty.

Ryan P. Ostendorf of American Medical Response, Topeka, KS who died in the line of duty on December 5, 2005 of injuries received in a motor vehicle collision while en route to duty his duty station.

Brendon D. Pearson of New York City Fire Department EMS, Brooklyn, NY who died in the line of duty on April 23, 2005 of complications of surgery for an on-duty injury.

Terry Lee Pearson of Roseau Ambulance, Roseau, MN who died in the line of duty on January 4, 2005 of injuries received in a motor vehicle collision while on duty.

William "Pod" Podmayer Jr. of TriState CareFlight, Durango, CO who died in the line of duty on June 30, 2005 of injuries received in an aeromedical aviation accident.

John Jeffrey "Jay" Rook of Pafford EMS, Hope, AR who died in the line of duty on February 19, 2005 of injuries received in a motor vehicle collision while on duty.

James Philip Saler of TriState CareFlight, Durango, CO who died in the line of duty on June 30, 2005 of injuries received in an aeromedical aviation accident.

Lori Ann Schrempp of LifeNet of the Heartland, Norfolk, NE who died in the line of duty on June 21, 2002 of injuries received in an aeromedical aviation accident.

Heinz Schulz of Emergycare/LifeStar of Erie, Erie, PA who died in the line of duty on October 7, 2005 of injuries received in an aeromedical aviation accident.

Patrick W. "Pat" Scollard of LifeNet of the Heartland, Norfolk, NE who died in the line of duty on June 21, 2002 of injuries received in an aeromedical aviation accident.

Ricky Allen "Rick" Seiner of Citizens Memorial Hospital EMS, Boliver, MO who died in the line of duty on September 2, 2005 of injuries received when struck by a vehicle while operating on the scene of a call.

William Anthony Stone of Riverhead Volunteer Ambulance Corp Inc, Riverhead, NY who died in the line of duty on May 3, 2005 of injuries received in a motor vehicle collision while on duty.

Jennifer Theresa Wells of Yampa Valley Medical Center, Steamboat Springs, CO who died in the line of duty on January 11, 2005 of injuries received in an aeromedical aviation accident.

National EMS Memorial

***

The main speaker is Dr. Norman McSwain, an EMS pioneer who was also the chief surgeon at Tulane Hospital during Hurrican Katrina. He gave a talk about what it was like to work there with the place surrounded by 9 feet of water after the levees broke. He said 80% of the police, fire, EMS people in New Orleans were still homeless.

***

My first session is called Improving Hemodynamics During CPR taught by Tom Aufderheide, M.D. He is one of the world's top CPR researchers and very involved in the new AHA guidelines. The new guidelines absolutely dominate the conference. Nearly every session I will attend hammers it in. Compressions, compressions. Allow full chest recoil and no hyperventilation. Ventiltate your codes at 8-10 times a minute. In recent years EMS has moved towards evidenced based medicine, and as more studies are being done, what we have taken for granted has been challenged.

The crux of Aufderheide's talk is this:

Studies show half the time in CPR compressions don't get done.

When you stop compressions, all blood flow ceases.

Studies show paramedics, doctors and nurses all ventilate at rates from 30-40 a minutes.

High ventilation rates screw up the interthoracic pressure preventing effective blood flow.

Normal people breathe through negative pressure. We ventilate people with positive pressure.

Our ventilations should be fewer and less both in terms of volume and duration.


He talked about a study with a new devive called a ResQPOD, which enhances negative thoracic pressure. (The device attaches to the ET tube and also has timing lights on it to keep you ventilating at 10 a minute.) The study showed the new device more than doubled short-term survival rates in patients presenting with pulseless electrical activity.

The American Heart Association gave the device a IIa rating, which is a higher rating than any ACLS drug recieves.

Clinical evaluation of an inspiratory impedance threshold device during standard cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest

RESQPOD

The drawback is the device costs around $90.

***

The next session was called Managing the Wheezing Patient by Dr. Corey Slovis. Very good presentation. He focused on asthma, COPD, CHF, and anaphalaxis. Here are some of his pearls:

He was big on magnesium for asthma and COPD, advocating 2 grams in 100cc over 1-10 minutes.

He advocated instead of doing one treatment followed by another, do a continuous treatment, which is basically dumping two treatments in the neb to begin with.

He was a big proponent of CPAP for CHF.

He was very cautious on lasix. He said never start with Lasix and never give it unless you are also giving nitro because lasix's initial action is as a vasoconstrictor.

(On the lasix issue there is a new study coming out that will show how often it is mistakenly given both in the field and the ER for pneumonia.)

On anaphalaxis, he said give epi IM in the thigh

He also said fluid boluses do absolutely nothing for asthmatics, which was new information to me, as I have been giving fluid to asthmatics for years, thinking, as I was once taught, that it helped break up the mucas.

***
The last lecture of the day was Lethal Power of the ET Tube by Brent Myers, M.D. Also a very good presentation. He also hit on the new AHA guidelines.

He said with all the problems there have been with ET intubation in this country there was no way the FDA would approve the procedure today based on available studies.

He emphasized the A was for airway, not intubation, and pressed the imporatnce of circulatining the blood. He said studies showed uninterrupted compressions increased survival by 300%. Anything that interrupts compresions is bad. He said for patients in vfib, you should delay intubation. They should have a good supply of oxygenated blood in their body that will last for five minutes or so. You could monitor their status by using a nasal end tidal CO2 cannuala while using a bag mask. When you do intubate try to keep compressions going while you pass the tube. If you need to stop compressions, stop only for a brief moment. On number of ventilations, he cited a pig study where when pigs were put into arrest, 6 of 7 pigs survived when they were ventialted 6 times a minute, only 1 of 7 survived when they were ventilated at 30 times a minute.

He said everyone intubated should have end tidal Co2 monitoring.

***

When the conference let out I walked along the inner harbor and went to Mo's Seafood restaurant and ordered the Mo's Famous Crabcake's. They were $33. I didn't order anything else, and just drank water. The crab cakes were huge. I could only eat 1, and took the other one back to the hotel.

Again, it was cold and a long walk back uphill to the hotel. I admit the room really depressed me. It seemed like the kind of room, you could die in alone one day and no one would find you for a couple days. I had a nasty coughing fit, and it went on so long I though people in the hall would probably think I was an old alcoholic. Instead, I was in the dim room with my large bottle of water trying to wash away the dryiness in my throat. I lay back on the bed and thought my eyesight was growing dim and I was losing my sense of colors when I realized the color TV wasn't really very colorful.

Still the room was cheap.