688 1732 441841 82357 3 1 PDF

FOOTBALL PLAYER C-Spine p. 36 ALBUQUERQUE Community EMS p. 54 The BVM Effect p.
58
OCTOBER 2015
A sobering look into

how the culture of EMS
affects provider stress
& suicide statistics, p. 30
ALSO INSIDE
Police use of
force injuries, p. 44
Treating sexual
assault victims, p. 50
Always En Route At
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®
30 CRITICAL STRESS
Survey reveals alarming rates of EMS provider stress & thoughts of suicide
By Chad Newland, EMT-P; Erich Barber, BA, NREMT-B;
Monique Rose, CCEMT-P & Amy Young, BBA, CCEMT-P
OCTOBER 2015 VOL. 40 NO. 10
Contents 36 HEAD & SHOULDERS

Prehospital treatment of athletes wearing a helmet & shoulder pads
By Michael J. Bilkasley, EMT-P, LO, L.Ped & Paul Sparling, MED, AT, ATC
36
44 UNDER POLICE CONTROL
Understanding & treating trauma caused by law enforcement use of force
By Derrick E. Jacobus, FP-C, MA
50 REPORTED SEXUAL ASSAULT

Emotional first aid & the facilitation of justice
By Abigail T. Harning, EMT-P, M.Ed
DEPARTMENTS & COLUMNS

8 EMS IN ACTION Scene of the Month
54 SERIAL INEBRIATES
Albuquerque Fire & Police Departments team up
on community EMS project
12 FROM THE EDITOR EMS Today 2016 By Frank Soto Jr., MPA, CFO, CEMSO, MIFireE, NRP
By A.J. Heightman, MPA, EMT-P
18 LETTERS In Your Own Words
20 PRIORITY TRAFFIC News You Can Use
25 LEADERSHIP SECTOR Pass It On
58 THE BVM EFFECT
An overview of studies assessing airway management
in out-of-hospital cardiac arrest
By Gary Ludwig, MS, EMT-P By Raymond L. Fowler, MD, FACEP, DABEMS; Christopher Leba, BS, MPH, LP;
Faroukh Mehkri, BA, AEMT & Ahamed H. Idris, MD, FACEP, FAHA
26 CASE OF THE MONTH Crash & Compression
By Chuck Bacon, EMT-P & James J. Augustine, MD, FACEP
28 RESEARCH REVIEW Real Emergencies?
By David Page, MS, NRP
29 STREET SCIENCE Triaging Geriatrics 44 50
By Keith Wesley, MD, FACEP & Karen Wesley, NREMT-P
62 HANDS ON Product Reviews from Street Crews
By Dominic Silvestro, EMT-P, EMS-I
64 FIELD PHYSICIANS Staying Informed
By Mark E.A. Escott, MD, MPH, FACEP
65 BERRY MUSING Magnets
By Steve Berry
66 CLASSIFIEDS
67 AD INDEX About the Cover
Depression and suicide are real threats to EMS providers. Find out more about the shocking statistics, pp.
68 LAST WORD The Ups & Downs of EMS 30–34. photo kevin nutt
2 JEMS | OCTOBER 2015 www.jEms.COm
1510jems_2 2 9/25/15 10:58 AM

THE CLOCK IS
TICKING
The Countdown to the 2015 Guidelines Has Begun.

Is your monitor CPR ready? The AHA says CPR monitoring should be “incorporated into
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ready at zoll.com/ClockisTicking.
1Meaney PA, et al. Circulation. 2013;128:417-35
©2014 ZOLL Medical Corporation, Chelmsford, MA, USA. ZOLL is a trademark and/or registered MCN EP 1409 0059
trademark of ZOLL Medical Corporation in the United States and/or other countries.
1510jems_3 3 9/25/15 10:58 AM

®
EDITOR-IN-CHIEF – A.J. Heightman, MPA, EMT-P – aheightman@pennwell.com

SENIOR EDITOR – Ryan Kelley – rkelley@pennwell.com
EDITOR – Allie Daugherty – allied@pennwell.com
ONLINE NEWS/BLOG MANAGER – Bill Carey – billc@pennwell.com
WEB EDITOR – Kristina Ackermann – kristinaa@pennwell.com
MEDICAL EDITOR – Edward T. Dickinson, MD, NREMT-P, FACEP

TECHNICAL EDITOR – Carolyn Gates, EMT-P, FP-C
ART DIRECTOR – Kermit Mulkins – kermitm@pennwell.com

PRODUCTION COORDINATOR – Katie Noftsger – katien@pennwell.com
CONTRIBUTING ILLUSTRATORS – Steve Berry, NREMT-P; Paul Combs, NREMT-B
CONTRIBUTING PHOTOGRAPHERS – Vu Banh, Glen Ellman, Craig Jackson, Kevin Link, Courtney
McCain, Tom Page, Rick Roach, Scott Oglesbee, Steve Silverman, Matthew Strauss, Chris Swabb
CONTRIBUTING WRITER – Elisse Miller
DIRECTOR OF ePRODUCTS – Tim Francis – timf@pennwell.com

DIGITAL MEDIA CAMPAIGN MANAGER – Adrian Zavala – adrianz@pennwell.com
PUBLICATION OFFICE
800-266-5367 — Fax 858-638-2601
ADVERTISING DEPARTMENT
800-266-5367 — Fax 858-638-2601
SENIOR ACCOUNT MANAGER – Cindi Richardson – 661-297-4027 – c.richardson@jems.com

ADVERTISING DIRECTOR – Judi Lawless – 619-583-5559 – judil@jems.com
REPRINTS, ePRINTS & LICENSING – Rae Lynn Cooper – 918-831-9143 – raec@pennwell.com
SHOULD YOU NEED ASSISTANCE WITH CREATING YOUR AD, PLEASE CONTACT:
MARKETING SOLUTIONS – Paul Andrews – 240-595-2352 – pandrews@pennwell.com
SUBSCRIPTION DEPARTMENT
847-763-9540
AUDIENCE DEVELOPMENT MANAGER – Linda Thomas – lindat@pennwell.com
CHAIRMAN – Frank T. Lauinger

PRESIDENT/CHIEF EXECUTIVE OFFICER – Robert F. Biolchini
CHIEF FINANCIAL OFFICER/SENIOR VICE PRESIDENT – Mark C. Wilmoth
SENIOR VICE PRESIDENT/GROUP PUBLISHER – MaryBeth DeWitt – marybethd@pennwell.com
TM
www.EMSToday.com
SENIOR VICE PRESIDENT/GROUP PUBLISHER – MaryBeth DeWitt
EDUCATION DIRECTOR – A.J. Heightman, MPA, EMT-P
MARKETING MANAGER – Amanda Brumby – amandab@pennwell.com
CONFERENCE MANAGER – Debbi Boyne – dboyne@pennwell.com
EVENT OPERATIONS MANAGER – Amanda Wilson – amandaw@pennwell.com
EVENT OPERATIONS MANAGER – Jennifer Lindsey – jenniferl@pennwell.com
EXHIBIT SALES REPRESENTATIVE – Sue Ellen Rhine – 918-831-9786 – sueellenr@pennwell.com
FOUNDING EDITOR – Keith Griffiths
FOUNDING PUBLISHER – James O. Page (1936–2004)
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®
EDITORIAL BOARD
WILLIAM K. ATKINSON II, PHD, MPH, MPA, DAVE KESEG, MD, FACEP JULLETTE M. SAUSSY, MD, FACEP
EMT-P Medical Director, Columbus Fire Dept. Medical Director, District of Columbia Fire & EMS Dept.
Health Care Advisor, Raleigh, N.C. Clinical Instructor, Ohio State Univ.
KATHLEEN S. SCHRANK, MD
JAMES J. AUGUSTINE, MD, FACEP W. ANN MAGGIORE, JD, NREMT-P Professor of Medicine and Chief,
Medical Director, Washington Township (Ohio) Fire Dept. Associate Attorney, Butt, Thornton & Baehr PC Division of Emergency Medicine, Univ. of Miami School of Medicine
Associate Medical Director, North Naples (Fla.) Fire Dept. Clinical Instructor, Univ. of New Mexico, School of Medicine Medical Director, City of Miami Fire Rescue
Director of Clinical Operations, EMP Management Medical Director, Village of Key Biscayne Fire Rescue
Clinical Associate Professor, Dept. of Emergency Medicine, Wright CONNIE J. MATTERA, MS, RN, EMT-P
State Univ. EMS Administrative Director & EMS System Coordinator, Northwest (Ill.) GEOFFREY L. SHAPIRO
Community Hospital Director, EMS & Operational Medicine Training, School of Medicine and
BRYAN E. BLEDSOE, DO, FACEP, FAAEM Health Sciences EHS Program, George Washington Univ.
Professor of Emergency Medicine, Director, EMS Fellowship SHAUGN MAXWELL, EMT-P
Univ. of Nevada School of Medicine Captain & Medical Services Officer, Snohomish County Fire District 1 JOHN SINCLAIR, EMT-P
Medical Director, MedicWest Ambulance (Everett, Wash.) International Director, IAFC EMS Section
Fire Chief & Emergency Manager, Kittitas Valley (Wash.) Fire & Rescue
CRISS BRAINARD, EMT-P MIKE MCEVOY, PHD, REMT-P, RN, CCRN
Deputy Chief of Operations (Ret.), San Diego Fire-Rescue EMS Coordinator, Saratoga County, N.Y. COREY M. SLOVIS, MD, FACP, FACEP, FAAEM
EMS Editor, Fire Engineering Magazine Professor & Chair, Emergency Medicine, Professor of Medicine,
CHAD BROCATO, JD, DHSC, CFO Resuscitation Committee Chair, Albany (N.Y.) Medical College Vanderbilt Univ. Medical Center
Assistant Chief, Pompano Beach (Fla.) Fire Rescue Medical Director, Metro Nashville Fire Dept.
Adjunct Professor, Kaplan Univ. JASON MCMULLAN, MD Medical Director, Nashville International Airport
Associate Director, Division of EMS, Dept. of Emergency Medicine, Univ.
CAROL A. CUNNINGHAM, MD, FACEP, FAAEM of Cincinnati E. REED SMITH, MD, FACEP
State Medical Director, Ohio Dept. of Public Safety, Division of EMS Director, Fellowship in EMS Medicine, Univ. of Cincinnati Co-Chairman, Committee for Tactical Emergency Casualty Care
Member of Medical Direction Team, Cincinnati, Blue Ash, Forest Park, & Operational Medical Director, Arlington County (Va.) Fire Depat.
JAY FITCH, PHD Green Hills (Ohio) Fire Depts. Emergency Physician, Virginia Hospital Center
President & Founding Partner, Fitch & Associates Associate Professor of Emergency Medicine, George Washington Univ.
MARK MEREDITH, MD
RAY FOWLER, MD, FACEP Associate Professor of Pediatrics, Pediatric Emergency Medicine, Le WALT A. STOY, PHD, EMT-P, CCEMTP
Associate Professor, Univ. of Texas Southwestern School of Medicine Bonheur Children’s Hospital (Memphis, Tenn.) Professor & Director, Emergency Medicine, Univ. of Pittsburgh
Chief of EMS, Univ. of Texas Southwestern Medical Center Director, Office of Education, Center for Emergency Medicine
Chief of Medical Operations, FIONNA MOORE, MBE, FRCS, FRCSED, FRCEM,
Dallas Metropolitan Area BioTel (EMS) System FIMC RCSED MICHAEL TOUCHSTONE, BS, EMT-P
Chief Executive & Consultant in Prehospital Care, London Ambulance Regional Director, Philadelphia Regional Office of EMS
ADAM D. FOX, DPM, DO, FACS Service NHS Trust Director, National EMS Management Association
Section Chief, Division of Trauma, Rutgers N.J. Medical School
Associate Trauma Medical Director, N.J. Trauma Center Univ. Hospital BRENT MYERS, MD, MPH, FACEP JONATHAN D. WASHKO,
Chief Medical Officer & Excutive Vice President, Evolution Health MBA, NREMT-P, AEMD
GREGORY R. FRAILEY, DO, FACOEP, EMT-P Associate Chief Medical Officer, American Medical Response Assistant Vice President, North Shore-LIJ Center for EMS
Medical Director, Prehospital Services, Susquehanna Health Mobile Integrated Healthcare Committee Member, NAEMT
Tactical Physician, Williamsport (Pa.) Bureau of JOSEPH P. ORNATO, MD, FACP, FACC, FACEP Measurement Design Group Committee Member, EMS Compass
Police Special Response Team Professor & Chairman, Dept. of Emergency Medicine, Virginia
Commonwealth Univ. Medical Center KEITH WESLEY, MD, FACEP
RYAN GERECHT, MD, CMTE Operational Medical Director, Richmond Ambulance Authority Medical Director, HealthEast Medical Transportation
EMS and Emergency Medicine Physician, Tacoma, Wash.
JERRY OVERTON, MPA KATHERINE H. WEST, BSN, MED, CIC
JEFFREY M. GOODLOE, MD, FACEP, NREMT-P Chair, International Academies of Emergency Dispatch Infection Control Consultant, Infection Control/Emerging Concepts Inc.
Professor & EMS Section Chief, Emergency Medicine,
Univ. of Oklahoma School of Community Medicine PAUL E. PEPE, MD, MPH, MACP, FACEP, FCCM KEITH WIDMEIER, BA, NRP, FP-C
Medical Director, EMS System for Metropolitan Oklahoma City & Tulsa Professor of Emergency Medicine, Internal Medicine, Pediatrics, Public EMS Educator, Univ. of Cincinnati College of Medicine
Health, Univ. of Texas Southwestern Medical Center Paramedic, CareFlight Air & Mobile Services
HUGO GOODSON Director, City of Dallas Medical Emergency Services for Public Safety,
Lecturer, Dept. of Paramedicine Auckland (N.Z.) Univ. of Technology Public Health and Homeland Security STEPHEN R. WIRTH, ESQ.
Attorney, Page, Wolfberg & Wirth LLC.
KEITH GRIFFITHS DAVID E. PERSSE, MD, FACEP Safety Officer, Hampden Township (Pa.) Volunteer Fire Company
President, RedFlash Group Physician Director, City of Houston EMS
Public Health Authority, Houston Dept. of Health & Human Services DOUGLAS M. WOLFBERG, ESQ.
ANDREW J. HARRELL, MD Associate Professor, Emergency Medicine, Attorney, Page, Wolfberg & Wirth LLC
Assistant Professor, Dept. of Emergency Medicine, Univ. of New Mexico Univ. of Texas Health Science Center—Houston
Associate Director, UNM EMS Medical Direction Consortium MATT ZAVADSKY, MS-HSA, EMT
Medical Director, Albuquerque Fire Dept. EDWARD M. RACHT, MD Director of Public Affairs, MedStar Mobile Healthcare
Medical Director, New Mexico Urban Search & Rescue Task Force 1 Chief Medical Officer, American Medical Response
Medical Director, Grand Canyon National Park WAYNE M. ZYGOWICZ, MS, EFO, EMT-P
Tactical EMS Physician, Bernalillo County (N.M.) Sheriff’s Dept. SWAT JEFFREY P. SALOMONE, MD, FACS, NREMT-P EMS Division Chief, Littleton (Colo.) Fire Rescue
Trauma Medical Director, Maricopa Medical Center
CHRIS KAISER, NREMT-P Professor of Surgery, Univ. of Arizona College of Medicine—Phoenix
Paramedic, Central Wisconsin
1510jems_6 6 9/25/15 10:58 AM

1510jems_7 7 9/25/15 10:58 AM

EMS IN ACTION
SCENE OF THE MONTH
DUMP TRUCK DIVE
A crew from the North Collier Fire Control and Rescue District
in Naples, Fla., treat a male patient pinned in his vehicle.
The driver’s car was broadsided and pushed off the road into
a riverbed when a dump truck veered into oncoming traffic.
The truck landed on top of the car’s front end, entrapping the
patient, who remained conscious and able to communicate
with responders. Read more about this rescue on p. 26.
1510jems_8 8 9/25/15 10:58 AM

Photo courtesy Chuck Bacon
www.jems.com ocToBeR 2015 | JEMS 9
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1510jems_11 11 9/25/15 10:58 AM

FROM THE EDITOR
PUTTING ISSUES INTO PERSPECTIVE
EMS TODAY 2016

Making good on important promises
By A.J. Heightman, MPA, EMT-P
>> >> Field termination of resuscitation of
A
t the 2015 EMS Today Conference Mental health of EMS providers
& Exposition, I made a personal >> Strategies to stay on your emotional track children
and professional commitment that >> Ethical dilemmas in EMS >> Managing technology-dependent patients
we would not only continue to focus on the >> Emotional hurdles of bad calls >> Spinal trauma update
key clinical and leadership areas important to >> Alcohol addiction >> Geriatric trauma
our industry, but also put special emphasis on >> Stress resiliency for responders Sessions that will discuss and present inva-
other critical issues facing our industry, such as sive and advanced clinical practice procedures
attacks on EMS workers; employee stress and NO MORE BLS & ALS and medications will now be offered in our
suicide; and ways to increase public awareness The EMS Today Conference philosophy is to new Advanced Clinical Practice track. First
and respect for EMS. offer education that challenges providers to responders and EMTs will still benefit from
I want to let you know that I, and the expand their knowledge and skills as well as attending these sessions, but they must be
JEMS and EMS Today staffs, are making perfect their basic skills. So, you’ll notice we’re aware that there are some drugs and proce-
good on those commitments. You’ll see it in no longer separating tracks by BLS and ALS dures referenced they won’t be able to apply in
the expanded and highly detailed EMS Today categories because, as Bryan Bledsoe, MD’s the field (yet). However, as we’ve seen in the
2016 Conference Program, an expansive and session will address, there’s no longer BLS past, EMTs in many areas are now, and will
diverse offering of more than 140 sessions and ALS—just EMS! be in the future, using continuous positive air-
that allow you to choose from the best and EMTs are now doing much of what was way pressure, starting intraosseous infusions,
most cutting-edge EMS educational topics. previously considered ALS and paramedics performing 12-lead ECG interpretations and
perform BLS skills on 80% of calls. Because using mechanical ventilators.
STRESS & SUICIDE most of what we do is related to the basics, Management and Assessment of Penetrating
In a special effort to address and combat pro- we’re offering sessions important to all EMS Trauma and How to Pack Wounds will help you
vider stress, as well as the increase in emer- providers in our new Basics of Clinical Prac- learn the best practices for managing penetrat-
gency responder suicide, we’re offering key tice track. Sessions include Considerations for ing trauma, as recommended by the nationally
sessions by industry experts on topics such Field Amputations: A First-Hand Perspective, recognized Hartford Consensus document,
as coping with stress and suicide prevention. by Melissa Kohn, MD, where she discusses from one of the nation’s top trauma and burn
One of my most anticipated sessions is how she performed a field amputation on a surgeons, Andrew Dennis, DO, FACS, FACOS.
titled, What’s Killing Our Medics? It’s presented section of railroad tracks in Philadelphia in In Real-World Cardiac Science: What’s Work-
by Chad Newland, EMT-P; Erich Barber, BA, the dark and in 100-degree F heat in late July. ing, What’s Not and Where We Might Be Going,
NREMT-B; Monique Rose, CCEMT-P and Through the Eyes of a Cadaver, presented by Jeremy Brywczynski, MD, focuses on the lack
Amy Young, BBA, CCEMT-P, and goes over Amanda Bowen, BS, NRP, IC, will show you of efficacy of epinephrine in cardiac arrest, the
the shocking results of their study on emer- how a hands-on, minds-on approach utiliz- current ineffectiveness of some aspects of the
gency provider stress and suicide. An in-depth ing procedural cadaver labs in your region can advanced cardiac life support algorithms, what
analysis and discussion of the results can be allow participants to increase their comfort systems are doing to improve their resuscitations
found in their article, “Critical Stress: Survey levels on high-risk, low-frequency skill sets such as the use of VSE (vasopressin/steroids/
reveals alarming rates of EMS provider stress related to trauma. epinephrine) therapy, as well as the use of anti-
& thoughts of suicide,” on p. 30. biotics post-return of spontaneous resuscitation
This information is so important that we’re Other key topics in the Basics to improve survival.
offering the session twice during the confer- of Clinical Practice track: If you’re interested in shock trauma, you’ll
ence. Someone from your service, particularly >> Implementing evidence-based guidelines want to attend Shock Trauma: Point of Care
your human resource manager, needs to attend >> New AHA guideline changes Testing in the Field, presented by Pratik Das,
one of these eye-opening sessions. >> Managing mangled extremities which will give you a first-hand look at how the
>> Destination dilemmas in pediatric trauma world-famous Baltimore Shock Trauma’s Point
Other key stress and emotional transport of Care Testing study is focusing on the use of
aspects of EMS topics: >> MCIs involving senior citizens tissue oximetry (StO2) and lab values such as
>> Decision fatigue—too tired to think >> Child abuse and neglect lactate, base excess, glucose and hemoglobin to
1510jems_12 12 9/25/15 10:59 AM

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HIGHLIGHTS OF PRESCRIBING INFORMATION :;( ;==;
These highlights do not include all the information needed to use NitroMist safely and effectively. :; =
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NitroMist® is a nitrate vasodilator indicated for acute relief of an attack or acute prophylaxis of angina Most common adverse reactions are headache, flushing, hypotension, and syncope (6).
pectoris due to coronary artery disease (1). To report SUSPECTED ADVERSE REACTIONS, contact Akrimax Pharmaceuticals at 1-888 383 1733 or
DOSAGE AND ADMINISTRATION FDA at 1-800-FDA-1088 or www.fda.gov/medwatch/report.htm.
:;At the onset of an attack, one metered spray or two metered sprays should be administered on or under the tongue. DRUG INTERACTIONS
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1 INDICATIONS AND USAGE NitroMist is contraindicated in patients with increased intracranial pressure.
NitroMist is indicated for acute relief of an attack or acute prophylaxis of angina pectoris due to coronary artery disease. 4.4 Hypersensitivity
2 DOSAGE AND ADMINISTRATION NitroMist is contraindicated in patients who have shown hypersensitivity to it or to other nitrates or nitrites.
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; ;

; ; =; ;
; ; ; =; ; = ; =; =; ; ; = ; ;
=; effective relief of the acute anginal attack should be used [see DOSAGE AND ADMINISTRATION (2)].
attention is recommended. NitroMist may be used prophylactically 5 minutes to 10 minutes before engaging
in activities that might precipitate an acute attack. As tolerance to other forms of nitroglycerin develops, the effect of sublingual nitroglycerin on exercise
tolerance, although still observable, is reduced.
2.2 Priming the Container
/ ;=;=; ;;; = ;=;
; = ;;* <;
;;;;;=; 5.2 Hypotension
;;; ;;; =;=
1= ;
; ;0;2;;;
;;;
; ( ; ;= = ;; ; ;= ; ; ;;=;
;; ;+;
0;2;;=;!;=
1= ;
;;; = ;* <;;= ==!;; ;;
; = ; ;
;
; ;!;
;;=;;=;;= ;!;

; ;; ;= ;
";
; = ; ;= ;!;;=;! ;;= ==!;
;

;;;! ;; = ; =;= ;= =
; ;) ;

;! ; ;= ;!;==
;! ;= =
=;
per use;; = ; ;; = ;=
;; 1 ;; bradycardia and increased angina pectoris.
2.3 Administration +; !; ; * <; ; =; ; =; =
=; = ; ; ; = ; = ; = ; ;
& ;;;=;
; ;
= ;;;;;+;= ;
;!;
; = ;; !; =!
; ; ; ; ; ; * <; ; ;
; = ; =; ;
=;
; = ;=
; ;=
;; = ; ;=;;;;;=;!;+;
;
; =! ; monitoring must be used because of the possibility of hypotension and tachycardia.
be sprayed into the mouth on or under the tongue by pressing the button firmly and the mouth should be 5.3 Hypertrophic Cardiomyopathy

;
= ;= ;=;
;+)';(%3/4;()5#&;*5+;6';*)/'&;%=;
;!;
;; Nitrate therapy may aggravate the angina caused by hypertrophic cardiomyopathy.
familiarize themselves with the position of the spray orifice, which can be identified by the finger rest on top 5.4 Headache
of the valve, in order to facilitate orientation for administration at night. * ;
;
=
;=
=;;= ;!; ;+ =;;=
=;
;;;&;;=2;= 6 ADVERSE REACTIONS
;;;3 ;=;= 6.1;)=
=;;= ;!; ;=
; ;= ; ;
= ;= ; ;;
;;;;;;; ;;;;!;press actuator button 10 times to ensure proper dose priming
(holding unit away from yourself and others). 6.2 Flushing, drug rash and exfoliative dermatitis have been reported in patients receiving nitrate therapy.
;;;)
;= ; ;; ;;;;;== ;! 6.3;% =; ;=;=;! ; ;=2;==;=
; ; ;= ;
;
;;;5;;=
;! ;;= ;=;;=;! occasionally, particularly in erect, immobile patients. Marked sensitivity to the hypotensive effects of nitrates
;;0;% ;;== ;!; ;; ;; =; = ;; ;
;; (manifested by nausea, vomiting, weakness, diaphoresis, pallor, and collapse) may occur at therapeutic doses.
;;.;3=;!;=
;;;+;
=;
;;!;;; ;;;
;
for 5 minutes to 10 minutes following administration. 6.4;( ;
;; =; =
==;=;!;

;;7;;=;
;=
=;; 1
;;!=; ; =;;;;=
;0;*; ;=;;
7 DRUG INTERACTIONS
;;;;;; = ;=;!; ;;=;;
7.1 PDE5 Inhibitors
;;";3=;=; Administration of NitroMist is contraindicated in patients who are using a selective inhibitor of cyclic
;;;
;;;
; ; ;=;0;2;;;=;!;=
1= ;
;;; = =; =; $<%;
=; ; ; %&'; %&'; ! ; ; =;
+; ;;;1
;;;= ;
;!;
= ;2
;8;;= ;;;; ; sildenafil, vardenafil, and tadalafil have been shown to potentiate the hypotensive effects of organic nitrates.
; ; ; 1
; =; ; ; ;
; ; ; ; ; ;

; ; ; = ; ;
;
; +;; ;=
;
;

;;; =;= ;;!;

;=
;;;=;;
= ;
;8;;1
; =;;!;;;;; =;
;;= ;;=;=!; of one another cannot be recommended. Appropriate supportive care for the severe hypotension has not
3 DOSAGE FORMS AND STRENGTHS been studied, but it seems reasonable to treat this as a nitrate overdose, with elevation of the extremities
=;= ;;; ; = ;;= ==!;; ;;
; = ; ;";
; = ; ;= =
; ; =; ; =;+; ; ; = ; ; ; ;
; ; = ;
= ; ; =;
4 CONTRAINDICATIONS =
=;= ; 1 ;= = ;=;;
=; ;=
;=;=
4.1 PDE5 Inhibitor Use 7.2 Antihypertensives
Administration of NitroMist is contraindicated in patients who are using a selective inhibitor of cyclic %=; ; = ;
; !==
; !2 ; =
; =;
; !; !
; ;
=; =; $<%;
=; ; ; %&'; =; %&'; ! ; ; =; possible additive hypotensive effects. Marked orthostatic hypotension has been reported when calcium
sildenafil, vardenafil, and tadalafil have been shown to potentiate the hypotensive effects of organic nitrates channel blockers and organic nitrates were used concomitantly.
[see DRUG INTERACTIONS .].
=!;!;; ;= =
=;

;! ; ;; ;; ;;;
4.2 Severe Anemia labetolol is used with nitroglycerin in patients with angina pectoris, additional hypotensive effects may occur.
NitroMist is contraindicated in patients with severe anemia.
1510jems_14 14 9/25/15 10:59 AM

7.3 Aspirin 12.3 Pharmacokinetics
ABCD CBBCCDB
C B DB
C DB
C 'B
CD
CB DB
B
C
CCD CBCC CB" D C

B CBC CCDA CD DCC
DB CBD
CB 1200 mcg dose (three activations of a 400 mcg dose) of NitroMist was administered to healthy volunteers (n=12), all
and hemodynamic effects of nitroglycerin may be enhanced by concomitant administration of aspirin. * CDD C
B

C C

CAmax38 / 593 / 5CDmax of 8 minutes, range
4 B.+ C0 BDB CD

B .!0 CAmax / 59.
7.4 Tissue-type Plasminogen Activator (t-PA) / 5 CD max 4 9 0. ! C .+ B 23 CD .!DB
CB

C B CD CB B B
D C B B
B
C B CAmax. / 593 / 5CD Cmax4. 903 !C 03 B23
CCB
C C

BC D D BCD DB
B !CB
B
D B DC B
D C B
BDBBB
B
B C BCD CB5/"

7.5 Heparin
DC - B C BC CB
B B
B
B
D CD
C BB
D CBC
C B CC DCC
B B
C mononitrate metabolites and ultimately to glycerol and organic nitrate. Known sites of extrahepatic metabolism
B
D BB DC CCDC BB
B"B
D D
BBD
CD C
C C
CDDB B B

! 0 C*B CB
! .!0 CD
effect occurs following single nitroglycerin doses. .!DB
C BD
C C C
CBC

BB.!0CD.!DB

CB 43 .!0 CD .!DB
CB
C B D B B B
7.6 Ergotamine pharmacological activity, whereas the glycerol mononitrate metabolites of nitroglycerin are essentially inactive.
#C
CD CBBB
C" D
D C C CB
BDDB BC CD 1
C CB CBB DB CB
! C
8B
D
B
CBC

!
$
C BC
BCC
C
% BC "BB C C C B B ! may contribute significantly to the duration of pharmacologic effect.
patients receiving sublingual nitroglycerin should avoid ergotamine and related drugs or be monitored for
symptoms of ergotism if this is not possible. CB DC CB" D C C C
C

½α BB
!CD.!0CD
.!DB
CB
C DB !.3 !CD.. !

8 USE IN SPECIFIC POPULATIONS C

B DC CC B B
½β + C C

C C

B
8.1 Pregnancy C CC ½α B .!0 CD .!DB
CB
B
B C CDDBC

CC BA& C
BDBCD CB D C B BD D'B( compartment into which the nitroglycerin disappears from plasma prior to being metabolized into the
B B

C
C
C
B B "B 'B( C C C
C dinitroglycerin metabolites. A second indication of this other compartment is that the appearance of nitroglycerin
administered to a pregnant woman or can affect reproduction capacity. A teratogenicity study was conducted CB

C CCD
C DB * !- B
C C

B4 B
in the third mating of F0 generation female rats administered dietary nitroglycerin for gestation day 6 to day 15 C DB B * !B
CB
C C DB
C B
Amax had been observed.
CDB

D CB BDBDB B DB B
B!
C D D B DCC C C CD D C D BD B BCB
C 13 NONCLINICAL TOXICOLOGY
finding probably reflects delayed development rather than a potential teratogenic effect, thus indicating no 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
clear evidence of teratogenicity of nitroglycerin. Animal carcinogenicity studies with sublingually administered or lingual spray nitroglycerin have not been performed.
C BCD $C CD
BB
DD CB 'B(B

D BC C :C B44 /" /DCBD CB
B0 CD
B DDB
C DBCD
woman only if clearly needed. neoplastic changes in liver, including carcinomas, and interstitial cell tumors in testes. At the highest dose,
D B CB

CCB CC+0B C DB3 C DBB
D B
8.3 Nursing Mothers
C B +08BB
5 D CCD CBBB.3+8 /" /DCB
B"B B
D C
") C CD C D C nitroglycerin was not tumorigenic in mice.
milk, caution should be exercised when NitroMist is administered to a nursing woman.
Nitroglycerin was found to have reverse mutation activity in the Salmonella typhimuriumC.++
8.4 Pediatric Use assay). A similar mutation in S. typhimuriumCCC
B B DBB '#DBB'
!
C CD BB
DCC C B C
D was no evidence of mutagenicity in an in vivo dominant lethal assay with male rats treated with oral doses of
8.5 Geriatric Use B CB /" /DC B ex vitro cytogenic tests in rat and dog tissues. In vitro cytogenetic assay
A
C
D B'B(DDB
D B* C D+CDB BD A C BC
B DBB BB C

C CB
BDD
B B * # B D
C
CBD D C CB BDBD!C DD CB
CDB BCB438 /" /DC
D B
D
C CB $C
B+ C CDB
C+ C C
B4+0 /" /DC C
B+ B C
B B C
BB C B
C C
!DB
BBC
D
C B
D CB!C
C C
B D F0 generation with treatment continuing through successive F1 and F2 CB DB C
B DB C !
C $ BD C D C! C
!BCDCB!CDB associated with decreased feed intake and body weight gain in both sexes at all matings. No specific effect
concomitant disease or other drug therapy. on the fertility of the F0 CB C
B D $ CB! B ! C
C DB C D C

CDC CB DB C

10 OVERDOSAGE
Signs and symptoms of hemodynamic effects: BB
B DB C C

B 14 CLINICAL STUDIES
nitroglycerin’s capacity to induce vasodilatation, venous pooling, reduced cardiac output, and hypotension. CCDB - D!DB

D!
!
CD CB!
C BBB
D!4 BDBB D

BDC C CC B C C CB!
D C DCCC
3* C
C C B!CC
CDB

C D C B
C
any or all of persistent throbbing headache, confusion, and moderate fever; vertigo; palpitations; tachycardia; following doses of 200 mcg, 400 mcg, and 800 mcg of nitroglycerin delivered by NitroMist compared to placebo.
visual disturbances; nausea and vomiting (possibly with colic and even bloody diarrhea); syncope (especially
in the upright posture); dyspnea, later followed by reduced ventilatory effort, diaphoresis, with the skin either 16 HOW SUPPLIED/STORAGE AND HANDLING
flushed or cold and clammy; heart block and bradycardia; paralysis; coma; seizures; and death. %C B B 'B( BC B
C B
BC D D/BC CC
C C
BC
CCD DCBB
D B
C D'B(CC
C
CC8+ ' AB
No specific antagonist to the vasodilator effects of nitroglycerin is known, and no intervention has been B B

C
C BB
C
D
03 D C BC 433 B B

* BBB
DDCC CBB

B DB ) C B BCBC D CCBBCC4. ' AB BB

C
C BB
C
D
23 DCBC
nitroglycerin overdose is the result of venodilatation and arterial hypovolemia, prudent therapy in this 400 mcg of nitroglycerin per actuation.
CBB
D D DBCD C C

DB
C
CBB C ,

may be sufficient, but intravenous infusion of normal saline or similar fluid may also be necessary. 03 DC&'7A043234.338
23 DC&'7A043234.334
B BB C C
CBBB B B D D
;<BC
C C
D C BB CC
! C
C
B
CBB <B CBB C 0+=A!=> ? B DB.+=B3=A+2=B8+=>
B C-CD C B B
B DB C C
CD D
! CD
C BB C $ D ;1CD

'B(BCC

C C
B
CC 7BBB
B C'B(B
!DBB
Methemoglobinemia: ( B
B C C C
B D B C C DC B have the container burned after use, and do not spray directly toward flames.
B
D DC B B C DB D
D CD $C C C
#2.
A
CC
! B
B
BBDD DCBB
C B!BB
BC B B BC 17 PATIENT COUNSELING INFORMATION
17.1 Interaction with PDE5 Inhibitors
B
B C !C BCD CBB

!. /" B0 /" BBD NitroMist should not be used in patients who are using medications for erectile dysfunction such as
weight, C $ D
D C
!CD C
!CDCDC
C
BDC BB C B B
11 DESCRIPTION nitrate drugs such as NitroMist.
'B
!CB CC !CCBD
CBC BBC CD C
17.2 Administration
C BB
.!0!BC B
C A15N#2 B BDCC B

C B C B
D DCBBC
B'B(5 C
C BB
! D
0032 C
& CH2–ONO2 CCBB.3 B B DB BDB DB B
C "! B
C CD $C
D0C
CH–ONO2 NitroMist is meant to be sprayed on or under the tongue at the beginning of angina or to prevent an angina
CH2–ONO2 CC" C B
BDC'B( C CBC D
CD D B
CD ! C
* C B C

C B C D BB C B $
'B( B

C
C BB
C DDB C BC 03 D C B 23 C B C B D C
BB
! C
BB
B B B B B
! C
metered sprays of B
BC BDD
433 BB
CCB B
D C D C" 'B( D
"
BBD B C
D B
CD D B
form of spray droplets on or under B C D & C
/C D
B
C ! dizziness [see DOSAGE AND ADMINISTRATION (2.3)].
B
!5 B
!C 17.3 Headache
12 CLINICAL PHARMACOLOGY 1 CDC CB CB C C B
C B CDC !
12.1 Mechanism of Action CDC CDC CB D B
C B CDC D
B
'B
B CDC
BD '# !CC C
C
C !
C C 17.4 Flushing
B CB ,!+, BBBC
6( BB
CDB C

CDB Flushing, drug rash and exfoliative dermatitis have been reported in patients receiving nitrate therapy.
dephosphorylation of myosin light chains, which regulates the contractile state in smooth muscle and results
in vasodilatation. 17.5 Container information
'B( B
B
D B B
B D ) C 'B( BC C

C C

12.2 Pharmacodynamics propellant (butane), do not have the container burned after use and do not spray directly towards flames.
C
C CB
B C
CB B B

CCB B C
C BB

B
B DB C !B
BD !CDB
C D C !D
CBBBC C
CD @
BC BB!
$D C BB DD
B B
B D B
B D 7
CB B BC
C
!
D
C ! B B C
BB
B BC ! C
B
D BC D @
$D C BB B B
!

BBD! D C B B C! CD D

C DDCB

BCD remaining doses will have less than label content.
Nitroglycerin also produces arteriolar relaxation, thereby reducing peripheral vascular resistance and arterial
pressure (after load), and dilates large epicardial coronary arteries; however, the extent to which this latter
effect contributes to the relief of exertional angina is unclear.
C DB BB
C D B
!DCB
CD CC C

BBD %
coronary perfusion pressure is usually maintained, but can be compromised if blood pressure falls
excessively or increased heart rate decreases diastolic filling time. Manufactured for Akrimax Pharmaceuticals, LLC, Cranford, NJ 07016
By Dynamit Nobel GmbH, Leverkusen, Germany
%
C D C
B CD
BC C
C D ! CD

BC CD C
C
C C C
B D DB
C1 CC C

C D! C
C

B B C

BBD ACDCD C C D!D C D!BC D(BCDC
Marketed and Distributed by:
B B BBD CDC C D C BD! B D !CDB" B" Akrimax Pharmaceuticals, LLC
D D C D CD C B CBC

D CD CB C C D C
C D
Cranford, NJ 07016 USA
ventricular filling pressure and increased systemic vascular resistance in association with a depressed cardiac .0288
D C
"
B C B CDCD BC!
CDCDC NitroMist is a registered trademark of 141F006

index are normal, cardiac index may be slightly reduced following nitroglycerin administration. NovaDel Pharma Inc., used by permission. 30/03.0
1510jems_15 15 9/25/15 10:59 AM

FROM THE EDITOR
predict the need for a blood transfusion or other of innovative, discrete, ballistic vests to match They include:
lifesaving interventions for a patient in hemor- their daily uniforms will be highlighted. >> Conducting Incident Investigations: Will
rhagic shock. Or, perhaps Samual Tisherman, In the two-hour Dynamic & Active Threats Your Agency Win in Court?
MD’s, session Saving Exsanguinating Trauma Panel, experts will address the incidents first >> Risk Management for EMS
Patients with Hypothermia and Cardiopulmonary responders are encountering. Panelists include: >> Creating Clinical Leaders & Mentors
Bypass is of more interest. Here, Tisherman will >> William Fabbri, MD, director of opera- >> Designing the Ambulance of the Future
show you how the Emergency Preservation and tional medicine for the FBI; >> Customer Service When the Patient is Not
Resuscitation for Cardiac Arrest from Trauma >> Douglas Mohl, FBI special agent and coor- the Customer
(EPR-CAT) Study is evaluating the use of dinator of the FBI’s Operational Medicine >> How to Prevent Your EMS System from
rapid cooling to buy time for surgeons to con- Program for the Washington Field Office; Failing: 2016 Update
trol bleeding and cardiopulmonary bypass for >> Terry Nichols, director of curriculum >> Using Data & Technology to Improve Oper-
delayed resuscitation. development for Texas State University’s ations & Clinical Care
ALERRT (Advanced Law Enforcement >> Using Data to Increase Performance in Vol-
Other key topics in the Advanced Rapid Response Training) and co-author unteer Rescue & EMS Agencies
Clinical Practice track: of Active Shooter Events and Response; >> Precepting: Is It a Privilege or a Right?
>> Flash pulmonary edema >> Geoffrey Shapiro, director of EMS and >> A Systematic Method of Improving Perfor-
>> Capnography operational medical training for theEmer- mance of People
>> Blunt force trauma gency Health Services program at George >> Keeping Your Organization (Favorably) in
>> Choosing ventilation devices Washington University; and the Public Eye
>> Mechanical CPR >> E. Reed Smith, MD, operational medical >> Creating a Social EMS Culture: A Balanced
>> Traumatic fractures and dislocations director for the Arlington County (Va.) Approach to Social Media
>> Tranexamic acid (TXA) Fire Department, attending physician at >> Implementing an EMS Culture of Safety:
>> Direct vs. video laryngoscopy Virginia Hospital Center and associate Near-Miss Analysis
>> Pediatric asthma and pain management professor of emergency medicine at the >> Conflict Resolution in EMS
>> Hyperthermia George Washington University. >> Do Your Employment Practices Scream Out,
>> Traumatic brain injuries “Hey, Sue Me!”
>> Active compression/decompression CPR Other key topics in the Dynamic To help advance our profession, we’ve
>> Noninvasive positive pressure ventilation & Active Threats track: added a special daylong preconference work-
>> Integrating police, fire and EMS responses shop, EMS Compass Town Hall Meeting, that
DYNAMIC & ACTIVE THREATS >> Active shooter incidents will have the brightest minds working on the
Our popular preconference workshop cadaver >> Washington, D.C., Navy Yard active federal EMS Compass initiative discuss how
and airway management labs are back, and new shooter incident review carefully crafted performance measures could
this year is a first-of-a-kind active shooter sim- >> Chemical suicides and their hazards transform EMS, increase our validity as an
ulation preconference workshop that allows >> Excited delirium syndrome and toxicology impactful profession, and not only improve
personnel to learn and practice warm zone >> Incident command systems for rescue task our position in the house of medicine but
operations in a realistic environment, rendering force operations in warm zones also increase the financial reimbursement and
care to cadavers as they move through rooms >> Joint rescue task force model support we receive. You’ll want a representa-
and hallways. In addition to this simulation, >> Legal issues with body cameras tive from you service to be in attendance to
we’re also offering a special Dynamic & Active >> Creating active bystanders learn about this game-changing federal, multi-
Threats track to help you be prepared and >> Selecting providers for tactical EMS organization consensus initiative.
act when your community is attacked by lone >> Community plan for a biologic disaster The preconference workshop Boosting
gunmen or terrorist groups. If you’re not yet in >> Preparing for mini mass casualty events Recruitment, Retention & Reputation, presented
compliance with the recommendations of the >> Legal issues with body cameras by Rich Wiehe and Jeff Yorke, will show you
Hartford Consensus documents, you’ll want how to recruit, retain and strengthen your
to have staff attend these important sessions. LEADERSHIP organization’s competitive advantage through
Self-Defense Tactics for EMS Providers, In another first-time offering, EMS Today will use of DISC personality assessments, employee
presented in two, four-hour preconference offer attendess the opportunity to receive cre- pairing and key organizational processes.
workshops taught by the Maryland State dentialing credit for leadership sessions under In The New Enhanced Role of the Public in
Police, will teach you how to identify poten- the National EMS Management Association’s EMS Response, Luckritz will show you how Jer-
tial threats and what self-defense techniques (NEMSMA) new credentialing process for sey City Medical Center adopted and imple-
to use in these dangerous situations. In When these levels of EMS officers. A majority of mented a successful program that involves
Responders Become Victims, presenter Robert this year’s leadership sessions, and many of the trained community members and EMS ser-
Luckritz will examine specific incidents and community paramedic and special topic sessions vice staff in an enhanced EMS response plan
true practices that surround scene safety and (identified in The 2016 Conference Program designed to get emergency care to patients
address the physical and emotional response by the special NEMSMA EMS officer icon), in a congested urban environment in three
of EMS providers. Jersey City EMS’s purchase will be eligible for NEMSMA credentialing. minutes or less.
1510jems_16 16 9/25/15 10:59 AM

COMMUNITY PARAMEDICINE 6. Innovations in MIH; Other special topics designed
We’ll have a full-day, information-packed 7. National credentialing models; and to meet your needs:
community paramedicine preconference work- 8. A day in the life of a community paramedic >> National Registry of EMTs 2016 update
shop as well as multiple key planning and (presented by community paramedics). >> National Continued Competency Program
implementation sessions on mobile integrated >> Paramedic psychomotor competency
healthcare (MIH) in a special MIH track. ADDITIONAL TOPICS & SESSIONS >> Using social media in EMS education
In another first-time offering, EMTs in need >> How to improve your bedside manner
Other key topics in the MIH track: of recertification will be able to ask for and >> Cycle of care for your EMS fleet
>> Payment strategies and innovations receive information on topics they’ve always >> Developing standardized scenario programs
>> Accredited point of care testing wished someone would’ve taught them or pre- >> Psychomotor competency profiles
>> The future of paramedicine sented in another way. No more boring, static
>> Case studies in hospice care lectures! When you register for our new EMT CONCLUSION
>> Discussions with healthcare partners “Design it Yourself ” Refresher Workshop we’ll Am I bragging, as the editor-in-chief of JEMS
>> Developing nontraditional partnerships ask you to submit what you want to learn. and the education director of EMS Today? You
>> One-on-one roundtable discussions, which Participant answers will then frame out the bet I am! I’m in my positions to improve EMS
will allow you to pick four of eight specific content of this energetic and refreshing pre- and, more specifically, improve your ability to
topics/themes: conference workshop. propel, advance and excel in clinical, adminis-
1. Funding models and success; As we’ve offered in the past, 10 of the trative, operational and emotional aspects of
2. Making the business case for hospitals, “Eagles” (members of the Major Metropolitan EMS. Join me at EMS Today 2016 to have
third party payers, hospice agencies and EMS Medical Directors Consortium from the one of the best educational experiences of your
home health; largest population centers in the United States career and to ensure that you and your agency
3. Working with other EMS agencies to cre- and other countries), will be presenting lectures are prepared for the future of EMS. JEMS
ate regional solutions for potential payers; on new trends and controversies in prehospi- *Preconference workshops aren’t included in
4. Partnerships for regional solutions; tal medicine as well as the ever-popular, two- the regular EMS Today pass price and are lim-
5. Provider selection, training and CE; hour Eagles Lightening Round Super Session. ited in the number of attendees.
1510jems_17 17 9/25/15 10:59 AM

LETTERS
IN YOUR OWN WORDS
AUTHOR STEVE WIRTH, ESQ., EMT-P, RESPONDS:

CONDUCT CONCERNS Thanks for the thoughtful comments—it’s nice to get some feedback
This month, Pro Bono columnist Steve Wirth, Esq., EMT-P, and to stimulate discussion on important topics.
responds to feedback on his article “Dealing with Police Mis- I’ve been a certified paramedic since 1979, and have functioned
conduct” from the July issue. Both letters were edited for space. as a paramedic or EMT for over 40 years now. I’ve been on a lot of
calls over the years and a few where I saw lack of action or improper
patient assessment and care by EMS providers where there were mul-
QUESTIONING COPS tiple officers and an arrest had taken place. I agree that medics and
I’ve been an EMT since 1982, a career paramedic since 1995, then a EMTs shouldn’t “judge” the actions of police officers on scene—but
career police officer in a relatively busy municipal police department EMS providers do have a professional and ethical responsibility to
in suburban Philadelphia since 2001, where I continue to work as a assert themselves when they see things being done that could harm
part-time paramedic. the person being placed in custody. From the videos I saw of the Eric
I read your article, and while I think I understand your underly- Garner incident, the EMS providers on scene didn’t do that. That was
ing premise, which I agree with, I also have concerns about it. True the point I was trying to make: As the trained medical professionals
misconduct and deliberate, vindictive mistreatment for any reason is on the scene, regardless how chaotic or difficult, we simply can’t sit
wrong and needs to be addressed. This is without question, and it is, I back and say or do nothing when we know we should.
hope, the point you were trying to make. My concern arises from the I didn’t intend to convey the impression that EMS professionals
section of the article that states, “Second, alleged misconduct such as should formally “report” every action by police that “appears” to be
what may appear to be excessive use of force by the police or abusive improper. Perhaps I should have explained that statement further.
treatment must be reported.” The very fact you use the word “appear” As you point out, there’s a lot going on with an arrest that we don’t
is very telling, and leads to my main point: It’s very hard to know know about, like the past history of the person being placed under
what’s actually going on in a violent and fluid situation merely from arrest and prior threatening actions that person may have made toward
what it appears to be. police. But when common sense tells us something just doesn’t look
When I moved from EMS to law enforcement, I thought I had right, it’s better to deal with these concerns promptly between the
a pretty good grasp of what being a cop was all about. After all, I’d agencies before a similar incident the next time becomes that day’s
worked very closely with police for many years while in EMS. hot YouTube video on the nightly news.
I was wrong. Very wrong. Being a police officer is a job that truly I’ve found that talking to the officers on scene and asking them
has to be experienced firsthand to fully understand it. You may think why they took the actions they did will resolve most concerns. I
you know what’s going on when you see police work, especially when would hope that police officers, too, would question an EMS pro-
you work closely with them like EMS providers do, but you don’t really fessional when that officer observed what appeared to be improper
know. There’s a significant difference between controlling a combative EMS care—like walking a patient with shortness of breath down
person who’s acting that way as the result of an injury or medical condi- six flights of stairs to avoid lugging a stretcher and equipment into
tion, and has no nefarious intent, and defending yourself from a violent the building. And if the other professionals on scene don’t take well
criminal who’s determined to not go to prison even if it means killing to those questions by other agency personnel on the scene and get
you. Not many people want to harm EMS providers—even criminals. defensive, well, then maybe a more formal report is needed.
Many people want to harm or kill police officers just because they’re My point to EMS providers is this: Don’t sit on your laurels. Take
officers. The level and type of resistance offered by a subject fighting the initiative to engage in communication with the police. Assert
for their life isn’t even in the same ballpark as a combative patient. yourself to get access to the detained person when the situation is
I can speak with the authority of experience that an EMS provider under control. In other words, don’t be lazy or overly deferential to
has absolutely no idea what a police officer is subject to, and what a others when it’s your responsibility for patient care.
physical altercation in the police world entails. I take strong excep- We all have to be cognizant of the fact that we must at all times
tion to telling an EMS provider to judge the actions of a police offi- be transparent in what we do as police, fire and EMS professionals.
cer. This would be no different from a police officer second-guessing We should assume our actions are being recorded by someone with
the medical decisions of an EMS provider and then reporting them a smartphone. That’s a good thing, in my view, as it helps us behave
for it. In fact, I’ve actually seen this happen. I’ve had officers from my as if we’re going to be viewed by thousands of people on social media
department ask me about actions taken by EMS providers that they within minutes.
thought were inappropriate, because they, the officers, didn’t have the The mark of a true professional is that we always question our
medical and hands-on EMS experience to understand what they were own actions, and we welcome that same questioning by others—that’s
seeing. Once I explained to them why certain things were done in a because providing service to the public is a collaborative process,
certain manner, they understood. and as professionals we must seek every opportunity for continual
In closing, I submit that the position taken in the article might improvement without getting defensive, even when others without
need to be refined a little, or at least explained a little deeper. Thank our training, knowledge or experience question our actions.
you for your consideration.
Mark Gindhart
Via email
1510jems_18 18 9/25/15 10:59 AM

ALL INTRAOSSEOUS SITES ARE NOT EQUAL
ůŝŶŝĐĂůĂƚĂ^ƵŐŐĞƐƚƐƚŚĞ/ŶĚŝĐĂƚĞƐZŽƵƚĞ/ŵƉƌŽǀĞƐWĂƟĞŶƚKƵƚĐŽŵĞƐ
Clinical Studies Suggest the Sternal IO Route
Improves Patient Outcomes
Hoskins, Stephen L, et al: “Based on the present data, we recommend that sternal IO
1 route be considered as the first choice of drug delivery during CPR when IV access has
not been established…” (1)
Pasley, Jason, et al: “...the sternal IO site provided the highest fow rates compared with
2 the humeral and tibial insertion sites. The sternal site was also associated with a 100%
success rate for initial placement facilitated by its consistent anatomy.” (2)
Burgert, James, et al: “There may also be a relationship between the anatomical location
3 of the IO device and serum drug concentrations; the more distal the IO infusion site is
from the sampling site, the longer concentrations of drug take to rise.” (3)
The quotes above are taken from three of the four important studies reviewed in the Clinical Review Paper by
Dr. Alan Molof. To download the full paper and access references (1), (2), and (3), visit www.pyng.com/sternal-io
Download the Clinical Review Paper

www.pyng.com/Sternal-IO
Pyng Medical www.pyng.com r (+1) 604-303-7964 r info@pyng.com r@pyngmedical rfacebook.com/pyngmedical
1510jems_19 19 9/25/15 10:59 AM

PRIORITY TRAFFIC
NEWS YOU CAN USE
Staying INFORMED
Podcasts can help you get educated & stay current
PREHOSPITAL CARE RESEARCH FORUM PODCAST
I
n today’s on-the-go society, sometimes it’s difficult to stay cur-
rent with the newest ideas and best practices in the ever-evolving Website: www.cpc.mednet.ucla.edu/pcrf
world of medicine. Many EMS providers work two or more jobs Podcast: www.fisdap.net/podcasts/pcrf
and have very little downtime. Is there really any time to keep up with Have you ever wanted to participate in an EMS journal club to dis-
all of this information? cuss the most current research in EMS? Then this podcast is a must!
The average American drives over 13,400 miles per year, according Join the folks from the Prehospital Care Research Forum as they meet
to the U.S. Department of Transportation’s 1990 Nationwide Personal regularly for their journal club to interact directly with authors of recent
Transportation Survey. Is there a way to maximize that time along with studies along with some of the most research-oriented minds in our
other potential unused time to stay current with changes in medicine? industry. If you’re unable to listen in on the live session, all meetings
Podcasts are a digital media source, usually audio but sometimes are recorded and archived to listen at your convenience.
containing video components, that allow listeners to hear about a given
topic. According to Edison Research, one-third of Americans have EMS OFFICE HOURS
listened to at least one podcast with 17% of users listening in the last Website: www.emsofficehours.com
month, and over 60% of podcast listeners use their smartphone to hear Podcast: www.emsofficehours.com/category/ems_office_hours/
the content. In fact, many smartphones have pre-installed apps that Jim Hoffman and the crew at EMS Office Hours review clinical
allow users to subscribe to their favorite podcasts and receive notifi- and operational topics to help EMS providers in their daily practice.
cations when new episodes are available. Topics include discussions on backboards along with techniques for
Although providers could learn plenty from TED Talk podcasts communicating with patients. One thing that Jim and his crew do very
or by following their favorite national news network podcasts, how well is making themselves open for Q&A through a variety of medi-
much of that truly helps our clinical practice? We’ve compiled a list ums. They even have full episodes dedicated to Q&A sessions where
of podcasts that are applicable to clinical practice, many of them affil- new providers can ask seasoned professionals their burning questions
iated with the #FOAMed movement. FOAM stands for Free Open about the industry.
Access Meducation, or medical education, and it’s an idea from the
emergency medicine/critical care arena to provide medical content PREHOSPITAL EMERGENCY CARE (PEC) PODCAST
that’s available anytime and anywhere that’s independent of platform Website: www.informahealthcare.com/journal/pec
or media. #FOAMed includes blogs, podcasts, tweets, etc., as long as Podcast: http://feeds.feedburner.com/PrehospitalEmergencyPodcast
they’re free and available to anyone. The PEC Podcast is operated by doctors from the National Asso-
ciation of EMS Physicians. The hosts discuss recent research articles
GROUND/PREHOSPITAL MEDICINE published in the journal Prehospital Emergency Care with the authors.
These podcasts revolve around EMS providers working primarily in The hosts do a great job of discussing the article and explaining how
ground-based emergency transport. The podcasts in this section are it applies to field providers and medical directors. The hosts stray off
driven by topic, news and/or research. All of the podcasts hosts are topic at times, but the discussions are always interesting and they pro-
actively involved in EMS as providers, educators or medical direc- vide a unique industry perspective.
tors. Beyond clinical components, these podcasts often incorporate
operations topics. EMERGENCY MEDICINE/CRITICAL CARE MEDICINE
Podcasts in this section are primarily aimed at physicians who work in
MEDICCAST emergency medicine or critical care medicine. However, a vast majority
Website: www.mediccast.com of this information is applicable to prehospital providers or those in
Podcast: www.mediccast.com/blog/subscribe-for-free critical care transport. The podcasts in this section are almost exclu-
You “don’t need no stinkin’ transmitters” to take a trip with the Pod- sively clinical, often heavily research-based and extremely interesting.
medic, Jamie Davis, as he talks with industry leaders about what’s new
and exciting in EMS. MedicCast takes on topics concerning both vol- EMCRIT
unteer and paid EMS providers, ALS and BLS providers, and issues Website: www.emcrit.org
affecting fire-based, third service, private and hospital-based EMS. Podcast: www.emcrit.org/category/podcasts
Whether he’s talking about suicide awareness in EMS, tidbits from Scott Weingart, MD, has developed a cult following of multi-
the most recent national EMS conference, or how Trek Medics is disciplinary, evidence-based medicine enthusiasts who regularly
bringing EMS to all ends of the world, the Podmedic discusses some watch him on various social media platforms and eagerly wait for
of the most interesting topics going on in the industry. him to put out his next blog and podcast. EmCrit has shown how
1510jems_20 20 9/25/15 10:55 AM

THE NEW 2015
RESUSCITATION GUIDELINES:
TRANSLATING SCIENCE INTO SURVIVAL
JOIN US IN SAN DIEGO!
Conference & Exposition

Conference December 8-11 • Pre-Conference December 7-8
Manchester Grand Hyatt, San Diego, California
Calling all EMS Instructors and Providers: ECCU 2015 with the new 2015 Guidelines on CPR and ECC
is for You!
• Be among the first to learn from the experts who developed the new Guidelines on CPR and ECC. Attend Official
Instructor Updates.
• Learn the latest resuscitation techniques and systems from the “Eagles,” consisting of EMS Medical Directors from the
most successful EMS systems in the United States under the leadership of Dr. Paul Pepe.
• Practice with the Seattle Resuscitation Academy team including Drs. Thomas Rea and Michael Sayer along with their
EMS leadership to “perfect perfusion.”
• Fine-Tune your airway management skills with Colby Rowe and other experts in simulation and management of the
difficult airway using the latest innovations.
• Network with other EMS and in-hospital providers while learning best practices for instruction and implementation.
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1510jems_21 21 9/25/15 10:55 AM

PRIORITY TRAFFIC
the power of social media can drive research when a team of pioneers TAMING THE SRU
took the idea of delayed sequence intubation to the masses to for- Website: www.tamingthesru.com
mulate a plan, and ended up with a peer-reviewed study published Podcast: https://itunes.apple.com/us/podcast/tamingthesru/
in the Annals of Emergency Medicine. EmCrit appeals to physicians, id732952768?mt=2
paramedics, nurses and a wide array of healthcare practitioners with Taming the SRU (“shock resuscitation unit,” pronounced “shrew”) is
its procedural videos, evidence-based medicine content and use run by the emergency medicine residency at the University of Cincin-
of edutainment. nati (UC) College of Medicine. It’s used as a tool to supplement their
residency education and as an adjunct to help train orientees with UC
LIFE IN THE FAST LANE Aircare/Mobilecare. Eager providers will be inundated with a wealth
Website: www.lifeinthefastlane.com of information since Jeff Hill, MD; Bill Hinckley, MD and their crew
Podcast: www.lifeinthefastlane.com/resources/podcasts post grand round synopsis and journal club synopsis, plus topics in
Life in the Fast Lane is responsible for the #FOAMed revolution EMS, critical care transport, emergency medicine and so much more.
and is a key player in the Social Media and Critical Care (SMACC) This program does an amazing job of providing a one-stop shop for
conference, which turns all its lectures into free podcasts for the com- any healthcare provider working with acutely ill patients who wants
munity. This podcast is physician-driven with a focus on clinical to learn what’s new, what’s current, and what’s best practice.
knowledge and skills from a vast array of internationally renowned
physician podcasters. Academic Life in Emergency Medicine social MEDSCAPE EMERGENCY MEDICINE PODCAST
media index regularly rates this podcast as No. 1 worldwide. With its Website: www.medscape.com/emergencymedicine
extensive clinical education library, tips for technology use, current Podcast: www.medscape.com/public/social
evaluations of research and so much more, there’s no doubt why it’s If you’ve worked in medicine for more than a few weeks, odds
seen as the leader in the #FOAMed community. are you’re aware of Medscape. Medscape is a fantastic resource for
1510jems_22 22 9/25/15 10:55 AM

healthcare providers. It also has a very active social media presence, FLIGHTBRIDGEED PODCAST
which includes a diverse array of podcasts. The emergency medicine Website: www.flightbridgeed.com/
podcasts themselves are extremely informative and current to what Podcast: http://www.flightbridgeed.com/home/index.php?Itemid=674
clinicians need to know. One of the things that truly makes it unique FlightBridgeED is the brainchild of flight paramedic Eric Bauer.
is that podcasts are available in over 30 different medical specialties. If Eric’s company provides review courses and test prep material for indi-
you have a specific interest in neurology, for example, you can subscribe viduals who are planning to take a transport credential exam such as
to the neurology podcast as well as the emergency medicine podcast. the FP-C, CCP-C, CFRN or CTRN. His podcast helps supplement
the courses he offers and is an excellent resource for individuals who
CRITICAL CARE TRANSPORT plan on taking a specialty certification. Practicing clinicians who’d like
The realm of critical care transport encompasses pieces of prehospital to brush up on things that are new and exciting, or that they haven’t
medicine, emergency medicine and critical care medicine. However, it also seen for a while, will also find this useful.
possesses unique challenges. As the need for readily available education
for flight and critical care paramedics increases with educational require- CONCLUSION
ments, these providers must be able to easily acquire quality information. These podcasts offer a wide variety of content for EMS providers and
anyone dealing with acutely ill patients. As you listen, you’ll notice cross-
PREHOSPITAL AND RETRIEVAL MEDICINE (PHARM) over between the categories. Make sure you check out the show notes
Website: www.prehospitalmed.com of the podcast episodes for more information about what was discussed.
Podcast: https://itunes.apple.com/us/podcast prehospital-retrieval- In the spirit of #FOAMed, share your favorite podcasts and become
medicine/id515752374?mt=2 part of the discussion. Share them on Facebook or Twitter and across
PHARM lets providers follow flight physician Minh Le Cong as other social media platforms. The goal is for providers to have quality
he discusses a wide variety of issues that affect critical care transport. education anywhere at any time. JEMS
Whether he’s discussing current evidence, talking about emergency air- — Keith Widmeier, BA, NRP, FP-C
way interventions, debating checklists or debunking myths about ket-
amine, this podcast is always informative with discussion points that will Learn more from Keith Widmeier at the EMS Today Conference & Exposition, Feb. 25–27,
have you question your assumptions or positions on controversial topics. TM in Baltimore, Md. EMSToday.com
1510jems_23 23 9/25/15 10:55 AM

PRIORITY TRAFFIC
ABCS OF THE DEA

FOR EMS
T o say that Drug Enforcement Administration (DEA) requirements for ambu-

lance services and EMS providers are confusing is quite an understate-
ment. Even for lawyers used to understanding complex laws and regulations,
are allowed to do in the other 12 states varies. Some states require their own
state-controlled registration; others don’t. With all these variations, it’s easy
to understand why so many are confused by DEA registration requirements.
DEA regulations rank at or near the top of the list of hard-to-understand and Many ambulance services obtain and administer controlled substances
complex regulations. For example, we weren’t able to find the words “ambu- through their EMS medical director’s DEA number. If your ambulance service
lance” or “EMS” in them anywhere, at least as of the drafting of this article. doesn’t have its own DEA number and isn’t from a state that gives an ambulance
Ambulance services are able to register as mid-level practitioners with the service the ability to obtain and administer controlled substances with its own
DEA. DEA regulations define a mid-level practitioner as “an individual practi- DEA number, then this is how the service typically obtains those controlled sub-
tioner, other than a physician, dentist, veterinarian, or podiatrist, who is licensed, stances. The ambulance service, the practitioner involved and especially the EMS
registered, or otherwise permitted by the United States or the jurisdiction in medical director could all face potential liability if the ambulance service experi-
which he/she practices, to dispense a controlled substance in the course of ences a drug diversion. That’s why strong policies on safeguarding, securing and
professional practice.” Paramedics and EMTs aren’t able to individually register accounting for all controlled substances stored and used is an absolute must.
as mid-level practitioners with the DEA. And, exactly what ambulance services EMS medical directors, agencies and the vast majority of practitioners all desire
registered as mid-level practitioners are able to do is up to each state. to comply with DEA regulations. But complying with drug control and security
At the time of publication, there are 38 states that don’t allow ambulance requirements can be challenging, and professional organizations representing
services registered as mid-level practitioners to dispense, administer or order EMS medical directors have been pushing the DEA for guidance for several years
any type of controlled substance. It’s no wonder many ambulance services now. Until this guidance is issued, confusion on this issue is likely to continue.
located in one of these 38 states don’t bother to register with the DEA as mid-
level practitioners! It appears registration wouldn’t do the ambulance service Pro Bono is written by EMS attorneys Doug Wolfberg and Steve Wirth, founding part-
any good, as it wouldn’t be able to do anything with the registration, anyway. ners at Page, Wolfberg & Wirth. This month’s column was written with the assistance of
What ambulance services registered with the DEA as mid-level practitioners PWW attorney Christie Mellott, Esq. Visit the firm’s website at www.pwwemslaw.com.
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1510jems_24 24 9/25/15 10:55 AM

LEADERSHIP SECTOR
NAVIGATING THE ADMINISTRATOR’S ROLE
PASS IT ON
Mentoring employees benefits everyone
By Gary Ludwig, MS, EMT-P
I
f you’re a leader in your EMS organization, who are you mento- inept and incompetent. They didn’t know the difference between lead-
ring? I’m not asking who you like and tell what’s going on inside ership and management. They didn’t know that you manage things
the organization, or who you’d like to see move up in rank because like budgets, fleets, payroll and inventory, and you lead people. They
of your relationship. No, I’m asking: Who are you truly mentoring? taught me plenty—plenty of what not to do. Their decisions impacted
Have you evaluated those underneath you and started preparing morale, operations and the overall function of the organization.
them for a leadership role? Or are you mentoring everyone at every I’ve tried to give back over the years while in St. Louis and Memphis,
opportunity you get? Tenn., and now Champaign, Ill., by mento-
ring others. I’ve learned to transition from
BETTERING PEERS using personal feelings of whom I liked to
A lot of people think mentoring is about Nobody, choose whom I mentored and instead saw
preparing someone to be your successor, but it as my responsibility as a leader to make
that’s not true. Mentoring isn’t only about even successful sure everyone succeeds.
someone succeeding you when you leave, I now mentor the chiefs and company
but also preparing someone who may be & famous people, officers in the Champaign Fire Depart-
three of four ranks below you to advance ment in both an informal and formal way.
to the next level. It’s also about making one has truly succeeded My formal mentoring includes meeting
of your subordinates better in their current once every six weeks with all the chiefs
position, whether they move up to the next by themselves. and company officers to discuss leader-
rank or not. ship issues, go through a problem-solving
A lot of successful people have been case management scenario that happened
mentored by other successful people. Socrates was a mentor to Plato, in another department, or review past adverse events I’ve experienced
and Plato was a mentor to Aristotle. Warren Buffet was mentored by so they aren’t repeated in Champaign. Sometimes, we’ll do an incident
renowned American economist and professional investor Benjamin command system tabletop exercise on some potential serious event
Graham. Bill Gates was mentored by Ed Roberts and Steve Jobs, and such as an Amtrak train crash with over 50 victims, or maybe even
the founder of Apple says he was mentored by Andy Grove—a science recreate an event in our community to learn where there are oppor-
pioneer in the semiconductor industry. Peter Drucker, a best-selling tunities to improve.
author of management books, says his best advice came from his first
editor-in-chief, who told him: “Get good or get out.” CONCLUSION
Nobody, even successful and famous people, has truly succeeded by There are myriad mentoring and learning opportunities. I even con-
themselves. Somebody, somewhere in their career gave them advice sider that I might learn something from the process with the goal of
and helped them go to another level. improving my skills.
I’ll always be grateful for those who imparted their wisdom on me.
MENTEE TO MENTOR If you’re in a leadership position and have the opportunity to mentor
I’ve been blessed with three mentors who’ve helped me advance in my your staff, don’t pass up the chance. Besides preparing them for future
career: Chief Richard Davis, Chief Neil Svetanics and Chief Richard positions, your employees will perform better in their current positions
Arwood. None of their mentoring was formal. They didn’t sit me down because they’re better trained in leadership skills. JEMS
and tell me they were going to mentor me. Instead, they took an inter-
est in me and provided sage advice. They made themselves available Gary Ludwig, MS, EMT-P, serves as the fire chief of the Champaign (Ill.) Fire
whenever I wanted to ask a question. Sometimes it was just sitting Department. He’s a well-known author, lecturer and consultant who’s suc-
and talking about some situation and why they made the decisions cessfully managed two large, award-winning metropolitan fire-based EMS
they did—whether it was an administrative decision or an emergency systems in St. Louis and Memphis. He has a total of 37 years of fire, rescue
scene—what their options were and how they weighed those options and EMS experience and has been a paramedic for over 35 years. He currently
and decided the best course of action. serves as past chair of the EMS section for the International Association of Fire Chiefs and has
I’ve also had some people who were my mentors but they didn’t a Master’s degree in management and business. He can be reached through his website at
know it. I watched them over the years try to manage, but they were www.garyludwig.com.
1510jems_25 25 9/25/15 10:55 AM

CASE OF THE MONTH
DILEMMAS IN DAY-TO-DAY CARE
CRASH & COMPRESSION

Dump truck pins patient in his car
By Chuck Bacon, EMT-P & James J. Augustine, MD, FACEP
O
n Oct. 10, 2014, the lone occupant of assessment of the incident scene. There are of vascular tone when compression is removed,
a small sedan is driving into North minor fluid leaks from both vehicles, but no with threats to airway including vomiting and
Naples, Fla., when a dump truck sud- major fuel leak, and ignition sources are elim- aspiration. Tourniquets are prepared in case an
denly veers into oncoming traffic and crashes inated. The impact of the crash has pushed open wound to an artery is exposed. The fluid
into the driver’s side of the car, forcing both the A-pillar and the steering wheel into the rate is adjusted to give a bolus of about a liter
vehicles off the road and into a roadside canal. driver, as well as the entire front end of the prior to extrication. Pain medicines are pre-
The canal has about a foot of water but, for- car. The driver’s chest is 12 inches from the pared in case the extrication results in severe
tunately, no alligators. front bumper of the truck. There’s no way to discomfort to the patient, which could then
The dispatch tones and subsequent mes- assess the damage to his abdomen, pelvis and delay further disentanglement and ultimately
sages from the county’s 9-1-1 communication lower extremities. cause further harm.
center advise of a wreck with entrapment and The auto is resting on an uncertain surface The county’s medical helicopter is placed
a vehicle in water. A full assignment includes below the water. There are no obvious drop-off in a safe landing zone for utilization when the
North Collier Fire Control and Rescue Dis- points around or under the car, and the surface victim is freed because ground transport to the
trict (NCFCRD) equipment, a Collier County is sandy and somewhat boggy. The weight of nearest trauma center will take 45 minutes.
EMS paramedic unit and a standby for the the dump truck is completely resting on the The 50-ton wrecker arrives and is placed in
county’s air ambulance. car, and movement of the truck may actually a prepared location; the extrication team has
First-arriving NCFCRD units find and pull the automobile up with it. already prepared all the necessary secondary
report a small vehicle with massive damage The weight of the truck is initially secured stabilization and disentanglement tools. With
under the front end of a high-capacity dump by winches on the front of two fire engines. safe but rapid movement of the wrecker, the
truck. The dump truck isn’t loaded, there’s no Command requests a heavy-duty wrecker to cables are attached and, at approximately 58
fire, and the severely entrapped driver of the assist with the operation, and fortunately one minutes into the event, the truck is lifted and
vehicle isn’t in immediate danger of drowning. is available and already en route. slid off the car. With a few hand tool maneu-
Command is rapidly established by the bat- The extrication will require moving the vers, the victim is freed and slid onto a back-
talion chief, and two portions of the operations dump truck safely both vertically and hori- board. He’s conscious, doesn’t lose his airway,
sector are organized—one group is responsi- zontally off the car and the victim. In the time and his pain is manageable. He’s noted to
ble for the extrication operation and one is before the large wrecker arrives, the crews use have significant lower extremity wounds that
responsible for medical care. hand tools to gain access to as much of the aren’t bleeding. He’s loaded into the helicop-
NCFCRD paramedics crawl into the water victim as possible and to stabilize the sedan ter and flown to the regional trauma center.
and into the remnants of the passenger side in the water and sand. The flight crew finds no unexpected wounds
of the vehicle. Some space is also available The medics stabilize the patient with the on secondary assessment en route.
behind the patient. Upon primary assessment, body parts they’re able to reach. A C-collar is On arrival to the ED, the patient is con-
he has a Glasgow Coma Scale score below 12. fitted, oxygen is provided, an IV line is placed scious. The trauma service finds significant leg
The front of his vehicle and the weight of the in the right arm and fluids are started. No large wounds, along with survivable chest and upper
dump truck are across his lower body and the hemorrhage is noted. A pulse oximeter pro- extremity injuries. He undergoes a number of
front of his chest. vides adequate assessment of pulse rate and surgeries, but is able to be released to a reha-
The driver’s seat is reclined backward so perfusion. The patient regains consciousness bilitation facility several weeks later.
the patient is able to breathe and an oxygen and is able to tell the rescuers he can feel his
mask is placed to improve oxygenation. There’s legs and wiggle his toes. But as minutes go DISCUSSION
only a right arm available for assessment of by, the patient begins complaining of pain in There were significant challenges in patient
pulse and perfusion. A single rescuer is placed the chest and left arm, and more intense pel- management in this incident, involving the
in the vehicle to provide an assessment, to vic and lower extremity discomfort. original crash and the secondary compres-
reassure the patient and to determine what The paramedics set up for more extensive sion. The challenges included limited access
movement of the vehicle is occurring as the advanced care and to mitigate the likely com- with very limited ability to assess the patient’s
extrication begins. plications that will occur when the vehicles are injuries and the uncertain time to extrica-
The extrication officer performs a six-sided lifted off the patient, such as the potential loss tion. A cooperative patient who was perfusing
1510jems_26 26 9/25/15 10:55 AM

There’s unlikely to ever be an evidence-based
treatment plan that’s best for victims of compres-
sion injuries. Photo courtesy Chuck Bacon
adequately to provide the responders some victim was given supportive care and a modest CONCLUSION
feedback on injuries they couldn’t visualize fluid bolus, but very importantly, the prepa- The early decisions in this incident were made
was an unusual aspect of this incident, com- rations were made for life-threatening inju- with an expectation of lengthier extrication.
pared to others that are normally reported. ries once the heavy object was removed from Fortunately, the time interval was abruptly
There’s some literature and experience that his body. shortened and the patient was extricated in
supports medical care for compression inju- There’s unlikely to ever be an evidence-based less than an hour. This victim had a very good
ries.1,2 But there were uncertain compression treatment plan that’s best for victims of com- outcome, and the scene was managed with no
forces on the lower body of this victim, who’s pression injuries. There will be no random- injuries to rescuers. JEMS
in a car and underneath a truck, with wet and ized controlled study that’s going to provide
sandy ground underneath. It’s much easier exact science on these issues due to unique Chuck Bacon, EMT-P, is captain and EMS coordinator at the North
to consider the effect of compressive forces scene characteristics, the medical circum- Collier Fire Control and Rescue District (NCFCRD) in Naples, Fla.
when you have a victim trapped with a known stances related to the crush injuries, coinci- James J. Augustine, MD, FACEP, is an emergency physician
amount of weight (10 tons) that’s fallen a cer- dental trauma, timing of extrication, preceding and a clinical associate professor in the Department of Emergency
tain height (20 feet) against an immoveable volume status and likelihood of vascular col- Medicine at Wright State University in Dayton, Ohio. Augustine
surface (a concrete floor) and a known dis- lapse after release from entrapment. serves as associate medical director with NCFCRD in Naples, Fla.,
tance of compression where part of the patient The two officers responsible for the extri- and is the director of clinical operations for EMP, an emergency
is compressed (inches). These scenarios also cation process and the medical care were in physician group based in Canton, Ohio.
play out in building collapse situations, such constant communications and able to make
as those in earthquakes. second-to-second decisions. Incident com- REFERENCES
The scene in this case indicated the lower mand was in position to negotiate any conflicts 1. Augustine JJ. Priorities in extrication. Emerg Med Serv.
body and legs were being compressed, and between those two officers. These operations 1994;23(6):53–61.
the patient would be found to have signifi- frequently are noisy, so some form of reliable 2. Augustine JJ. Wreck with entrapment. Preplanning and commu-
cant injuries once extrication was completed. communication must be available, even if it’s nication pay off when a serious crash leaves a woman entrapped.
With uncertain timing of extrication, the hand signals that are mutually understood. EMS Mag. 2007;36(6):26, 29–30, 32–33.
1510jems_27 27 9/25/15 10:55 AM

RESEARCH REVIEW
WHAT CURRENT STUDIES MEAN TO EMS
REAL EMERGENCIES?
Qualitative study questions if psych calls are a burden on EMS
By David Page, MS, NRP
BEHAVIORAL HEALTH were cataloged, consolidated and sometimes the way they interact with these patients.”
Prener C, Lincoln AK. Emergency medical ser- prioritized in an agreed-upon scientific process. Discussion: Although the public often cites
vices and “psych calls”: Examining the work of Results: The good news is that the results law enforcement as having a role in the care of
urban EMS providers. Am J Orthopsychiatry. show commonalities and agreement in the mentally ill patients, it’s in fact EMS who often
July 20, 2015. [Epub ahead of print.] interviewees, allowing for identification of transports them. We’re in a unique position to
common themes that can lead to future inter- help these patients, especially because of gaps
Although this column often reviews quantita- ventions to address them. in the healthcare system and stereotypical bias
tive medical research, qualitative research is The bad news is that the common beliefs that objectifies behavioral health patients.
also important and can offer in-depth insight of these EMS professionals are somewhat con- The results of this study may sound disturb-
into a topic that might not otherwise come cerning: Providers believe that so-called “psych ing to some, but anyone involved in EMS has
out in numbers. calls” are a burden on the EMS system, ques- heard these beliefs before. This study helps shed
Methods: The authors of this study inter- tioning the value of EMS response to calls that light on the complexities of this belief system.
viewed EMTs and paramedics to learn more aren’t “real emergencies.” In fact, every case we respond to involves an
about their attitudes, experiences and beliefs Interviewees disliked trying to convince a element of crisis intervention, de-escalation and
with so-called “psych calls,” which was classi- patient to voluntarily go to the hospital, espe- mental health assessment. Understanding the
fied as cases with mental illness and substance cially when the police didn’t want to involun- value of simple interventions, such as suicide
abuse. Some readers may find the themes in tarily commit someone with mental illness. assessments and therapeutic communication,
the interviews offensive or not representative of Other major themes included frequent contact could help EMS providers feel a better sense
their beliefs, but this research clearly exposes the with substance-abusing or intoxicated patients, of their worth.
ugly underbelly of some of our beliefs systems. and homeless patients they classified as “psych We should all be reminded of the value of
The primary author, Christopher Prener— calls” even though no mental illness was present. good assessment and referral for appropriate
a former EMT himself—rode along as an Another common theme was dislike of inter- care by a healthcare provider who simply cares
observer during four 12-hour ambulance shifts facility transfers for psychiatric patients that enough to listen. For those who might want to
in a busy urban EMS system. After performing often require little skill and may involve a high have law enforcement care for patients with
this observation, he conducted 20 interviews risk of violence, noting that these calls often altered mentation, please reconsider. EMS is
with four EMTs and 16 paramedics. occur overnight and interrupt the provider’s specially trained and equipped to assess and
The interviews were recorded, transcribed sleep during a 24-hour shift. care for these patients. We ensure that another
and then rigorously analyzed. Common themes A common perception was that mentally ill treatable and potentially life-threatening under-
patients, particularly the homeless, abuse the lying condition, such as hypoglycemia or drug
EMS system by taking resources away from overdose, is detected and reversed if possible.
BOTTOM LINE patients with “more genuine medical needs,” Let’s make sure EMS providers are appro-
What we know: One-third of patients admit- and manipulate the system when the complaint priately trained to work with behavioral health
ted to EDs are diagnosed with a psychiatric is minor. Although the authors stop short of patients so the role strain described in this study
condition. EMS responds to many traumati- reporting poor treatment, they acknowledge can be converted to job satisfaction for having
cally injured and medically ill patients whose provider frustrations that “could lead to change helped those in psychological pain. JEMS
illness may have been caused, or complicated,
by a behavioral emergency. David Page, MS, NRP, is the director of the
What this study adds: EMS providers expe- GLOSSARY Prehospital Care Research Forum at the Uni-
rience significant role strain with behavioral Qualitative research: A method of study versity of California, Los Angeles, a field para-
health cases. Initial training in behavioral that focuses on human behavior, examining medic with Allina Health EMS in Minneapolis/
healthcare is brief, and there’s a mistaken per- in-depth the how and why of a topic. It’s pop- St.Paul, Minn., and a member of the JEMS
ception that the provider’s role is to respond ular among social scientists and educators, Editorial Board. Send him feedback at dpage@emsed.net.
to exciting, life-threatening cases involving and can involve participant observation in
Learn more from David Page at the EMS
lifesaving procedures. the field and structured interviews. Today Conference & Exposition, Feb. 25–27, in
TM Baltimore, Md. EMSToday.com
1510jems_28 28 9/25/15 10:55 AM

STREET SCIENCE
CONVERSATIONS ABOUT EMS RESEARCH
TRIAGING GERIATRICS
110 is the new 90 for systolic blood pressure in elderly patients
By Keith Wesley, MD, FACEP & Karen Wesley, NREMT-P
THE RESEARCH for trauma center care isn’t surprising. The MEDIC WESLEY COMMENTS
Brown JB, Gestring ML, Forsythe RM, et al. Sys- signs and symptoms of shock are often blunted As we examine the nuances of patient assess-
tolic blood pressure criteria in the National in the geriatric patient because of the effect ment and the age-specific concerns, it becomes
Trauma Triage Protocol for geriatric trauma: of aging on survival reflexes. Tachycardia is more obvious that triage of patients needs to
110 is the new 90. J Trauma Acute Care Surg. the first indication of hypoperfusion in the encompass these considerations.
2015;78(2):352–359. healthy adult and, once the blood pressure We looked closely at pediatrics the last
drops below 90, the survival benefit of a faster several years and identified significant dif-
THE SCIENCE heart rate is lost. The older heart is less likely ferences in physiologic concerns when caring
These researchers attempted to determine the to become tachycardic due to aging and is for this age group. Prehospital education for
impact of using a systolic blood pressure (SBP) often a result of hypertension medications that geriatric emergency medicine has somewhat
of < 110 in geriatric patients (> 65 addressed the special needs of the
years of age) as a positive criteria for elderly, but mostly just reviews
care at a trauma center. They com- what we already know: Getting
pared this impact against the tradi- The signs & symptoms of old is no fun.
tional SBP indicator of < 90. They This study looks at the physi-
examined data from roughly 1.5 shock are often blunted ological differences of aging and
million patients from the National different parameters in assess-
Trauma Data Bank (2010–2012). in the geriatric patient ment that mean a higher level of
Geriatric patients triaged for priority in the triage guidelines.
transport to trauma centers based because of the effect of It makes sense. The elderly main-
on an SBP of < 110 had the same tain much of their health with the
level of injury severity and mortal- aging on survival reflexes. old adage of “better living with
ity as non-geriatrics with an SBP of pharmaceuticals.” The effects of
< 90. Utilizing this criteria would these medications, as Doc says,
result in an reduction in under-triage of 4.4% prevent tachycardia. Thus, the older patient often mask the lack of resilience seniors
and an increase in over-triage of 4.3%. doesn’t have this survival reflex. Therefore, have when injured or exposed to environ-
The authors concluded that the physiologic if the SBP drops below “normal,” the patient mental extremes.
criteria for geriatric patients of using an SBP may very well be in shock. I personally would like to see more educa-
of < 110 as an indicator of shock may benefit Although I agree with the authors’ assess- tion and training on this every growing pop-
this population of trauma patients. ment of the “potential” value of using SBP of < ulation. After all, I’m one of them. JEMS
110, the reality is that mechanism of injury is the
DOC WESLEY COMMENTS most common reason EMS activates the need Keith Wesley, MD, FACEP, is the medical
The current National Trauma Triage Proto- for trauma services. Vital signs in the prehospital director for HealthEast Medical Transportation
col is divided into four steps. Step 1 is based environment are rarely the initiating factor. If a in St. Paul, Minn., and United EMS in Wiscon-
on physiologic criteria that include a Glasgow provider obtains an SBP of < 110, they should sin Rapids, Wis. He’s served as the state med-
Coma Scale (GCS) of < 14, SBP < 90, and a take the patient to the highest available trauma ical director for both Minnesota and Wisconsin.
respiratory rate < 10 or > 29. Step 2 is based center. But in much of the nation, EMS is often He can be reached at drwesley@charter.net.
on various anatomic findings such as two or limited to the nearest available hospital. It’s here Karen Wesley, NREMT-P, is a paramedic and
more long bone fractures, penetrating injuries, the true value of this research can be utilized. educator for Mayo Clinic Medical Transport
etc. Step 3 is based on mechanism of injury It’s the smaller, non-trauma hospitals that often and is the medic team leader for the Eau Claire
such as ejection from the vehicle. And step 4 receive the elderly trauma patient for their initial County (Wis.) Regional SWAT team. She can
is special consideration for geriatric patients, evaluation, and it’s here that recording an SBP be reached at admkaren22@hotmail.com.
children, pregnant women and burns. < 110 in this special population should trigger
Learn more from Keith Wesley at the EMS
The authors’ finding that an SBP of < 90 in early transfer to a higher level of care, regard- Today Conference & Exposition, Feb. 25–27, in
the geriatric patient correlates with the need less of other findings. TM Baltimore, Md. EMSToday.com
1510jems_29 29 9/25/15 10:55 AM

Survey reveals alarming rates of her co-workers was more intimidating than
addressing her issues. The idea that she may
EMS provider stress & thoughts of suicide need counseling was even scarier.
Courtney’s co-workers, friends and family
By Chad Newland, EMT-P; Erich Barber, BA, NREMT-B; were surprised by her suicide. They said every-
thing in her life seemed fine. She was happy,
Monique Rose, CCEMT-P & Amy Young, BBA, CCEMT-P vibrant and excited about her future. They said
she loved her job, loved her children and loved
C
ourtney Smith, 54, drove to a des- of bodies mangled in a vicious car wreck, and her husband. She was the person they could
olate country road on a cold winter the memories of all the suicides—the smells all count on when they needed help.
morning. It was three hours from the and the sounds—would plague her no more. Others saw something—a shift in her out-
city where she worked as a medic for 28 years. Courtney always seemed to be able to man- look, her mannerisms, her attitude—but didn’t
Courtney pulled to the side of the road and age the stress that accompanies the critical know what to do or what to say. Their con-
sent a text to her three children. She told them calls—the type of calls that haunt most people. cerns for appearing too nosy or breaching some
she was proud of them and that she loved It was all a facade. Courtney was able to hide unknown boundary into Courtney’s personal life
them. She then walked out into the field beside the pain and subdue the effects of the night- seemingly outweighed what was really import-
the road, pulled out a pistol and succumbed to mares and flashbacks she had almost every ant. They were unable to see the depth of her
the memories that had been nagging her for day. She knew if she showed any weakness, pain and her need for help. They felt guilty for
years of shift work, responding to countless she would be pulled off the truck and possi- not speaking up and talking to her about their
horrific calls. The flashbacks of a mother’s wail bly lose her job. The thought that she would concerns and now there was nothing they could
when she’s told her child has died, the vision lose the respect of her partner, her boss and do except support her family and each other.
1510jems_30 30 9/25/15 10:55 AM

REVIVING RESPONDERS any connections between an EMS provider’s incident that had a significant impact upon
It’s stories like these that led us to form the stress level and the associated culture in which you, or the accumulation of stress over a period
group Reviving Responders. This began as a they are immersed. of time. This stress has a strong emotional
research assignment from Fitch & Associates’ impact on providers, regardless of their years of
Ambulance Service Manager Program, which is PREVALENCE & SEVERITY service.” Some of the questions asked respon-
designed to provide new leaders and managers OF CRITICAL STRESS dents if they’ve ever experienced CS, if they’ve
with an up-to-date curriculum of the indus- A group at Ambulance Service Manager, ever contemplated suicide and if they’ve ever
try’s best practices and foremost challenges. which consisted of seven individuals from attempted suicide. The survey went on to ask
We chose to research the prevalence and Missouri, Texas, Oregon, Colorado, California if support was available and if it was used.
severity of EMS provider stress in the work- and Nevada, created the survey questions. This The survey then explored the different types
place. We created a survey to address some- survey, hosted by SurveyMonkey, was then sent of support, such as employee assistance pro-
thing we termed “critical stress” (CS) and also to all employees of each member’s EMS sys- grams (EAP) and critical incident stress man-
looked at providers who’ve either contem- tem as well as continuing education classmates, agement (CISM) teams, with the intent of
plated or attempted suicide. Additionally, we the Trauma Regional Advisory Council, the finding how effective EMS providers found
attempted to measure how effective current National EMS Management Association and the help, and what they felt would have made
support mechanisms are from the provid- other contacts from the medical field. Many the support more effective. Finally, the survey
er’s point of view, and what can be improved recipients then shared the survey via social asked questions about whether the provider
through these support institutions. Lastly, we media, allowing the survey to spread to pro- felt supported by their peers and management
took a snapshot of the various cultures of EMS viders and organizations across the country. team with respect to their mental wellness, and
throughout the country as they pertain to pro- In the survey, we defined CS as “the stress asked whether or not an employee was encour-
vider support for mental health and looked for we undergo either as a result of a single critical aged by their peers and management team
1510jems_31 31 9/25/15 10:55 AM

CRITICAL STRESS
Figure 1: Comparison of suicide contemplation and attempt rates: of time, or an EAP counselor who knows abso-
survey respondents vs. national average (n = 4,022) lutely nothing about the EMS industry and
40% spends the sessions in horror, learning about
37.0% events providers are routinely exposed to.
35% EMS provider survey respondents We’ve heard those same stories as well, and
1,383
CDC national average we expected the survey results to show that
30%
formal support institutions such as EAP and
35% CISM are ineffective or mediocre at best in
20% dealing with provider CS. We were surprised
to find that these institutions received higher
15% ratings than we expected.
10% Of the 86% of respondents who experienced
6.6% critical stress, 18% (614) attended CISM-
5% 3.7% 225 type programs and 63% (388) of them found
0.5%
0% the sessions very helpful or extremely helpful.
Suicide contemplation Suicide attempts Of the 11% (394) who attended EAP ses-
sions, 53% (210) found them very or extremely
to use the formal support services available. respondents experienced CS, but the shock- helpful. (See Figure 2.)
We didn’t know how many responses we ing discovery was that 1,383 (37%) of the This isn’t to say that the support couldn’t
would receive, but we knew that our project respondents had contemplated suicide and be improved, or that the stories we’ve all heard
hinged on getting enough data to make the 225 (6.6%) had actually tried to take their own aren’t real. Indeed, 51% of the people who
study statistically valid. So it was with a consid- life. (See Figure 1.) These statistics are roughly used EAP for support stated that the support
erable amount of trepidation that we pressed 10 times greater than the national average for would have been more helpful if the therapist
the “send” button and initially distributed the adults in America, according to a study done was experienced in dealing with people in the
survey. We initially thought that something by the Centers for Disease Control and Pre- EMS industry or with post-traumatic stress
could be put together with 100 responses, but vention in 2012.1 Even taking into account disorder. One respondent summarized the
we were really hoping to get something closer inherent survey bias, these figures were mind- EAP interaction as such: “I described the call
to 500 by the time the survey was closed. blowing. This information concretely estab- that I was having trouble with only to have
Within one hour there were 100 responses, lishes the fact that EMS provider stress is the psychologist look at me and say, ‘How do
and within one week there were over 1,000. prevalent in our nation and is extreme, to say you guys do what you do?’ She was clueless
The survey quickly had respondents from all the least. and ill-equipped to help me.”
50 states and we wound up with a total of There were other common themes in the
4,022 responses. THE EFFECTIVENESS OF FORMAL critiques of formal support institutions. Some
That many responses in such a short SUPPORT INSTITUTIONS people who used CISM teams stated they
time was nothing short of amazing, but we Most people have heard a story (or been a part received the CISM support too late or that
surely weren’t ready for what came next. The of one) about a caregiver who goes to a CISM they didn’t feel comfortable sitting in a room
results showed that 3,447 (86%) of the 4,022 debriefing and believes it to be a colossal waste full of people to talk about how they felt, and
were horrified to have to “relive the call.”
Figure 2: Effectiveness of formal support institutions There were two critiques prevalent in the
responses, regardless of what type of support
50% 47% they utilized: the support was either not acces-
45% 288 43% sible or the provider felt discouraged from
40% 170 using the support. Some comments from the
35% survey that illustrate these critiques include:
30% >> “Fear of being fired. We’re not allowed
CISM at our service.”
35% 21% >> “I asked for help and ended up losing my
20% 18%
15% 16% 81 17% 22-year career.”
15% 110 67 >> “Asked for help and was laughed at.”
94 96 10%
10% 9% >> “Was told to get back to work. Was told
4% 36 40
5% I signed up for it so deal with it.”
27 >> “It wasn’t offered even though we all
0%
CISM (n = 614) EAP (n = 388) thought it should be. One co-worker
stated it didn’t even bother him. A differ-
Not helpful at all Somewhat helpful ent co-worker who heard about it made
Slightly helpful Very helpful Extremely helpful comments about me being ‘mentally fit
1510jems_32 32 9/25/15 10:55 AM

enough to be on a truck’ because the kid’s Figure 3: EMS cultures and the presence of critical stress
death bothered me.” 100% 99%
The survey results revealed that 1,592 (40%) 98%
of the respondents had access to support but 97% 483 97%
668
didn’t seek help. Roughly a quarter of these 95% 621 455
respondents who didn’t seek help for their CS
were concerned about how they’d be viewed
at work if they had sought support. Over 90%
40% of those who had either contemplated
or attempted suicide and didn’t get help also
listed scrutiny from others as the reason why 85%
they didn’t seek support.
CRITICAL STRESS & EMS CULTURE 80%

Indeed, another shocking revelation was this No encouragement Peer and management
notion that EMS culture is a huge barrier or support (n = 639) support only (n = 681)
to providers getting relief for their sleepless Peer support only Full support and
nights or relived nightmares. As an industry, (n = 489) encouragement (n = 470)
how we support our EMTs and paramedics
when they’re feeling overwhelmed varies from When it comes to a provider seeking help CONCLUSION
one department to the next. for CS from either a CISM or EAP program, Stories like Courtney’s are becoming all too
A portion of the survey gathered data about the data suggests that being in a supportive common. If we’re really looking, we can walk
the different EMS cultures around the coun- environments isn’t enough. The major factor through the operations building or sit on the
try. Four prominent cultures dominated the increasing the likelihood that a respondent tailboard of a truck with some of the crews
data, but didn’t represent the results in their would seek help is if he or she was encour- and see the haunted look in so many eyes. We
entirety. They were cultures where: aged to seek said help by either their peers of can even tell when somebody is less engaged,
>> A field provider doesn’t experience men- management. (See Figure 5, p. 34.) despondent or is having trouble coping with
tal wellness support from their peers or Furthermore, the perceived effectiveness the burdens that come with helping uncon-
management team. This field provider is of the formal support institutions is greater ditionally whenever asked.
also not encouraged to engage in formal when a field provider is supported by peers and Suicide contemplation and attempt rates
support institutions like EAP or CISM; management with respect to mental wellness, among EMS practitioners are significantly
>> A field provider experiences support from and is encouraged to utilize formal support. higher than the general population. There
their peers regarding their mental wellness, (See Figure 6, p. 34.) Also worthy of note here may be a variety of factors that contribute to
but doesn’t feel supported by the man- is that the support effectiveness was greater CS beyond the things we see throughout our
agement team. This field provider isn’t when the provider attended on a voluntary careers. Sleep deprivation, feeling underap-
encouraged to engage in formal support basis versus instances where a field provider preciated, poor nutrition and exercise are just
institutions like EAP or CISM; was mandated to attend. a few of many issues that may contribute to
>> A field provider experiences support from
their peers and management team, but Figure 4: Suicide contemplation and attempts in EMS cultures
there’s no encouragement for a field pro-
60% 56%
vider to utilize CISM or EAP; and
>> A field provider is supported by both Suicide contemplation
50% 357
peers and the management team. This Suicide attempts
43%
field provider is also encouraged to utilize
40% 208
the formal support institutions like EAP
and CISM. 28%
30%
The survey results show that presence of CS 23%
is roughly the same in all of these cultures (see
190
20% 108
Figure 3), but the rates of suicide contempla-
12%
tion and suicide attempts (see Figure 4) sig-
10% 78 6%
nificantly decrease when a field provider has 5% 4%
the support of their peers and is encouraged 27 31 18
0%
to utilize the formal support institutions in No encouragement Peer Peer and Full support
place: A supportive and encouraging environ- or support support management and
ment cut suicide contemplation rates in half (n = 639) only support only encouragement
and attempt rates by 66%. (n = 489) (n = 681) (n = 470)
1510jems_33 33 9/25/15 10:55 AM

CRITICAL STRESS
Figure 5: EMS providers who sought help for stress in various EMS cultures Erich Barber, BA, NREMT-B, has been working for Grand
County (Colo.) Emergency Medical Services (GCEMS) for over
60%
10 years. He earned an EMT certification while serving his
52%
50% community as a volunteer firefighter. Now a captain at GCEMS,
244 he manages the Mountain Medical Response Team, a spe-
40% cialized division that assists search and rescue by providing
medical care in the backcountry of the Rocky Mountains.
30% 31% Before EMS, he worked in the mental health field, utiliz-
30% 28%
189 151 ing his bachelor’s degree in psychology and youth guidance
187
20% he earned through Colorado Christian University. Positions
included executive director of a residential treatment center,
10% group living director and counselor.
Monique Rose, CCEMT-P, is a captain and works in the
0% special operations division at Humboldt General Hospital in
No encouragement Peer and management Winnemucca, Nev. She’s been a paramedic for several years and
or support (n = 639) support only (n = 681) also serves as a logistic chief, coordinating special events. She
Peer support only Full support and also serves as a reserve police officer and tactical paramedic.
(n = 489) encouragement (n = 470) She holds a paramedic specialist (critical care) certification
from the University of Iowa and is working toward an associ-
poor mental health in this field. More research resources available. Help and encourage each ate’s of applied science from the College of Southern Nevada.
is forthcoming to look at how those issues other to get the help needed. Amy Young, BBA, CCEMT-P, is the director of ground oper-
affect our well-being. You need to decide to be part of the solu- ations west at CareFlite in Grand Prairie, Texas. She’s been
There’s one thing we can all do, right now, tion, and not tolerate the behavior of those a paramedic since 1996 and has worked in hospital-based,
to make an impact on rates of suicide con- who are part of the problem. Confront the rural, and third-service EMS systems. She holds a critical
templation and attempts in EMS workers. A behavior of those who promote a negative care paramedic certification from the University of Maryland,
conscious decision is needed to make a posi- culture at your workplace. Support those who Baltimore County and a bachelor of business administration
tive change in the culture surrounding mental promote a positive culture. Together we all can with a minor in management from Tarleton State University
health. Nobody needs special training to sup- work to make a change in the culture to help in Stephenville, Texas.
port their co-workers. Ask them how they’re improve the well-being of our profession. JEMS
doing, and be honest when others ask you REFERENCE
how you’re doing. Support each other, sup- Chad Newland, EMT-P, is the deputy operations manager for 1. Centers for Disease Control and Prevention. (2012). Suicide
port yourself and take care of yourself. Talk the Contra Costa County (Calif.) division of American Medical Facts at a Glance. Retrieved Aug. 7, 2015, from www.cdc.gov/
and listen to each other. If you feel like one Response. He started his career with this division eight years violenceprevention/pdf/suicide-datasheet-a.pdf.
of your peers needs more advanced help, there ago after obtaining his paramedic license in 2007, and worked
are several resources out there. as both a front-line paramedic and a paramedic supervisor. Learn more about these important issues
in two lectures from Amy Young at the EMS
Websites like www.revivingresponders.com He holds a bachelor’s in physics from the California State Today Conference & Exposition, Feb. 25–27, in
and www.codegreencampaign.org have several University, Sacramento. Baltimore, Md. EMSToday.com
Figure 6: The effectiveness of formal support in different EMS cultures

60%
52%
50% 49%
244
41% 333
40%
199
33%
30% 212
22% 21% 22% 22%
20% 19% 17%
15% 141 120 105 109 15% 16% 15% 105
96 11% 9% 101 112 114
10%
69 7% 1% 9% 71
46 4%
33 27 6 44
0%
No encouragement or support Peer support only Peer and management Full support and
(n = 639) (n = 489) support only (n = 681) encouragement (n = 470)
Not helpful at all Slightly helpful Somewhat helpful Very helpful Extremely helpful
1510jems_34 34 9/25/15 10:55 AM

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Prehospital treatment of athletes
wearing a helmet & shoulder pads
By Michael J. Bilkasley, EMT-P, LO, L.Ped & Paul Sparling, MED, AT, ATC
BOTH OR NONE
Y
ou’re detailed to the local high school foot-
ball game; it’s the biggest game of the sea- There are more benefits to leaving the
son. The event is a sellout in front of over shoulder pads and helmet in place
10,000 fans, and all four of the local news stations than removing them. 1,2
are filming. After the kickoff return, you notice However, sometimes you
officials and players from both teams waving to may need to remove them.
the sideline for the medical staff. You’re called onto It’s important to note two things:
the field; you have an unconscious patient lying on First, if you’re going to remove one, you
his side and an athletic trainer has control of the must remove both. Second, you need to
cervical spine (C-spine). What do you do next? be properly trained and need to practice
Do you want to remove the helmet and shoulder the procedures for removing the helmet and
pads or leave them place? Why? This definitely shoulder pads.
isn’t the time for on-the-job training. Paul Sparling notes that in his 30-plus years
working with the NFL, he’s never removed the
BE PREPARED helmet and shoulder pads from a player with
Potential spinal injuries in football can quickly any suspicion of a C-spine injury. It’s best to leave
become a complicated treatment and transport the equipment on the patient and transport them to the
problem if you’re not properly trained and prepared. hospital (preferably a trauma center) where the patient has
Football players and other athletes who wear access to proper advanced medical care. If possible, a mem-
shoulder pads and helmets will very rarely be found ber of the team’s medical staff should accompany the patient.
lying perfectly straight and in a supine position A cross-table lateral C-spine X-ray should be performed to
We’re going to discuss how to properly immo- rule out fractures before making the decision to remove the helmet
PHOTOS COURTESY ERIC BALASH
bilize and treat athletes with a helmet and shoul- and shoulder pads. This also allows the patient to be in a more con-
der pads in place and discuss situations when the trolled environment so if a cervical fracture or dislocation/sublux-
equipment should be removed. It’s our hope this ation is found, the patient will have access to a full medical staff,
article will provide direction on how to treat these including emergency medicine staff, orthopedic surgeons, neuro-
patients and how to train for an event before an surgeons, anesthesiologists and respiratory staff, during the removal
incident occurs. of the equipment in the event a problem occurs.
1510jems_36 36 9/25/15 10:54 AM

1510jems_37 37 9/25/15 10:54 AM

HEAD & SHOULDERS
IMMOBILIZATION TECHNIQUES
Immobilizing a Patient with a Helmet
If the injury takes place at a high school, college or professional foot-
and Shoulder Pads ball game, one of the team’s training staff or team physicians may have
control of the head. Clear the area of coaches and players so you have
room to work. Then, logroll the patient onto a backboard and fur-
ther assess them. The trainer should have tools (e.g., a cordless screw
driver, Trainer’s Angel, FM Extractor) to remove the face mask rap-
idly so you can asses the airway and perform advanced airway proce-
dures if necessary. Intubation won’t be as difficult as you might expect
if you leave the helmet and shoulder pads on the patient: simply have
someone maintain manual immobilization the same as you would on
a trauma patient involved in a motor vehicle crash.
Once the airway is secured, secure the patient to the backboard
with a strap at the torso. Fill in any gaps around the helmet, neck
1 Fill in void spaces between the helmet and shoulders using towels. and shoulders with rolled towels to help secure the patient’s head
and then tape the helmet to the board. Remember that these patients
may have difficulty maintaining their airway, so have suction devices
readily available and continue to monitor the airway throughout the
incident and transport.
Finish securing the patient to the backboard with straps at the
knees and then secure the arms. If access is needed to the chest, cut
the jersey and open the front of the shoulder pad assembly to perform
CPR or defibrillation.
INTUBATION TECHNIQUES
Apply pads to the right and left side of the helmet to help secure it to Preoxygenate the patient if time allows. One study showed that use of
2 the backboard. Note the chin strap has been left in place. This is vital oxygen by nasal cannula at 15 Lpm during intubation and insertion of
to assure the head is secured properly. a supraglottic airway (SGA) aid in the preoxygenation of the patient.
Preoxygenation using a nasal cannula with bag-valve mask (BVM)
ventilations also increases the oropharyngeal fraction of inspired oxy-
gen (FiO2).2 (See photos, p. 39.)
Just as you would with any known/suspected C-spine injury, main-
tain continuous manual in-line cervical stabilization (which is superior
to a C-collar) during the intubation procedure.2 If possible, place the
patient in the reverse Trendelenburg position by elevating the head of
the backboard 20 degrees during
the intubation procedure. Once
Manual C-spine should be held in you’ve confirmed endotracheal
place until the helmet is taped and (ET) tube placement, secure the
secured. In addition, the patient’s ET tube before any patient move-
torso should be strapped onto the ment. If there’s enough time to
Begin taping the helmet to the backboard, again noting that the chin board before proceeding to immo- intubate the patient in the prehos-
3 strap is left secured and in place on the helmet and patient. bilize the head to the backboard, pital setting, then there’s enough
just as you would do in any other time to secure the tube.
spinal immobilization procedure. A frequently stated reason for
accidental esophageal intubation
is “the tube moved.” The tube
position should be rechecked after each patient movement (e.g., back-
board to stretcher, stretcher to ambulance); end-tidal carbon dioxide
(EtCO2) use provides continuous placement monitoring. Additionally,
make sure you document the procedure on your patient record, includ-
ing—but not limited to—the use of manual in-line immobilization
during the procedure, how you secured the patient to the backboard,
preoxygenation, the tube size and depth of insertion (the centimeter
number on the tube at the lip line), the number of intubation attempts,
4 The patient is now secured to the backboard and ready for transfer. any complications, and the method of confirmation of correct tube
1510jems_38 38 9/25/15 10:55 AM

placement (e.g., esophageal intubation detector, auscultation, colori- Intubating a Patient Wearing a Helmet
metric CO2 detector or waveform capnography).
There are some incidents where you may need to remove the helmet
and shoulder pads, such as when the face mask can’t be removed in a
timely manner for airway control. However, keep in mind, it’s much
more time consuming to remove both the helmet and shoulder pads
correctly, and you’ll need at least 3–4 properly trained personnel to
safely accomplish the task. Another example for helmet and shoulder
pads removal is if the helmet isn’t a proper fit and is causing airway
problems and/or immobilization problems; this would be more com-
mon in youth league football.
REMOVAL TECHNIQUES
When removing the helmet and shoulder pads, one of the most dif-
ficult tasks is to maintain neutral C-spine alignment. The first step is
to have someone maintain cervical immobilization at the head. Then,
cut the jersey off and expose the front of the shoulder pads. Open the
buckles or cut the straps on the shoulder pads to expose the chest and
then open or cut the side straps (some manufacturers have a quick-
release strap on the upper-right side of the chest plate).
Next, have a second member place their arms up and under through
the front of the shoulder pads and take control of the C-spine at the
jaw. The member at the head will now remove the helmet while the These photos show that intubation can be performed with the helmet in
second member maintains cervical immobilization and alignment. place. It’s much easier if a video laryngoscope is available; standard intubation
When the helmet is off, the first member will then pull the shoulder equipment can also be used.
pads off above the shoulder and head. Next, apply a C-collar, immo-
bilize the patient to the board and apply CID pads and straps.
There are a couple “levitation” techniques for removal of the helmet Removing a Helmet and Shoulder Pads
and shoulder pads, but they’re difficult and require 4–6 personnel and
a lot of practice to perform efficiently (and they’re weight-dependent
on the athlete). These techniques may work for younger athletes and
players such as receivers and defensive backs, but would be extremely
difficult to perform on a lineman weighing over 300 lbs.
Recently, the National Athletic Trainers Association (NATA) pub-
lished a position paper titled, “Appropriate care of the spine injured
athlete: Updated from 1998 doc-
ument.” The paper was followed
by an addendum that essentially Although there are only few situa-
leaves it up to medical personnel tions when it’s best to remove the
to evaluate and assess each indi- helmet and shoulder pads, such
vidual circumstance to determine as when the helmet isn’t a proper
if equipment should be removed fit and is causing airway problems 1 Cut the chest straps on the anterior side of the shoulder pads.
before transport. This approach and/or immobilization problems,
is consistent with what most ath- it’s important to be well-practiced
letic trainers have been doing for in equipment removal to ensure
years. For example, prior to the patient safety.
addendum from NATA and during
our recent Emergency Action Plan
review at Paul Brown Stadium with paramedics, team physicians and cer-
tified athletic trainers, all agreed that the medical staff would continue to
evaluate each situation on a case-by-case basis. The Cincinnati Bengals’
medical staff ’s approach is essentially what the addendum now calls for.
Our position remains that except in extreme circumstances that
require the equipment be removed to render care to the patient, the
equipment should remain on because removing it on the field can take Slide your arms between the chest and anterior shoulder pads and gain
valuable time from ensuring the patient gets to a trauma center for
2 control of the C-spine on the anterior side of the head and jaw.
1510jems_39 39 9/25/15 10:55 AM

HEAD & SHOULDERS
Removing a Helmet and Shoulder Pads (continued)
Remove the bilateral chin pads from the helmet. A tongue depressor Using a fourth caregiver, elevate the shoulders enough to slide the
3 works well for this.
7 pads over the patient’s head.
4 Remove the helmet chin strap.
8 After the pads are removed, lower the patient to the ground.
Begin removing the helmet, ensuring there’s good anterior C-spine

control (arms will be between the chest and shoulder pads, and C-spine
5 will be controlled holding the side of the head). With the chin pads
removed, total contact is easily achieved.
9 Apply a C-collar.
The third caregiver will take control of the back of the head as the Fully immobilize the patient to the backboard with straps and head
6 helmet is removed by the second caregiver.
10 blocks.
1510jems_40 40 9/25/15 10:55 AM

appropriate care as quickly as possible. Addi- On further neurological exam, the patient as safely and quickly as possible. In addition,
tionally, the NATA statement specifically has diminished hand grips bilaterally and has we recommend the patient be transported to
pointed out that there should be a minimum no noted plantar-flexion or dorsi-flexion to the the closest trauma center or air transported
of three trained emergency care providers in lower extremities. Given this information, you if necessary. JEMS
order for equipment to be removed in advance decide the best choice for this patient would
of transport. In the vast majority of emer- be to immobilize him with the helmet and Michael J. Bilkasley, EMT-P, LO, L.Ped, is a fire lieutenant/
gency sports injury situations that occur (youth shoulder pads in place. You continue to mon- paramedic and EMS officer with the Blue Ash (Ohio) Fire
football programs, junior high and some high itor the patient’s airway and vitals and start Department, where he’s been since 1994. He has over 30 years
school football programs), there may be one an IV according to protocol. You ready the experience in fire and EMS and is also an ABC-certified and
or two at the most who are trained and expe- patient for transport to a trauma center while Ohio-licensed orthotist with 21 years experience in the field.
rienced to handle such equipment removal your partner calls the receiving staff. He’s also a consultant to the Cincinnati Bengals.
in the field. This would render a situation in Paul Sparling, MED, AT, ATC, is the head athletic trainer
which there isn’t sufficient staffing to remove CONCLUSION for the Cincinnati Bengals. He’s been in this position since
the equipment in a timely or efficient manner. Ultimately, how you immobilize a patient with 1992 and has been with the Bengals for 36 years. He’s a fre-
helmet and shoulder pads should be based quent guest speaker on various sports medicine topics and
CASE CONTINUED on local protocols, and your department or was recently elected to the Wilmington College of Ohio Ath-
The male patient is on his side and the athletic organization’s medical director’s instruction. letic Hall of Fame, where he’s a 1981 alumnus.
trainer has manual control of the C-spine. The You should be well-trained in the procedures
patient appears to be breathing, but you want to directed in your protocol, especially if your REFERENCES
do a better assessment. You place the backboard department or organization is detailed as the 1. Theodore N, Aarabi B, Dhall SS, et al. Transportation of patients
behind him and logroll him onto it. Your part- EMS unit for local football games. with acute traumatic cervical spine injuries. Neurosurgery.
ner takes over control of the C-spine and asks We recommend conducting annual train- 2013;72(Suppl2):35–39.
the trainer to remove the face mask. As you’re ing with the school or team’s training and 2. Weingart SD, Levitan RM. Preoxygenation and prevention of
working, the patient begins to regain conscious- medical staff so that everyone is on the same desaturation during emergency airway management. Ann Emerg
ness and complains of numbness. page and a potential incident can be managed Med. 2012;59(3):165–175.
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44 JEMS | OCTOBER 2015
1510jems_44 44 9/25/15 10:54 AM

AP PHOTO/MARY ALTAFFER
Understanding & treating trauma

caused by law enforcement use of force
By Derrick E. Jacobus, FP-C, MA
Y
ou’re dispatched to the 800 block of are on scene with an unconscious 23-year-old
North 32nd Street in a part of the city male who was struck with a conducted energy
that’s been plagued with violence over device and bleeding. You ask your partner what
the past few months. There have been several a conducted energy device is and what you’re
shootings and assaults on law enforcement. supposed to do—is it a Taser or stun gun?
You and your partner are advised that police Why is he bleeding?
1510jems_45 45 9/25/15 10:54 AM

UNDER POLICE CONTROL
Upon arrival you hear the commotion on scene and see an

abundance of law enforcement vehicles and officers, as well as a
large crowd of bystanders, many with cellphone cameras facing
AP PHOTO/TED S. WARREN
in their direction. You exchange glances with your partner
and exit the rig wondering what happened.
USE OF FORCE CONTINUUM others, officers are legally entitled to use appropriate means, including
The use of force by police has been around for centuries. In the 19th cen- force.”1 Every day, law enforcement officers are faced with split-second
tury, police officers in New York and Boston used mostly wooden clubs decisions on what types of force to use when carrying out their duties
as their weapons. After criminals armed themselves with guns, police and responsibilities. There are occasions where the force applied results
departments began issuing firearms in an injury and EMS is summoned
to officers. Modern-day law enforce- to assist. These encounters can be
ment has since added to the toolbox met with a multitude of problems as
of force and officers now have many Officers are taught to many levels of force may have been
options to control a subject. applied to the subject based on the
In its study, Police Use of Force in strike their baton at the resistance faced by officers. In addi-
America 2001, the International Asso- tion, the patient is under the influ-
ciation of Chiefs of Police (IACP) suspect’s attacking limbs ence of alcohol or drugs 88.1% of the
defined the use of force as “the amount time when the officer engages force.2,3
of effort required by police to compel & large muscle groups The U.S. National Institute of Jus-
compliance by an unwilling subject,”1 tice states that law enforcement offi-
but there’s no single, generally accepted & to avoid areas like the cers should use only the amount of
definition. Likewise, throughout the force necessary to mitigate an incident,
United States, there’s no single policy head, neck or spine. make an arrest, or protect themselves
or law that dictates how law enforce- or others from harm. The levels, or
ment use of force is to be employed; continuum, of force police use include
police must employ a reasonable amount of force given the totality of basic verbal and physical restraint, less-lethal force and lethal force.
the circumstances. So how are you supposed to know what guides law When faced with a situation, many police departments allow their offi-
enforcement officers in your jurisdiction? cers to match or escalate the use of force “necessary” to “reasonably”
The U.S. Commission on Civil Rights has stated, “in diffusing situ- gain control of the subject.4 In the U.S., only 2% of police and public
ations, apprehending alleged criminals, and protecting themselves and contacts results in force being threatened or exercised.4 Unfortunately,
1510jems_46 46 9/25/15 10:54 AM

in those few occasions, many have gained the
national spotlight.
SIGNIFICANT RECENT EVENTS

Recently throughout the world, law enforce-
ment has gained attention by causing injury
and mortality to subjects after applying force.
Despite a 4.4% drop in violent crimes between
2012 and 2013, according to the FBI, the
tensions between media, the public and law
enforcement continue to grow.5 There’s a per-
ception that there’s been an increase of vio-
lence against law enforcement—so much so
that the U.S. Attorney General has stepped in
with safety initiatives for police officers. The
court of public opinion has concluded that
there’s a “war on cops,” which means miscon-
duct among the public and law enforcement
officers will be highlighted and may increase.
Freddie Gray, Eric Garner and Michael
Brown have highlighted the media attention
drawn by violence between law enforcement Deployment of OC spray is typically in the face, which will cause respiratory distress, irritation of ocular and
and the public. Although these incidents nasal passages and the feeling of anxiety. AP Photo/Ross D. Franklin
resulted in death, there are many more that
don’t and that’s where EMS is often requested TYPES OF FORCE & also results in the highest incidence of inju-
to treat the subject. This is important for EMS ASSOCIATED INJURIES ries to both the subject and the police officer.
providers to understand, as calls for service as The first level of the use of force continuum is In one study of 12 U.S. police departments,
a result of these encounters may surge. merely officer presence and verbalization. You physical force resulted in minor injuries to the
EMS response to use of force incidents may think that this isn’t an effective tool, but subject 49.1% of the time, hospitalization 4.1%
by law enforcement must be done in a pro- a police officer with command presence has of the time and no fatalities. Injuries com-
fessional, ethical and unbiased manner. Your been shown to deter crime or diffuse a situ- monly seen at this part of the continuum are
response as an EMS professional may be ation without physical contact.7 Some states, similar to those of physical assault.3
recorded and placed on any number of media such as New Jersey, consider displaying the
outlets, and includes the potential to go viral officer’s duty handgun and pointing it at a
on social media. Smartphone cameras continue subject to be in this step of the continuum.
to increase in popularity and bystanders have Nonlethal methods of force use different
grown to be “field reporters.” techniques, such as physical force using only
Anything recorded may be seen by mil- the officer’s body, blunt impact with a baton or
lions of eyes, so you as an EMS professional other similar object, chemical substance such as
must continue to follow the National Asso- oleoresin capsicum (OC) spray, deployment of
ciation of EMTs’ code of ethics: “To provide a canine (K-9) and conducted energy devices
services based on human need, with com- (CEDs), to gain control of a subject. Not all
passion and respect for human dignity, unre- police departments use or employ these meth-
stricted by consideration of nationality, race, ods, but these are the most commonly used in
creed, color, or status; to not judge the merits the U.S. (See Table 1, p. 48.)
of the patient’s request for service, nor allow Physical force (e.g., empty hand control):
the patient’s socioeconomic status to influence The second level of the force continuum,
our demeanor or the care that we provide.”6 empty hand control, uses bodily force to gain
Scene safety on law enforcement assists is control of a subject. This physical force step
of utmost priority. Just because the police are can be broken down into two categories: soft
on scene doesn’t mean that it’s safe. Always and hard control. With soft control, the offi-
“watch your six,” keep situational awareness cer uses grabs, holds and joint locks to restrain
high and remember that the only controllable an individual. If soft control doesn’t work, the
factor is you. Scenes can deteriorate quickly officer can employ a hard control technique For patients sprayed with OC, rinse the eyes and face
without warning, so always have an escape of punches and kicks.7 This is the most com- with copious amounts of water used with dish soap
plan just in case. monly used physical use of force option, but that’s non-oil-based. AP Photo/Rich Pedroncelli
1510jems_47 47 9/25/15 10:54 AM

UNDER POLICE CONTROL
Blunt impact (e.g., baton): Blunt impact injuries are commonly
associated with the use of a baton or other similar object, such as
a flashlight or radio. Baton types vary throughout the world. Some
police departments use the expandable baton, which is made of alu-
minum or metal. Others still use the fixed PR-24 type, which is made
of polycarbonate, is about the length of an arm and has a side handle.
Use of a baton results in minor injuries to the subject 32.3% of the
time and requires hospitalization 3.2% of the time.3 Officers are taught
to strike at the suspect’s attacking limbs and large muscle groups and
to avoid areas like the head, neck or spine —unless deadly force is
objectively reasonable, when other methods of force such as the hand-
gun may be deployed.
The severity of injuries inflicted as a result of baton use is depen-
dent on the amount of kinetic energy transferred and the tissue to
which the energy is transferred. The kinetic energy associated with a
moving object is equal to one half the mass of that object multiplied
by the velocity of the object squared (½ mv2). In general, a somewhat
lighter object traveling at high speed will cause more damage than a Police K-9s use a full mouth bite, which means they use all their teeth and hold on
heavier object traveling at low speed. Note that modern police batons to the subject until commanded to let go. AP Photo/Rich Pedroncelli
are now being made of more lightweight construction.
OC spray: OC spray is nearly universal for all law enforcement not the use of OC spray itself.
officers. OC comes from the oily extract of the cayenne pepper plant. Deployment of OC spray is typically in the face, which will cause
This tool causes the subject to be temporarily disoriented by a burning respiratory distress, irritation of ocular and nasal passages and the feel-
and irritation to the sprayed area. Death has been associated with the ing of anxiety. Treatment for a subject sprayed with OC is to calm the
use of OC spray, but in these instances it was the result of positional patient down verbally, ensuring them that the irritation is temporary.
asphyxia, pre-existing health conditions or drug-related factors, and Copious amounts of water should be used with non-oil-based dish
soap such as Dawn. The use of oil-based products will trap the irritant
Table 1: Prehospital treatment of law enforcement force
and cause further discomfort. Oxygen may be applied as OC causes
Force used Prehospital treatment modality dilation of the capillaries, which may cause some distress, although
there are rarely any associated physiological respiratory problems.
Physical force Treatment based on injuries presented; bleeding K-9: Deployment of a K-9 on a subject can result in a variety of
(e.g., empty control, cervical precautions based on mecha-
injury patterns depending on the area of the bite, the level of resistance
hand control) nism of injury; will present similar to assaults.
of the subject and the length of the apprehension before the K-9 is
withdrawn. Police departments across the U.S. favor large dog breeds,
Treatment based on injuries presented; will
such as the Belgian Malinois and the German Shepherd, each weigh-
Blunt impact present similar to blunt force trauma; primarily
(e.g., baton) ing 70–90 lbs. These dogs have the capability of exerting 450–800 psi
supportive: cervical precautions and IV fluid
for hypotension. and use a full mouth bite, which means they use all their teeth and hold
on to the subject until commanded to let go. It’s common for officers
to allow their dogs to continue to bite suspects as long as they strug-
Cervical precautions for falls; bleeding con-
trol (possible evisceration and tearing of skin); gle and fight to free themselves. Police dogs aren’t trained to bite any
Canine (K-9) flushing of wounds with normal saline and specific area of the body, and the injury locations can vary based on
applying sterile dressings to minimize infec- the position and activity of the subject prior to the K-9 deployment.
tion; stabilizing extremity fractures. Dog bite treatment relies on basic first aid such as rinsing the
wound with normal saline, bleeding control and dressing the wound.
Oleoresin Supportive and calming techniques/anxiety Spinal immobilization may be considered if the K-9 caused the sub-
capsicum reduction; copious amounts of water with ject to fall or be knocked down. Most bite wounds can be treated in
(OC) spray Dawn dish soap; oxygen as needed. the ED. Essentials of treatment are inspection, debridement, irriga-
tion and closure, if indicated. A complete trauma evaluation is occa-
Cervical precautions for fall; dart stabilization sionally indicated.
Conducted
energy device
with bulky dressings; cut wires from ejected car- CEDs: CEDs (e.g., Tasers) use propelled wires or direct contact to
(CED) tridge; bleeding control; pain management and conduct energy that affects the sensory and/or motor functions of the
oxygen; treat secondary injuries accordingly. nervous system. CEDs produce 50,000 volts of electricity. The elec-
tricity stuns and temporarily disables people by causing involuntary
Airway, breathing, circulation (ABCs); cervical muscle contractions. Typically it isn’t the CED itself that leads to the
Gunshot
precautions; chest seal for thoracic trauma; IV need for transport to the hospital, rather the events that have led to
wound (GSW)
fluid for hypotension. the deployment of the CED, such as excited delirium. Treatment must
1510jems_48 48 9/25/15 10:54 AM

consist of a complete physical examination, There are different sizes of ammunition
including glucose, oxygen, ECG and cervical used by law enforcement officers. The most
precautions if the subject fell after being struck. commonly used is the 9 mm, .357, .40 and
In most cases, EMS personnel won’t per- .45 calibers that typically penetrate the body
form the removal of the probes. In the event between 11–12" at short distances (< 25 yards).
that the probes are still embedded upon arrival, In comparing ballistics, there’s not a large dif-
the probes should be considered an impaled ference between the types of handgun ammu-
object and treated according to the appropriate nition in regards to penetration depth, only the
medical protocol. It’s likely that the wires to size of the entry wound in the body.
the probes will need to be removed in order to Within the last decade, rifles such as the
transport the patient. This can be done by sim- Colt M4 have been placed in patrol cars
ply cutting them with a pair of trauma sheers. throughout the country. This gun shoots
In the event that the probes are removed by .223/5.56 caliber ammunition that has nearly
the police officer, the probes should be treated 2.5 times the velocity and can penetrate the
as a contaminated sharp. The probes can be body up to 16" from distances of 200–300
stored in the Taser cartridge in the absence of yards.9 When checking for bleeding and the
a sharps container. presence of GSWs, ensure the patient is fully
For documentation purposes, determine undressed and count the amount of holes in the
the amount of cycles of energy the subject was body. It isn’t your responsibility to determine
exposed to. If the subject doesn’t comply after entry and exit wounds. If there’s any sucking
the first cycle of energy, the officer may con- chest wounds or penetrating trauma to the CEDs use propelled wires or direct contact to conduct
tinue to apply cycles of energy until resistance chest, place a chest seal over that region. The energy that affects the sensory and/or motor func-
ceases. In the majority of CED incidents it patient should be transported to a trauma cen- tions of the nervous system. AP Photo/Toby Talbot
won’t be possible for EMS personnel to deter- ter for an evaluation of their injuries.
mine the extent of injuries that the patient Archive of Criminal Justice Data. Retrieved Aug. 14, 2015, from
has sustained. Although it’s unlikely that the FINAL THOUGHTS www.icpsr.umich.edu/icpsrweb/NACJD/studies/25781.
CED itself will have caused an injury, there’s Although patients subjected to use of force by 3. Butler C, Hall C. Police/public interaction: Arrests, use of force
a high likelihood of an occult injury secondary law enforcement encompasses a small popula- by police, and resulting injuries to subjects and officers. Law
to the event. Examples of this are fall injuries tion, with the advent of smartphone cameras, Enforcement Executive Forum. 2008;8(6):141–157.
as a result of incapacitation and pathological these events are often captured and go viral in 4. MacDonald JM, Kaminski RJ, Smith MR. The effect of less-lethal
fractures secondary to muscle contraction.8 days. Law enforcement officers are faced with weapons on injuries in police use-of-force events. Am J Public
Lethal force (e.g., gun shots): Deadly force the pressure of making the right decision amid Health. 2009;99(12):2268–2274.
is the force a person uses knowing it has a sub- this publicity, and a small population will con- 5. FBI. (May 14, 2014.) Crime in the U.S. in 2013. Retrieved
stantial risk of causing death, serious bodily tinue to challenge those decisions with taunt- May 17, 2015, from www.fbi.gov/about-us/cjis/ucr/
harm or injury. Many people think deadly ing and violence. This behavior may lead to crime-in-the-u.s/2013/crime-in-the-u.s.-2013.
force by law enforcement can only be inflicted increased use of force injuries and more con- 6. Gillespie C. (June 14, 2013.) Code of ethics for EMS practitioners.
by a handgun, but it may also include strikes tact with these types of calls by EMS, and we NAEMT. Retrieved May 1, 2015, from www.naemt.org/about_us/
by a baton to a critical area such as the head need to be ready for these incidents. We must emtoath.aspx.
or chest, running into a subject with a vehi- be more alert of our surroundings as there’s 7. The Use-of-Force Continuum. (Aug. 4, 2009.) National Insti-
cle and in some states placing a roadblock no discrimination of violence in the eyes of tute of Justice. Retrieved April 12, 2015 from www.nij.gov/
on a pursuit. our patients. JEMS topics/law-enforcement/officer-safety/use-of-force/Pages/
The basic treatment for any patient who’s continuum.aspx.
been subjected to deadly force is ABCs (air- Derrick E. Jacobus, FP-C, MA, is a decorated law enforce- 8. Whitehead S. After shock: A rational response to Taser strikes.
way, breathing and circulation). If the patient ment veteran serving as executive accreditation manager JEMS. 2005;30(5):56–66.
is handcuffed and you can’t appropriately treat and detective with the Monroe Township Police Department 9. Courtney A, Courtney M. (Nov. 30, 2012.) Physical mechanisms
the patient, ask officers to have the patient in Gloucester County, N.J., and flight paramedic with Virtua of soft tissue injury from penetrating ballistic impact. Air Force
handcuffed in front. Remember, any hand- SouthSTAR, the state-sponsored air medical program in New Academy. Retrieved Aug. 14, 2015, from www.dtic.mil/dtic/tr/
cuffed patient must have an officer in the Jersey. Contact him at djacobus@monroetownshipnj.org. fulltext/u2/a570804.pdf.
ambulance with you during transport. Once
you secure an airway carefully, assess for REFERENCES RESOURCES
breathing, and then check for bleeding. 1. Use of Force. (2004). Community Oriented Policing Ser- • Blume JH. (1984.) Deadly force in Memphis: Tennessee v. Gar-
When assessing a gunshot wound (GSW), vices. Retrieved April 5, 2015, from www.cops.usdoj.gov/ ner. Cornell Law Faculty Publications. Retrieved Aug 14, 2015,
it’s important to understand the differences default.asp?Item=1374. from http://scholarship.law.cornell.edu/facpub/27.
between types of guns and bullets used when 2. Alpert G, Smith M, Fridell L. (April 28, 2011.) Multi-method • Saunders MJ, McKenna K, Lewis LM, et al.: Mosby’s Paramedic
treating patients, as the total damage done evaluation of police use of force outcomes: Cities, counties, and Textbook. Jones & Bartlett Learning: Burlington, Mass., pp. 1045–
depends on the type of ammunition used. national, 1998-2007 [United States] (ICPSR 25781). National 1046, 2012.
1510jems_49 49 9/25/15 10:54 AM

CANSTOCKPHOTO/LUCIDWATERS
Emotional first aid & the facilitation of justice
By Abigail T. Harning, EMT-P, M.Ed
I
t’s estimated a sexual assault occurs in the United States every cooperation from within the judicial process. EMS education also
107 seconds,1 with 1:6 of the victims being women and 1:33 vic- leaves large gaps in knowledge needed to help preserve biological evi-
tims being men.2 For every 100 sexual assaults, there are only 32 dence and maintain the chain of custody of evidence taken into our
that lead to police reports. Of those reports, there are only two felony possession. EMS providers are often one of the first people to contact
convictions with as few as two rapists spending just a single day in a victim, and their actions play an important role, whether or not an
prison.3 (See Figure 1.) immediate life threat is present.
The long-term effects of sexual assault include high rates of depres-
sion and post-traumatic stress disorder. Rape victims are also 13 times EMOTIONAL FIRST AID
more likely to abuse alcohol and four times more likely to contemplate Sexual assault is a violent act to humiliate, terrorize and degrade the
suicide.2 Emotional recovery and cooperation victim, with survivors feeling fear of rejec-
with the judicial process are vastly improved Figure 1: Statistics for every 100 rapes3 tion, humiliation, shame and degradation as
when positive social services and emotional part of a host of emotions they experience.
support are provided as early as possible fol- 32 Get reported to police Fear of being judged or being seen as liars
lowing the traumatic event.4 7 Lead to an arrest are two prevalent reasons for not assisting
Several months ago, I was told by a rape in the judicial process.4 For many male vic-
crisis counselor that, “A lot of rape cases are 3 Are referred to prosecutors tims, the shame and secrecy is compounded
lost because of EMTs.” I followed up with by the fear that their own sexuality may have
her for clarification, and her response was 2 Lead to a felony conviction something to do with being targeted, or at
very poignant: EMS providers work well at Rapists will spend a single day least that others will think so.5 A sexual
2
addressing the patient’s medical needs, but in prison assault patient will need frequent reassur-
often fail to comprehend or meet a patient’s ance that their privacy and confidentiality will
98 Walk free
emotional needs, causing a withdrawal of be protected.
1510jems_50 50 9/25/15 10:54 AM

Victims may fear interrogation and forensic report the move to the police and document should inform patients that they may damage
physical examination. Patients must always be exactly where it was and where the object was evidence, but the final choice is the patient’s.
informed of their right to decline any forensics moved. Don’t walk through other footprints, When cutting clothes, stay at least six inches
evaluations and made aware that their consent tire marks or blood stains. If you inadvertently away from holes, tears and soiled areas. Avoid
will be requested each step of the way. Ini- disturb a blood spill or spatter on floors, walls excessive handling of articles that contain body
tial cooperation doesn’t prevent patients from and other surfaces, document what occurred fluids. Retain all equipment and supplies used
changing their mind at any moment or from and notify one of the police investigators. in the treatment of your patient including ban-
opting out of part or all of the investigation. Also inform police investigators if blood dages, sheets and body fluids such as emesis
Victims who are unable to consent due to is spilled while starting an IV or performing or tissues that may contain mucous. All body
age or cognitive ability are sometimes unaware other invasive care. Blood left behind due to fluids can provide potential forensic evidence.
they were sexually assaulted. Impairment from medical procedures can confuse the evidence. If police are on scene, the evidence should
the use of alcohol or drug precludes consent. Victims should be discouraged from engag- be immediately put in police custody. When
Intoxicated victims may have no recollec- ing in activities that can destroy evidence, such police aren’t available, which may occur during
tion of the sexual assault, but may have an as urinating, defecating, vomiting, douching, transport to the hospital, police should be
unexplained loss of time, or may note evidence removing or inserting a tampon, wiping the notified as soon as possible that EMS has
such as soiling of clothing, injuries or discom- genital area or other contaminated body areas, evidence to be transferred. When a patient is
fort, all suggestive of sexual assault. These vic- bathing, showering, gargling, brushing teeth, critically injured, it’s likely that clothing will
tims often require greater reassurance that the smoking, eating, drinking, chewing gum, be removed enroute. It may be possible to
assault wasn’t their fault. changing clothes or taking medications. have an investigator ride onboard to handle
Self-blame and desire to protect the attacker Remember, if the patient insists they must, evidence collection if it won’t delay transport.
are common, particularly when the attacker is the patient retains their rights. EMS providers Each article of evidence should be bagged
known to the victim, and especially in cases of
domestic violence and sexual abuse. In about 4
of 5 of all sexual assaults, the victim knows the WHAT To Say
perpetrator.6 There are many agencies avail- Here are six suggestions for opening a rapport offered by the Rape, Abuse, and Incest
able to help victims of domestic violence and National Network, and adapted for EMS providers.8
sexual abuse. Positive, supportive interactions
can empower the victim to accept assistance “I’m sorry this happened.” Acknowledge but also be comfortable with periods
and begin rebuilding their life. their experience and express empathy. of silence.
Victims often have deep fear caused by Say things like, “This must be really “You can trust me.” Reassure them you won’t
coercion and threats of retaliation if the crime tough for you.” judge and you’ll protect their privacy and
is reported. Some victims may fear punishment “It’s not your fault.” Reassure your patient confidentiality. Keep that promise.
for partaking in illegal behaviors when the they aren’t to blame, and that you won’t “Can we take you to the hospital?” Med-
sexual assault occurred.7 For example, one vic- judge them. ical attention is always needed, even if
tim was so violently attacked that she jumped “I believe you.” Don’t use words like the assault happened a while ago. Your
from a second story window to save her own “alleged” or “supposed.” While the patient may not be aware there are desig-
life. She was initially reluctant to press charges accused has the right to remain inno- nated facilities that are prepared to meet
because she had agreed to meet her attacker cent until proven guilty, the victim has a their needs. Offer to transport them to
to share illicit drugs. right and emotional need to be believed. an appropriate facility or direct them to
Prostitution and the use of illicit drugs make “I’m here to listen.” Be an attentive listener, information and resources.
individuals more susceptible to violence, but
those behaviors don’t make it legal or morally A victim of sexual assault has experienced a traumatic event that took away their control
acceptable to victimize another human being. of their own body. Offering the patient choices gives back control. Even simple ques-
The victim is in great need of emotional sup- tions like, “Would you be more comfortable with a pillow?” or, “Can I get you another
port, and very fragile to judgment. blanket?” can be beneficial. EMS providers must request consent before medical eval-
Finally, victims may be concerned about uation and treatment. This isn’t only legally required, but also vital for the patient’s
medical costs and may not be aware that sex- well-being. Evidence collection and transfer of evidence to police may also require con-
ual assault victims are eligible for financial sent. In most states, EMS providers are to report suspected cases of child sexual abuse.
reimbursements in most states to cover most Your patient will have to repeat their story many times. You should only ask perti-
related expenses.7 nent questions related to their emergency medical care, but should the patient choose
to share their story with you, listen carefully. Be certain to document patient state-
EVIDENCE PRESERVATION ments as accurately as possible using quotations whenever applicable. You may later
Minimize the number of EMS providers be asked to serve as a witness, and your memory and the victim’s are freshest at the
entering the scene, and ideally, enter escorted immediate point in time.
by a police officer. Avoid touching or disturb-
ing any objects. If you must move an object,
1510jems_51 51 9/25/15 10:54 AM

REPORTING SEXUAL ASSAULT
separately to avoid cross-contamination. Com- damage. Wet biological evidence bags used in never leave evidence in a hot vehicle, where
mercially prepared wet biological evidence the field are typically made of Tyvek, which is a moisture and mold are promoted more quickly
bags are ideal for this purpose, but presently strong but breathable plastic. Plastic biohazard and can alter biological evidence.9
not stocked on most ambulances.9 bags are acceptable for short-term transporta- Proper labeling and handling of the biohaz-
Cloth bags, such as pillow cases, shouldn’t tion of wet biological evidence until it can be ard bag can prevent it from being accidently
be used because fibers from the cloth can dried and transferred to a more appropriate disposed and will protect the chain of custody.
cause cross-contamination of the evidence. evidence bag at a forensic lab. Bags used for evidence must be of ample size
Paper bags aren’t appropriate for wet biolog- Evidence must be protected from tempera- to allow for a complete seal. Evidence must
ical evidence, as evidence can be damaged or ture extremes and from direct sunlight. Don’t be fully sealed with tape to prevent tamper-
lost when the bag breaks down due to water leave evidence unattended and unsecured; ing, and the seal must be signed. Collection
and bagging of evidence should be witnessed.
Keep all evidence in your custody until
properly transferred to a police investigator
with thorough documentation of the chain
of custody.
You must label each item with a description
of what was taken into custody, who secured it,
the date and time the item was collected, who
controlled the package, whom it was trans-
ferred to, and the date and time of transfer.
Commercial evidence bags have a label to be
completed and signed, making the chain of
evidence easier to document thoroughly.
DOCUMENTATION & TRANSPORT

Document injuries with great detail and accu-
racy, and double-check to make certain there
are no errors. Right/left errors are common;
be sure to document injuries in reference to
the patient’s right or left side. Details should
include the location of soft tissue injuries, size,
shape, and type of injury such as abrasion, lac-
eration or incision. The patient’s report may
be subpoenaed for court, and inaccuracies can
be damaging. Also, be certain to document
thoroughly to avoid having to rely on mem-
ory later on. Because rape is a legal definition,
documentation should use the term “reported
sexual assault.” Never use terms like “alleged”
or “supposed” in documentation of a sexual
assault. In court, those statements can be used
to imply that even the responders didn’t believe
the victim’s story. If the term “rape” is used in
a patient report, it should be in the context of
a quote and written within quotation marks.
Victim-focused programs have been estab-
lished to ensure timely, appropriate, sensitive
and respectful care, and to facilitate multi-
agency collaboration. These programs have
proven to minimize physical and psycholog-
ical trauma to the victim, increase report-
ing, improve quality of evidence collection,
and decreased waiting time for victims to
be examined.
Paper bags can be used to store dry items containing biological evidence. Evidence bags must be sealed Within designated facilities, a sexual assault
completely to prevent tampering. CanStockPhoto/showface response team (SART) has protocols and
1510jems_52 52 9/25/15 10:54 AM

dedicated resources for care of sexual assault victims including spe- The offenders. Retrieved Feb. 15, 2015, from https://rainn.org/get-information/statistics/
cialized equipment to detect and document injuries and evidence, sexual-assault-offenders.
dedicated private exam areas and shower facilities, trained advocates, 7. U.S. Department of Justice Office on Violence Against Women. (April 2013.) A national protocol for
full-time social workers for follow-up counseling services, and emo- sexual assault medical forensic examinations: adults/adolescents, 2nd edition. Retrieved May 2,
tional support 24 hours a day, seven days per week. As leaders of the 2015, from www.ncjrs.gov/pdffiles1/ovw/241903.pdf.
team, sexual assault nurse examiners (SANEs) and sexual assault 8. Rape, Abuse and Incest National Network. (2009.) How to respond to a survivor. Retrieved Feb. 15,
forensic examiners (SAFEs) have extensive training to prepare them 2015, from https://rainn.org/get-information/sexual-assault-recovery/respond-to-a-survivor.
to meet sexual assault patients’ needs and to collect forensic evidence. 9. National Institute of Standards and Technology. Biological evidence preservation handbook: Best
Sexual assault victims who don’t require immediate emergency medi- practices for evidence holders. U.S. Department of Commerce Technical Working Group on Biologi-
cal care should still be offered compassionate and confidential transport, cal Evidence Preservation: Gaithersburg, Md., 2013.
since evaluation and follow-up care are always recommended and the
psychological needs of the patient can too easily be underestimated. RESOURCES
If the patient refuses non-emergency ambulance transportation, they • American College of Emergency Physicians. Evaluation and management of the sexually assaulted
should be encouraged to immediately go to an appropriate ED, rape or sexually abused patient, 2nd edition. ACEP: Dallas, Texas, 2013.
crisis center or other designated facility for evidentiary examination • Asaeda G, Braun J, Prezant D. Keeping patients SAFE: New York City providers respond to sexual
to collect physical evidence and for crisis counseling. assault victims. JEMS. 2001;36(8):52–53.
• Beckman K: Domestic violence and sexual assault. In Beebe R (Ed.), Professional paramedic, volume
CONCLUSION II: Medical emergencies, maternal health and pediatrics, 1st edition. Delmar, Cengage Learning: Clif-
Victims of sexual assault are most often the only people who can iden- ton Park, N.Y., pp. 916–926, 2011.
tify the sex offender, and they need to trust they’ll be protected phys- • Behar J. (n.d.) Emergency medical services protocol for sexual assault. Ohio.gov. Retrieved Feb. 3, 2015,
ically and emotionally in order to do so. from www.healthy.ohio.gov/sadv/sassault/~/media/211A5115C7BE49D99029A92199B29347.ashx.
Our first mission is always to assure safety and find and manage • Chen O, Steer S. (2012.) Emergency medical services protocol for sexual assault. Ohio.gov. Retrieved
life threats, but never overlook the importance of providing emotional Feb. 3, 2015, from www.healthy.ohio.gov/~/media/HealthyOhio/ASSETS/Files/SADVP/Ohio%20
support and preserving evidence of a crime. Protocol/Appendix%2017%20revised%202013.ashx.
A reassuring, supportive and nonjudgmental approach is pivotal to • FBI. (Dec. 11, 2014.) Frequently asked questions about the change in the UCR definition of
recovery and to prosecution of perpetrators. EMS providers have the rape. Retrieved June 7, 2015, from www.fbi.gov/about-us/cjis/ucr/recent-program-updates/
power to help assure justice for the survivor, aid in the prevention of new-rape-definition-frequently-asked-questions.
future assaults, and possible save countless lives indirectly. JEMS • Futrelle J. (May 23, 2009.) EMS response to sexual assault. The EMT Spot. Retrieved Feb. 16, 2015,
from www.theemtspot.com/2009/05/23/ems-response-to-sexual-assault/.
Abigail T. Harning, EMT-P, M.Ed, is a professor for the EMS department at Erie Community • New York State Department of Health. (March 2007.) Sexual assault forensic examiner program.
College in Buffalo, N.Y., and has taught in EMS for over 25 years. Her EMS career started in the Retrieved Feb. 17, 2015, from www.health.ny.gov/professionals/safe/.
city of Buffalo. She then gained rural experience in Pennsylvania before returning to New York. • The U.S. Department of Justice. (n.d.) Raising awareness about sexual abuse: Facts and statistics.
Until recent years, she remained active in the field in suburban settings. Retrieved June 22, 2015, from www.nsopw.gov/en/Education/FactsStatistics?Aspx.
Acknowledgment: The author would like to thank
collaborator Karen Beckman, RN, MSN/Ed, SANE-A, for
ALL NEW
her help with this article.
Portable.
REFERENCES
Afordable.
1. Rape, Abuse and Incest National Network. (2009.) Sta-
tistics. Retrieved Feb. 15, 2015, from www.rainn.org/
statistics.
Safe. SHARPS DART
Tested to the Standard of ASTM
2. Rape, Abuse and Incest National Network. (2009.) F2132-01 for Puncture Resistance
Who are the victims?. Retrieved Feb. 15, 2015,

from https://rainn.org/get-information/statistics/
sexual-assault-victims.
3. Rape, Abuse and Incest National Network. (2009.)
Reporting Rates. Retrieved Feb. 15, 2015, from https://
rainn.org/get-information/statistics/reporting-rates.
4. Davis MA: Understanding sexual assault victims’ willing-
ness to participate in the judicial system. Portland State
University: Portland, Ore., 2014.
Call for a distributor near you
5. Kulikowski A. (March 26, 2013.) Common victim behaviors
of victims of sexual abuse. Pennsylvania Coalition Against 800-876-8264
Rape. Retrieved Aug. 10, 2015, from www.pcar.org/blog/ Infection Control www.gomedsource.com
common-victim-behaviors-victims-sexual-abuse.
6. Rape, Abuse and Incest National Network. (2009.) For more information, visit JEMS.com/rs and enter 20.
1510jems_53 53 9/25/15 10:54 AM

Albuquerque Fire & Police Departments Photo (above): If the patient’s vital signs and assess-
ment are within normal limits, they’re asked if they
team up on community EMS project want a ride to a county treatment center instead of a
hospital ED. Photos courtesy Frank Soto Jr.
By Frank Soto Jr., MPA, CFO, CEMSO, MIFireE, NRP
ALBUQUERQUE’S
T
oday, firefighters have become the used by today’s forward-thinking fire depart-
jack-of-all-trades in emergency pre- ments is community EMS (CEMS). NON-EMERGENT CALLS
vention, preparedness and response. Often referred to as mobile integrated The city of Albuquerque has a population
When a customer calls 9-1-1 for help, fire- healthcare or community paramedicine, of 557,169 people1 and, like other cities of
fighters respond with appropriate units, equip- CEMS is the hot topic in EMS. CEMS similar size, a large volume of 9-1-1 calls
ment and personnel—or do they? isn’t really new—it’s been around since the are non-emergent. In 2014, the Albuquer-
Sending six firefighters to a 9-1-1 call early-90s—but it’s been gaining traction and que Fire Department (AFD) responded to
might appear legitimate, but it may also be is making a positive impact on communi- 84,834 emergency 9-1-1 calls, with 88% of
fiscally irresponsible and excessive. In truth, the ties nationwide. Simply put, sending a non- those being for EMS—a 36% increase in EMS
emergency 9-1-1 system has become today’s emergency unit to a non-emergent 9-1-1 call call volume since 2004.
primary healthcare system. Many customers can save wear and tear on both response vehi- If 9-1-1 calls requesting EMS response
know—especially after calling 9-1-1 a few cles and personnel. In fact, it saves the customer, continue to grow, AFD’s current resources
times—exactly what to say when they want an the response organization and other commu- may be stretched too thin, possibly causing
emergency response. So how are communities nity EMS partners a lot of money, while still bad outcomes for waiting 9-1-1 customers.
and administrators dealing with this issue? The providing appropriate patient care and using In a profession where “time is muscle,” AFD
latest, cutting-edge and much hyped method emergency response units for true emergencies. Fire Chief David Downey, Deputy Chief
1510jems_54 54 9/25/15 10:54 AM

Table 1: Groups of frequent 9-1-1 customer encounters (2008–2014)
6 or more frequent customer encounters 12 or more frequent customer encounters
Total EMS Number of Number Percent of Number Number Percent of
Year PIIP
calls people of calls EMS calls of people of calls EMS calls
2008 no 63,690 408 4,219 6.62% 67 1,254 1.97%
2009 no 59,890 416 4,043 6.75% 68 1,317 2.20%
2010 no 59,429 353 3,628 6.10% 55 1,252 2.11%
2011 no 60,917 381 3,879 6.37% 67 1,330 2.18%
2012 no 63,272 410 4,047 6.40% 61 1,265 2.00%

2008–2012
no 394 3,963 6.45% 64 1,284 2.09%
average
2013 yes 70,616 242 2,231 3.16% 34 697 0.99%
2014 yes 74,553 361 3,155 4.23% 48 886 1.10%

2013–2014
yes 302 2,693 3.70% 41 792 1.09%
average
Karl Isselhard and Medical Director Andrew provided food, shelter and a safe environment fight fires, right? Not anymore. A study in 2012
Harrell, MD, decided to be proactive in their to recover from acute intoxication. The PIIP found that the number of fires in the U.S. has
response configurations in order to meet the team responds in a van or police squad car and fallen by more than 40% over the last 35 years.4
needs of their community. is on duty four days a week (Tuesday, Thursday, So how did AFD sell the PIIP program to
Specifically, Downey supported the need Friday and Saturday) from 1:00–11:00 p.m. firefighters and APD police officers? Educa-
for ED alternatives, preventing hazards for the The citywide PIIP unit locates inebriates by tion, education, education. By educating the
elderly and chronic alcohol and drug abusers actively driving around and looking for them in city’s firefighter/EMTs and police officers on
through the implementation of new emergency known locations or after being dispatched from the positive impacts of PIIP, they understood
response methods and believed that relief to a 9-1-1 dispatch center or by an on-scene APD and believed that they could make a decisive
local hospitals, jails and emergency response or AFD unit. Between responses or requests for difference in Albuquerque—that lowering a
units—through CEMS—would provide a bet- service, the PIIP unit drives around Albuquer- specific group of non-emergent 9-1-1 calls can
ter quality of life for citizens of and visitors que offering education and aid to those in need. and will directly affect several areas of pub-
to Albuquerque.2 Once on scene with a possible patient, the lic safety, providing: 1) proper navigation and
police officer makes first contact, clearing the treatment of PIIP customers; 2) more ED beds
A SOLUTION EMERGES patient for assessment and the scene of any dan- for emergency 9-1-1 patients; 3) more jail and
Solving non-emergent 9-1-1 call problems gerous issues or concerns. The firefighter EMT detention center beds for true offenders; and
can be very complex due to factors ranging then performs a quick head-to-toe assessment 4) longevity to both the city’s first responders,
from psycho-social issues, fragmented care, (including alertness) and gathers basic vital response units and equipment.
lack of follow-up and an aging population.3 signs, including heart rate, blood pressure, blood
It’s important to take a close look at the data glucose level and oxygen saturation. PROGRAM FUNDING
to discover possible solutions. Analyzing Albu- If the vital signs and assessment are within The PIIP program was made possible by
querque’s call data revealed that many call- normal limits, the PIIP patient is asked if they grant funding, not to AFD or APD, but a
ers suffered from chronic inebriation, so the want a ride to MATS. The patient may decline grant awarded to MATS by the UNMH. The
AFD partnered with the Albuquerque Police transport to MATS as long as they are alert UNMH ED is constantly overcrowded with
Department (APD), the University of New and oriented to person, place, time and date patients in need of detoxification services and,
Mexico Hospital (UNMH), and the Berna- (A&Ox4). If the assessment reveals that the in order to alleviate those numbers, UNMH
lillo County Metropolitan Assessment and patient isn’t A&Ox4, is in need of medical awarded MATS a $416,000 Serial Inebri-
Treatment Services (MATS) Center to create attention, or is severely intoxicated, then the ate Intervention Program Grant ($104,000
a CEMS response program: the Public Ine- PIIP unit requests a 9-1-1 medical dispatch per year, 2013–2017) to keep serial inebri-
briate Intervention Program (PIIP). for transport to a local ED. ates and substance abuse customers out of
Staffed with an AFD firefighter EMT and the hospital’s ED.
an APD police officer, the PIIP unit responds GETTING STAFF ON BOARD The UNMH grant funds only the intake
to public inebriates and offers transportation to Proactive changes in the fire service require and care for PIIP patients at MATS. UNMH
those who qualify (i.e., has no medical issues forethought, aggressive attitudes and a para- saves money by not admitting inebriates as
and is nonviolent) to MATS, where they’re digm shift from the norm. After all, firefighters patients and MATS makes money by caring
1510jems_55 55 9/25/15 10:54 AM

SERIAL INEBRIATES
for them. The AFD/APD PIIP unit doesn’t hospital investment. an average of 394 customers for 2008–2012 to
receive any grant money and is provided by Now consider CMS penalties for hospital an average of 302 for 2013–2014, with total
the city’s public safety departments—funded readmissions afforded through the Afford- EMS call volume falling from 6.45% to 3.70%;
by taxpayers. Funding AFD and APD partic- able Care Act. Presbyterian Hospital and and the 12 times a year frequent caller num-
ipation in the program is the main obstacle, UNMH—the two largest EDs in Albuquer- bers fell from an average of 64 customers from
and it’s blocking expansion of other possible que—have 30-day readmit percentages of 18% 2008–2012 to 41 for 2013–2014, with total
CEMS programs. and 20%, respectively.3 EMS call volume falling from 2.09% to 1.09%.
To offset the costs of Albuquerque’s PIIP It can be reasonably assumed that it would Although these results are compelling, they
(as well as future CEMS programs), all funding be more fiscally responsible for both hospitals don’t neatly transform to dollars and cents.
sources must be investigated. State or federal to pay for PIIP (and other CEMS programs) When attempting to analyze cost vs. bene-
government grants, like FEMA’s Assistance than continuing to pay CMS ED readmit pen- fit, especially when dealing with previously
to Firefighters Grant Program or the Centers alties, which will grow to 3% in 2015.6 funded resources, one must get creative, using
for Medicare and Medicaid Services (CMS) old costs and projections in order to answer
Health Care Innovation Challenge Award, PIIP RESULTS 2013–2015 the revenue question.
are two potential funding sources. At the end of April 2015, PIIP numbers were Simply put, revenue is the return on an
Other possible sources include pri- reevaluated and the two years of data indi- investment. In this case, the return can be
vate industry grants and awards, like the cated the program was having a direct impact measured several ways: the right care for PIIP
Patient-Centered Outcomes Research on Albuquerque’s frequent 9-1-1 customer customers; bettering the EMS/9-1-1 system;
Institute (PCORI), which awards grants to encounters. AFD keeps records—including and being fiscally responsible.
organizations for new ways of improving names—of all 9-1-1 and PIIP patients, allowing The city is paying $127,000 per year to
healthcare systems. AFD to generate a report showing how often staff the 40-hour per week PIIP unit with one
Local hospitals may be the most successful 9-1-1 was used. Comparing customer names AFD firefighter (regular time) and one APD
funding source for CEMS programs, because from 9-1-1 call records and PIIP data showed officer (overtime), and the program is posi-
they’re the most financially affected. In that the inebriate population in Albuquerque tively impacting all partnerships within the
Albuquerque, an ED visit is eight times more frequently calls 9-1-1 for non-emergent events. city. Along with preventing regular on-duty
costly than an urgent care clinic visit—$1,423 For tracking purposes, AFD put PIIP police and fire units from responding to the
vs. $178, respectively.5 Imagine that num- patients into one of two frequent 9-1-1 caller 2,828 non-emergent customer callouts, the
ber multiplied by thousands of nonpaying categories: six calls a year or more and 12 calls PIIP unit has directly saved local EDs 1,931
inebriate patients and it’s readily apparent a year or more. (See Table 1, p. 55.) The six avoidable admits—a nearly $2.5 million sav-
that future funding of AFD’s PIIP is a smart times a year frequent caller numbers fell from ings based on UNMH’s average cost per ED
Table 2: Projected costs and savings for Albuquerque municipal agencies and PIIP partners (April 2013–April 2015)
MATS EMS 2-year 2-year Total 2-year
Company Explanation Expense Refusals
transports transports costs savings cost savings
AFD 1 PIIP FF/EMT $47,000.00 ($94,000.00) $0.00 ($94,000.00)
AFP 1 PIIP officer $80,000.00 ($160,000.00) $0.00 ($160,000.00)
1,931 $0.00 $2,747,813.00

Current UNMH
ED admit for $1,423.00 403 ($573,469.00) $0.00
UNMH ETOH patients $2,420,281.00
319 $0.00 $453,937.00
Grant for MATS $104,000.00 ($208,000.00) $0.00
1,931 $0.00 $1,093,718.40

Tariff for BLS
AAS emergency $566.40 403 ($228,259.20) $0.00 $1,046,140.80
transport
319 $0.00 $180,681.60
Per MATS admit $18.13 1,931 ($35,009.03) $0.00

MATS $172,990.97
UNMH grant $104,000.00 $0.00 $208,000.00
Total AFD & APD costs for 2 years ($254,000.00)
Total cost savings (direct and indirect) by the other three companies from AFD & APD PIIP for 2 years $3,639,412.77
1510jems_56 56 9/25/15 10:54 AM

visit.5 In addition, AFD’s contracted trans-
port provider, Albuquerque Ambulance Ser-
vice (AAS), owned by Presbyterian Hospital,
has saved over $1 million in avoidable patient
transports by not transporting the 1,931 PIIP
customers to local EDs7—a service provided
free of charge by AFD and APD.
Taking all this into account, the AFD PIIP’s
combined total savings for the city’s EMS sys-
tem is $3.6 million. (See Table 2, p.56.)
Besides reducing the amount of frequent
9-1-1 calls and customers from previous years,
the PIIP is directly saving Albuquerque’s fire
and police units on fuel and wear and tear
costs. By not sending an engine or rescue unit
to frequent 9-1-1 callers, AFD can increase
the life of their units, saving the city time and
money on future purchases.
The AFD spends $500,000 per new engine
and $186,000 per new rescue unit, with a unit
life expectancy of 10 and five years, respec-
tively. By removing 1% of AFD’s 9-1-1 EMS
calls with PIIP, AFD is essentially extending
the life of one rescue unit by 26% (over five When the PIIP team encounters an inedbriate, the Albuquerque police officer makes first contact, clearing the
years) and one engine by 29% (over 10 years), scene of any dangerous issues or concerns and confirming it’s safe for the EMT to assess the patient.
savings of $48,360 and $145,000, respectively.
Since 2013, frequent customer encoun- to lead and expand their role in CEMS. Pro- InterimCommittees/LHHS/2010/Memorial%20Reports/
ter numbers (2008–2012) have gone down, viding the most accurate patient care is our HM33%20Draft%20Report%20Final%2011-1-10.pdf.
revealing additional cost savings directly tied purpose; fulfilling that purpose through a suc- 6. Goodman DC, Fisher ES, Chang CH. (Sept. 28, 2011.) After hos-
to PIIP. Based on AFD’s hourly use rate of cessful and affordable CEMS program is an pitalization: A Dartmouth atlas report on post-acute care for
one rescue unit ($121.32) and one engine asset to the entire community. JEMS Medicare beneficiaries. Dartmouth Atlas of Health Care. Retrieved
($247), over the past two years the AFD has Aug. 27, 2015, from www.dartmouthatlas.org/downloads/
saved between $60,000 and $154,000 in rescue Frank Soto Jr., MPA, CFO, CEMSO, MIFireE, NRP, is the EMS reports/Post_discharge_events_092811.pdf.
unit responses and $121,000 and $313,000 in Division Commander for the Albuquerque Fire Department. 7. Albuquerque Ambulance Service. (April 19, 2013.)
engine unit responses. This article was inspired by his third-year Executive Fire Offi- AAS tariff: Rules, regulations, rates, and charges.
cer Program Applied Research Project from the National Fire Retrieved Aug. 27, 2015, from www.nmprc.state.nm.us/
CONCLUSION Academy. He can be reached at fsoto@cabq.gov. consumer-relations/company-directory/ambulances/
With the number of nationwide hospital ED Albuquerque%20Ambulance%20Service-01168.pdf.
visits continuously growing alongside increases REFERENCES 8. Pitts SR, Niska RW, Xu J, et al. National hospital ambulatory
in both non-emergent and repeat customers, 1. U.S. Census Bureau. (2013.) 2014 Population Estimates Program medical care survey: 2006 emergency department summary.
opportunities exist for new CEMS programs Annual Population Estimates. Retrieved Aug. 27, 2015, from Natl Health Stat Report. 2008;(7):1–38.
like PIIP.6,8,9 With nearly a quarter of Albu- http://factfinder2.census.gov. 9. Rodriguez RM, Fortman J, Chee C, et al. Food, shelter and safety
querque’s ED visits being non-emergent10 and 2. Lohmann P. (May 5, 2014.) ABQ fire chief looking at new ways to needs motivating homeless persons’visits to an urban emergency
a significant rate of repeat customers within 30 cut ER visits. Albuquerque Journal. Retrieved Aug. 27, 2015, from department. Ann Emerg Med. 2009;53(5):598–602.
days of discharge;6 the use of the CEMS PIIP www.abqjournal.com/394493/news/abq-fire-chief-looking-at- 10. Domrzalski D. (Aug. 8, 2011.) Nonemergency ER visits costly to
program must be continued; especially in light ways-to-cut-emergency-room-visits.html. patients’health, pocketbooks. Albuquerque Business First. Retrieved
of 14 New Mexico hospitals receiving CMS 3. Davis K, Blatt MN, Wilson B. Reducing readmissions at Presbyte- Aug. 27, 2015, from www.bizjournals.com/albuquerque/print-
ED readmit penalties ranging from 0.04% to rian Healthcare Services [white paper]. Intel Corporation: Santa edition/2011/08/05/nonemergency-er-visits-costly-to.html.
0.52% in 2013.11 Interestingly, according to the Clara, Calif., 2011. 11. Domrzalski D. (Aug. 5, 2013.) NM hospitals face penalties for patient
CMS 2013–2015 readmit penalties hospital 4. Tabarrok A. (July 18, 2012.) Firefighters don’t fight fires. readmissions. Albuquerque Business First. Retrieved Aug. 27, 2015,
list, Presbyterian Hospital has been penalized Marginal Revolution. Retrieved Aug. 27, 2015, from from www.bizjournals.com/albuquerque/news/2013/08/05/
the last two fiscal years and UNMH, who www.marginalrevolution.com/marginalrevolution/2012/07/ hospitals-rate-cuts-patient-readmissions.html.
funds PIIP, has not.12 firefighters-dont-fight-fires.html. 12. Rau J. (Oct. 2, 2014.) Medicare fines 2,610 hospitals in third round of
Non-emergent 9-1-1 calls will continually 5. New Mexico Department of Health. (Nov. 1, 2010.) University of readmission penalties. Kaiser Health News. Retrieved Aug. 27, 2015,
perpetuate problems for Albuquerque’s EMS New Mexico Hospitals’urgent care task force. New Mexico Legisla- from www.khn.org/news/medicare-readmissions-penalties-2015.
and hospital services unless the city continues ture. Retrieved Aug. 27, 2015, from www.nmlegis.gov/Sessions/
1510jems_57 57 9/25/15 10:54 AM

An overview of studies assessing In the majority of papers reviewed, adult patients in
OHCA ventilated with a BVM alone were more likely
airway management in out-of-hospital to survive to discharge than those ventilated with an
advanced airway. Photo courtesy Acadian Ambulance
cardiac arrest
intubation (ETI), a procedure requiring con-
By Raymond L. Fowler, MD, FACEP, DABEMS; siderable training and skills maintenance to
be performed successfully.2,3
Christopher Leba, BS, MPH, LP; Faroukh Mehkri, BA, AEMT & The development of additional airway
adjuncts—including supraglottic airways
Ahamed H. Idris, MD, FACEP, FAHA (SGAs) such as the laryngeal mask airway
(LMA) and the King Laryngeal Tube (King
E
volving CPR guidelines follow the Although the safest and most effective LT)—have offered an intermediate approach,
growing understanding of the physi- airway management for the patient in car- providing an advanced airway alternative while
ology surrounding cardiac arrest. For diac arrest still remains to be ascertained, generally requiring less training and skill than
example, it’s been shown that the maintenance the initial approach in airway management that required for ETI. Application of these
of high-quality chest compressions with min- in out-of-hospital cardiac arrest (OHCA), approaches in the prehospital setting has varied
imal interruptions is a cornerstone of pro- however, is typically the application of the widely, depending principally upon the treat-
viding adequate CPR.1 However, the role of bag-valve mask (BVM) to assist ventilation. ment protocols of individual services.
airway and ventilation management during The gold standard for airway management Substantial published research, however,
CPR remains less well understood. for OHCA has historically been endotracheal has suggested that advanced airway use in
1510jems_58 58 9/25/15 10:54 AM

OHCA management is associated with wors- RESULTS deteriorated into a non-shockable rhythm.4
ened patient outcomes.4–12 This suggests that Our search found nine observational stud- Study 2 examined almost 11,000 patients
some survival advantage is associated either ies meeting our inclusion criteria and specif- with OHCA in which ETI was attempted in
with the BVM device specifically, with avoid- ically associating survival from OHCA with 5,118 (47.5%) patients.5 This study demon-
ing the use of advanced airways, or perhaps the type of airway management used during strated a lower chance of one-month survival
reasons associated with both. CPR. These papers were published from 1997 correlated with the use of ETI during man-
The objective of the following study was to 2014 with patient data ranging from 1990 agement of OHCA. Patients who were suc-
to elucidate a relationship between survival to 2011. Patient populations varied substan- cessfully intubated had a 3.6% one-month
from OHCA and the type of airway tech- tially, with the smallest sample size being 355 survival rate vs. 6.4% who weren’t intubated.5
nique employed during resuscitative efforts. and the largest being 649,359. The authors, in noting the limitations of
The spectrum of resuscitative literature was The datasets covered many different regions their study, found that there was no way to
studied to isolate factors associated with sur- across the world, including North America, control for experience or training in placement
vival from OHCA relative to the use of BVM Europe and Asia. Each paper employed a set of airways by the medics delivering care and
alone vs. advanced airways. Consideration was of controls for confounding variables, and that their study wasn’t randomized, making
given to examining each study for any evidence generally followed the collection of data using control for possible confounders difficult.5
regarding the maintenance of the quality of recommended Utstein guidelines. Statisti- Study 3 highlighted the unique charac-
CPR during resuscitation efforts and its poten- cal analysis generally involved multivariate teristics of pediatric patients and adults in
tial relationship to “the BVM effect.” regression models with some studies using the OHCA patient population.6 The authors
propensity-score matching. studied 624 patients divided into three age
METHODS groups: < 1 year (infants;
The authors conducted a lit- n = 277), 1–11 years (children;
erature review in July 2014 n = 154), and 12–19 years
to identify papers addressing Substantial published research, (adolescents; n = 193). The
airway management during study had significant power
OHCA. Electronic databases however, has suggested that in their age comparisons and
PubMed and Google Scholar was able to show statistically
were searched using the key- advanced airway use in OHCA significant differences among
words out-of-hospital, pre- the various age groups studied.
hospital, emergency medical management is associated with They found that “the inci-
services, heart arrest, cardiac dence of OHCA in infants
arrest, airway and survival. worsened patient outcomes. approaches that observed in
Relevant material was also adults” and is “lower among
obtained through reviewing children and adolescents.”
references from articles identified in the study Study 1 reviewed data from 1991 through They also found that “survival to discharge
and by contacting subject matter experts. A 1994 collected in a “Heartstart” program.4 was more common among children and ado-
total of 171 scientific studies were found. Resuscitation was attempted for 8,651 patients lescents than infants or adults.” Finally, these
The various airway management tech- with 3,427 (39.6%) attempts at ETI. The pri- authors concluded that there was no signif-
niques analyzed were BVM, SGA (LMA, mary results found a survival to discharge rate icant difference in survival among the types
King LT, Combitube), esophageal obtura- for patients receiving ETI of 3.7% vs. 9.1% of airways used in pediatric OHCA victims.6
tor airway (EOA) and ETI. Generally the for patients receiving BVM alone (p < 0.001). Study 4 evaluated 1,294 nontraumatic
comparisons in the studies focused between Of interest, the proportion of patients intu- OHCA patients from 1994–2008 in south-
BVM and advanced airways or among dif- bated increased with the number of defibrilla- western Los Angeles County.7 This study
ferent advanced airways. Primary outcomes tory attempts and was higher in patients with found that 1,027 (79.4%) patients received
largely focused on survival to discharge, with unwitnessed arrest. The trend in decreased ETI, 131 (10.1%) received either Combitube
some studies including neurological function survival with ETI vs. BVM persisted regard- or EOA, and 131 (10.1%) received only BVM.
post-discharge as well. less of EMS witnessed, bystander witnessed The overall survival to discharge rate was
Specific attention was then directed toward or unwitnessed arrest, or number of shocks. 4.3%. Odds ratio for survival to discharge of
criteria addressing cardiac arrest management The EMS providers in the study followed patients receiving BVM compared to ETI
in the out-of-hospital environment, cardiac European Resuscitation Council guidelines, was 4.5 (95% CI: 2.3–8.9) after adjusting for
arrest victims, comparison of advanced airway which stated that intubation should only be bystander CPR, witnessed arrest, age, sex and
with BVM and survival outcomes. attempted after three shocks if spontaneous location of arrest.
Exclusion criteria included qualitative stud- circulation hadn’t been restored. However, a Interestingly, the authors found that the
ies, studies focused on traumatic arrests, studies substantial proportion of patients shocked group receiving Combitube or EOA had no
comparing only advanced airways excluding less than three times were intubated, suggest- survivors. In this paper there was a reported
BVM, and studies solely commenting on the ing that these patients regained a pulse but rate of bystander CPR of 45%, and no signif-
training or feasibility of certain airway use. were either not spontaneously breathing or icant association was found between the rate
1510jems_59 59 9/25/15 10:54 AM

THE BVM EFFECT
opposed to training on patients in the oper-
ating room.
This training using simulation, combined
with a median of two LMA uses per pro-
vider over two years, might suggest less skill
proficiency, though there was no mention in
the study of the annual number of ETIs by
the providers.9
Study 7 examined the relationship between
two advanced airways (SGA and ETI) using
data from the Resuscitation Outcomes Con-
sortium (ROC) PRIMED Trial.10 The authors
studied the data from 10,455 adult OHCAs
between June 2007 and October 2009. In this
study, 8,487 patients (81.2%) received ETI and
1,968 (18.8%) received SGA.
The authors found that the overall survival
to hospital discharge with satisfactory func-
tional status was 4.7% with ETI and 3.9%
with SGA (adjusted odds ratio: 1.40; 95%
CI: 1.04–1.89). However, careful analysis of all
data points (as revealed in supplemental data
fields within the study) in this report reveals
that patients receiving no advanced airways
(BVM only or BVM after failed advanced
airway attempts) had a significantly higher
rate of survival to discharge. Indeed, when the
final airway management used was BVM, the
odds ratio of survival over the successful use of
an ETI was 1.79 (CI: 1.33-2.40; p < 0.001).10
Study 8 presented an observational study
of patients from the All-Japan Utstein Reg-
istry, a vast nationwide database of OHCA
patients.11 This study found favorable out-
comes with BVM airway management over
Research has shown a substantial survival benefit from OHCA with the use of BVM ventilation rather than ETI that had strong statistical significance due
advanced airways such as ETI or SGA. Photo Courtney McCain to the power produced by this large patient
population, revealing a strong inverse relation-
of bystander CPR and survival to discharge.7 Thus, in OHCA where on-scene care was ship between the use of advanced airways and
Study 5 analyzed 355 OHCA patients in prolonged, performing an advanced airway favorable neurological outcomes.
Tokyo whose time from emergency call to may lead to a higher overall rate of ROSC The overall unadjusted favorable neurolog-
hospital arrival was > 30 minutes.8 This study without improving the overall rate of survival.8 ical survival in this study was 2.2%, ranging
focused on comparing outcomes between Study 6 looked at a South Korean OHCA between 1.1% for OHCA patients managed
advanced airway use and BVM use in pro- database including patients from 2006–2008.9 with advanced airways and 2.9% for patients
longed cardiac arrest. The authors discovered a Of 5,278 patients reviewed, 250 (4.7%) managed with BVM (odds ratio: 0.38; 95%
significant increase in overall return of sponta- received ETI, 391 (7.4%) received LMA CI: 0.36–0.39). This data must be interpreted
neous circulation (ROSC) and ICU admission and 4,637 (87.9%) received BVM. Overall carefully with respect to the low overall sur-
in patients who received an advanced airway survival to discharge was found to be 6.9%. vival in this observational study as compared
vs. BVM alone. However, no difference in Odds ratio for survival to discharge for ETI to various urban centers across the world.11
prehospital ROSC or survival to discharge vs. BVM alone was 1.44 (95% CI: 0.66–3.15) Study 9, the most recent study found by
was apparent between the two groups. and wasn’t statistically significant. The odds the authors on this subject, analyzed 10,691
Of note, the analysis found a similar time ratio for survival to discharge for the use of OHCA patients from the Cardiac Arrest
from the emergency call to arrival on scene LMA vs. BVM alone was 0.45 (CI: 0.25–0.82). Registry to Enhance Survival (CARES) in
in both groups, but the patients receiving It’s of interest that the study involved 2011.12 Of these patients, 5,991 (56%) were
advanced airways had longer on-scene man- EMT-intermediates who were trained in air- treated with ETI, 3,110 (29%) received SGA
agement times by approximately two minutes. way placement through the use of manikins as and 1,929 (18%) had no advanced airway
1510jems_60 60 9/25/15 10:54 AM

placement. The data demonstrated 5.4% survival, namely the choice of airway used analysis of the data from a prospective, ran-
survival to discharge with good neurological during resuscitation. domized trial of OHCA patients included
outcomes in patients receiving ETI, 5.2% in This article has brought together a num- only non-trauma patients and excluded var-
patients receiving SGA, and 18.6% in patients ber of studies that have found an association ious populations (e.g., pediatrics). The study
receiving BVM only. between the type of airway utilized during required that the participating agencies meet
Of note, patients receiving ETI tended to cardiac arrest management and survival. The benchmarks for quality of CPR.
be slightly older, more likely to be male, and question arises as to whether the choice of These studies reveal the existence of a BVM
less likely to receive defibrillation by use of the type of airway utilized during resuscita- effect from multiple regions of the world that
an automated external defibrillator located tion—i.e., BVM vs. advanced airway—is an are quite heterogeneous. This suggests that
in a public place. The authors also found that independent predictor of survival or whether this effect persists across regional variations
patients receiving BVM alone tended to have the airway choice is associated with other fac- in training, available equipment, attention to
suffered OHCA in a public place, that the tors that may affect the chance for survival. CPR quality and skill levels. This effect was
arrest tended to have been witnessed by EMS, For example, in study 9, OHCA patients also observed independent of the years stud-
and that the patient was more often in a shock- receiving BVM alone were significantly more ied (1990–2011).
able cardiac rhythm.12 likely to have suffered cardiac arrest in the Although it’s possible common underlying
The authors stated their beliefs that the presence of an EMS provider, arrested in phenomena produce this effect, it remains to
association of improved survival with BVM a public place or been in a cardiac rhythm be demonstrated conclusively why OHCA
alone “reflect[ed] the presence of unmeasured amenable to defibrillation.12 patients managed with BVM alone seem
and immeasurable confounders.” These con- On the other hand, the above associations to have improved survival. It has been well
founders could include short distance described that the patient in cardiac
to the hospital, provider procedural arrest suffers from over-ventilation
skill, perceived health status of the during resuscitation.16 We propose
patient and airway anatomic factors.12 The underlying cause that it’s more difficult to over-ventilate
They called for a future study that patients receiving BVM only, as com-
would integrate information includ- of this phenomenon pared to an advanced airway. Thus, part
ing airway management steps such as of the cause of the BVM effect may be
duration of attempts, ventilation rates remains to be determined. due to less over-ventilation of patients.
and procedures attempted in the ED.12 Other possibilities for the BVM
effect include less interruption of chest
DISCUSSION addressing the benefit of BVM alone over compressions with BVM compared with ETI
The management of OHCA patients remains advanced airway, while statistically significant, and other advanced airways, and the avoidance
one of the most difficult clinical challenges in weren’t orders of greater magnitude. So, the of the risk of esophageal intubation that may
the practice of medicine. These patients may apparent benefit of BVM alone indeed may occur with ETI, but further study is needed
have an arrhythmic cause of arrest that may be yet be found to be related to measurable or to elucidate the causes of or associations with
rapidly treated through defibrillator efforts, or unmeasurable confounders, as suggested by the BVM effect.
they may have a cause of arrest that’s the result study 9’s authors. To better understand the cause of the BVM
of a devastating event such as airway obstruc- We propose the BVM effect of enhanced effect, such studies should include factors
tion, massive pulmonary embolism, or major survival with BVM over advanced airway use such as response time, the time to first com-
trauma that may often be inherently lethal. is also likely unrelated to the maintenance of pression, the quality of CPR, initial cardiac
The approach to these patients must be the overall quality of CPR. Study 8’s authors rhythm, interruptions in chest compressions
systematic, with the rescuer initiating CPR, also found this BVM effect in their enormous for airway placement, the rate of assisted ven-
performing rhythm analysis, managing the observational study, in spite of their overall tilation, type of airway selected initially, final
airway and providing IV therapy as indicated. reported rate of survival from OHCA of a bit type of airway placed, time to airway attempt,
The chance of survival for these patients is less than 3% (only 1.0% with ETI).11 number of airway attempts, on-scene time
multifactorial, including the length of time in This low overall survival rate, as compared and final determined cause of the cardiac
cardiac arrest, the cause of the arrest and the to centers in which OHCA cardiac arrest qual- arrest. Only through the careful inclusion
skill level of the rescuer. ity is carefully managed, raises the possibility of these and possibly other parameters in
Evidence has become available demon- of potential confounders that might affect sur- future studies can the cause of the BVM effect
strating that providing high-quality CPR—as vival, such as the quality of CPR performed. be understood.
measured by maintaining a high compression Importantly, traumatic arrests were included
fraction,1 satisfactory compression depth,13 in this study,11 likely decreasing overall survival SUMMARY
appropriate compression rate,14 and limiting compared to a cardiac arrest patient popula- Numerous studies addressing airway man-
peri-shock pauses15—is essential to optimiz- tion not including traumatic arrest patients.10 agement in OHCA have shown a strong
ing survival with good neurological outcome. The BVM effect was also present in obser- association between improved survival with
Nonetheless, growing evidence suggests vational study 7, examining data from the treatment using BVM alone rather than with
an additional association with optimizing ROC PRIMED trial.10 This observational advanced airways. — Continued on page 67
1510jems_61 61 9/25/15 10:54 AM

HANDS ON
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He can be reached at d.silvestro@jems.com.
1510jems_62 62 9/25/15 10:54 AM

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1510jems_63 63 9/25/15 10:54 AM

FIELD PHYSICIANS
EMS DOCS’ PERSPECTIVES ON STREET MEDICINE
STAYING INFORMED
Help clinicians take control of the self-directed learning process
By Mark E.A. Escott, MD, MPH, FACEP
M
y paramedics often come to me on the Internet, you have to be a discerning self-directed learning, which requires access to
with clinical questions about a consumer of information in order to sort the print journals or, preferably, electronic data-
patient they had or a new idea useful sites from the garbage. bases. UpToDate will also have references they
they ran across that they want to bring to our can follow and then pull full-text journals, but
service. My two questions back to them are STEP 2: UPTODATE often this is expensive for the individual medic
always the same: “What did you find out when Once you have a better-formed question, due to fees associated with electronic access.
you researched this yourself ?” and, “Where UpToDate is by far the clinicians’ choice as In one of my local EMS systems, several
did you look to try to answer the question?” the go-to resource for current information members of the clinical team have access
The answer to the first is sometimes a on clinical questions. It provides an excellent through an associated medical school and
thoughtful and well-organized argument, but resource for the standard of care in the eval- medics can email and request that papers be
more often than not is an explanation for how uation, treatment and disposition of a broad accessed for them. Just like hospitals and medi-
they didn’t know where to look, or even worse: variety of medical topics. It’s used in all the top cal schools, EMS services need to look for ways
“I couldn’t find it in my paramedic text- to provide this access to their practitioners.
book.” The answer to the second question We need to appreciate that our paramed-
is always the same: “Google!” ics are highly intelligent and motivated
I’ve talked before about self-directed If I have to read stuff individuals who want and need to learn.
learning as an essential element of para-
medic continuing education. The problem & be tested on it, BEYOND THE RESEARCH
is that historically, we haven’t encouraged Access to information alone isn’t enough.
this in our medics nor provided appropri- so should my medics. Our paramedics need engaged EMS phy-
ate clinical resources to adequately answer sicians to not only teach the clinical infor-
their questions. While Google may be mation, but to also facilitate their ability to
a nice start to the investigation of a clinical medical schools in the United States. It’s eas- read and understand scientific literature. We’ve
question, and admittedly is often my starting ily searched and categorized in a way to make been addressing this for the past several years
place if it’s something I’ve never heard of, it it easy to handle for paramedic practitioners. by holding regional EMS journal clubs, where
should not be the end of the search. Montgomery County (Texas) Hospital Dis- we discuss how to understand the difference
Over and over again, I met with medics the trict (MCHD) EMS was generous enough to between a randomized controlled trial and a
past several years who were frustrated by the support this for our providers so starting this cohort study, and to finally understand that
limitations of the paramedic publications and summer, 100% of our staff have desktop, laptop burning question “What the heck is a p-value?”
books when trying to research clinical ques- and smartphone access to this critical resource. It’s a huge leap from protocol-driven prac-
tions. When thinking about this issue at my tice to chi-squared tests, but while the indi-
current EMS practice, I thought about how STEP 3: FIND & READ THE STUDY vidual medics are slow to adapt to this change
I solve clinical problems in the ED. It usually The ultimate step in being a true clinician is in thinking, it only takes a few sparks to start
involves a stepwise process. understanding what literature to read and how the fire of change! JEMS
to analyze the data. A great source I’ve begun
STEP 1: PRELIMINARY to share with my paramedics is the reading Mark E.A. Escott, MD, MPH, FACEP, is the med-
INTERNET SEARCH list from the American Board of Emergency ical director and founder of Rice University EMS
An Internet search is a quick way to find out Medicine’s Life-Long Learning and Self- in Houston. and founder/director of the Baylor
about a clinical question. Although this will Assessment (LLSA) for Board Certified EMS College of Medicine EMS Collaborative Research
inevitably lead to alleged “expert” reviews on Physicians. This is a list compiled by the board Group, where he also serves as the director of
clinical topics from the Modern Medicine of the essential papers for all EMS physicians the Division of EMS and Disaster Medicine and an assistant profes-
Conspiracy Group or some other non-vetted to be familiar with. sor in the Section of Emergency Medicine. He also serves as the
organization, there are often legitimate sites My philosophy is that if I have to read public health authority in Montgomery County, Texas, and is board
to allow you to gain enough insight to ask a stuff and be tested on it, so should my med- certified in emergency medicine and subspecialty board cer-
better clinical question. Like with anything else ics. Ultimately, however, they may want to do tified in EMS.
1510jems_64 64 9/25/15 10:54 AM

BERRY MUSING
A
MAGNETS
What kind of calls do you attract?
By Steve Berry
T
hey’re among us—always. They appear to be just like you and sometimes years—while others have only periodic moments of magne-
me. They have the same amount of training, work the same tism lasting a week or two. But either way, it’s during those times when
hours, eat the same fast food, breathe the same air, wear the great war stories become permanently warehoused synaptically—and
same uniform, speak the same language and walk the same walk. But continue to be referred to for the rest of one’s life.
in reality, they play the game of EMS with a different deck of cards Our adrenals, despite the evolutionary process, never really lost their
(9-1-1 calls)—mind you, not as charlatans with a deck purposely selfish need for relevance in a world that was once filled with peril
stacked in their favor. No, despite mathematical improbability, these and no Starbucks. They despise the comforts of a modern age where
cards seem to be dealt unevenly in their direction. survival doesn’t depend on one’s ability to fight or flee. And once you
There’s no particular rhyme or become a magnet, the adrenals
reason as to why these cards, no yearn for more. But even magnets
matter how well shuffled, fall into have their moments when their
their hands. There are no lucky plethora of colorful triaged red
trinkets, no special underwear can fade to a dull green—a wel-
they wear, no rituals they prac- come respite from it all as long as
tice. It doesn’t matter which shift it’s temporary. If dejected for too
they’re on: night or day, weekdays long, the adrenal glands begin to
or weekends, winter or summer, resent their now-deprived hor-
full moon or no moon, holidays monal influence, tamed by the
or workdays. It matters not if return of routine day-to-day
they’re old guard or newbies, for transport of stable patients.
they are the chosen ones. They This brings me to another type
are the magnets. of magnet out there. Opposing in
We call them magnets because nature, these magnets (My Ambu-
they’re pre-destined to be dis- lance Gets Nothing Except Tedious
patched to calls of an undesirable Senselessness) are a reversed
nature (or desirable, depending on polarity to bad (good) calls. They
your cup of tea) that are much more extreme than the normal, run- repel any prospect of coming in contact with any patient truly requir-
of-the-mill 9-1-1 call. A MAGNET (Medic Attracts Gravis Never- ing emergency medical care. Also known as KOLs (Kiss Of Life), these
Ending Tragedies) is usually expressed as a two-word euphuism to guardians bring an aura of peace and harmony wherever they happen
denote a stronger, undesirable negative connotation, but for my edi- to be stationed. Skills become atrophied and the lack of motivation to
tor’s sake, I will leave that s--- out. move forward in learning until the next string of good call comes along
Most of us have experienced a time when there was such a contin- can even make it hazardous for others, especially if a crew gets to the
uous string of bad calls that when other medics were assigned to work point of such frustration that they purposely turn their siren on just
with us, they instinctively lined their pockets with two dozen 14-gauge as a pedestrian crosses in front of their ambulance grill in the hopes
angiocaths while inserting copies of their personal advanced directives of creating an acute adrenalin-induced cardiac arrhythmia.
under their bulletproof vest. For me, those were some of the worst and I began to write this article two weeks ago out of the pure frustra-
best of times. Despite the tragedies that had befallen others, my skills tion of being a KOL magnet for the past several months. Ironically,
as a medic were never sharper and, yes, I thrived on the adrenalin. every time I now try to sit down to finish it, I get toned out for a call
To be honest, bad calls for the most part were in reality good calls. adrenal in nature. Is there a happy medium between the KOL mag-
Never have I felt more alive than when I was so close to death. I would netic and s--- poles, or are we all doomed to be 9-1-1 bipolar? I’ll let
also feel guilty that others had to suffer for me to reach that level of you know after I get back from this call. JEMS
exhilaration, but I also rationalized that bad things were bound to
happen to people, so why shouldn’t I be the one to practice the art of Steve Berry is an active paramedic with Southwest Teller County EMS in Colorado. He’s
emergency medicine I worked so hard to perfect? the author of the cartoon book series I’m Not An Ambulance Driver. Visit his website at
Some EMS providers have been magnets for a long time— www.iamnotanambulancedriver.com to purchase his books or CDs.
1510jems_65 65 9/25/15 10:54 AM

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HAVE OPEN linkedin.com/groups?
WE WANT TO HEAR FROM YOU POSITIONS? about=&gid=113182
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JEMS welcomes your suggestions for departments and Get them filled with a jems.com/news
articles you believe would be helpful to colleagues. JEMS recruitment classified.
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Please send your ideas to the Senior Editor, Eastern Region: Western Region:
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1510jems_66 66 9/25/15 10:53 AM

THE BVM EFFECT
— Continued from page 61
This BVM effect appears to persist despite REFERENCES Med. 2012;42(2):162–170.

variations in geographical region, patient pop- 1. Christenson J, Andrusiek D, Everson-Stewart S, et al. Chest 9. Shin SD, Ahn KO, Song KJ, et al. Out-of-hospital airway manage-
ulation, and CPR quality. compression fraction determines survival in patients ment and cardiac arrest outcomes: A propensity score matched
The underlying cause of this phenomenon with out-of-hospital ventricular fibrillation. Circulation. analysis. Resuscitation. 2012;83(3):313–319.
remains to be determined. Of note, the sur- 2009;120(13):1241–1247. 10. Wang HE, Szydlo D, Stouffer JA, et al. Endotracheal intubation
vival benefit with BVM alone vs. advanced 2. Jacobs LM, Berrizbeitia LD, Bennett B, et al. Endotracheal intu- versus supraglottic airway insertion in out-of-hospital cardiac
airways doesn’t appear in the pediatric popu- bation in the prehospital phase of emergency medical care. arrest. Resuscitation. 2012;83(9):1061–1066.
lation in the papers reviewed by the authors. JAMA. 1983;250(16):2175–2177. 11. Hasegawa K, Hiraide A, Chang Y, et al. Association of prehospital
The authors recommend that a prospective 3. Pepe PE, Copass MK, Joyce TH. Prehospital endotracheal intu- advanced airway management with neurologic outcome and
randomized study be conducted in order to bation: Rationale for training emergency medical personnel. survival in patients with out-of-hospital cardiac arrest. JAMA.
explore this finding and to attempt to deter- Ann Emerg Med. 1985;14(11):1085–1092. 2013;309(3):257–266.
mine its causation. JEMS 4. Adams JN, Sirel J, Marsden K, et al. Heartstart Scotland: The 12. McMullan J, Gerecht R, Bonomo J, et al. Airway management
use of paramedic skills in out of hospital resuscitation. Heart. and out-of-hospital cardiac arrest outcome in the CARES reg-
Raymond L. Fowler, MD, FACEP, DABEMS, is professor and 1997;78(4):399–402. istry. Resuscitation. 2014;85(5):617–622.
chief of the Division of EMS in the Department of Emergency 5. Holmberg M, Holmberg S, Herlitz J. Low chance of survival 13. Stiell IG, Brown SP, Christenson J, et al. What is the role of chest
Medicine at University of Texas Southwestern (UTS). He can be among patients requiring adrenaline (epinephrine) or intuba- compression depth during out-of-hospital cardiac arrest resus-
contacted at ray.fowler@utsouthwestern.edu. tion after out-of-hospital cardiac arrest in Sweden. Resuscitation. citation? Crit Care Med. 2012;40(4):1192–1198.
Christopher Leba, BS, MPH, LP, is a Rice University EMS 2002;54(1):37–45. 14. Idris AH, Guffey D, Aufderheide TP, et al. Relationship between
reserve lieutenant and UTS MD candidate. He can be contacted at 6. Atkins DL, Everson-Stewart S, Sears GK, et al. Epidemiology chest compression rates and outcomes from cardiac arrest. Cir-
christopher.leba@utsouthwestern.edu. and outcomes from out-of-hospital cardiac arrest in children: culation. 2012;125(24):3004–3012.
Faroukh Mehkri, BA, AEMT, is a Rice University EMS The Resuscitation Outcomes Consortium Epistry-Cardiac Arrest. 15. Cheskes S, Schmicker RH, Christenson J, et al. Perishock pause:
reserve supervisor and University of North Texas Health Circulation. 2009;119(11):1484–1491. An independent predictor of survival from out-of-hospital shock-
Sciences Center DO candidate. He can be contacted at 7. Hanif MA, Kaji AH, Niemann JT. Advanced airway management able cardiac arrest. Circulation. 2011;124(1):58–66.
faroukh.mehkri@live.unthsc.edu. does not improve outcome of out-of-hospital cardiac arrest. Acad 16. Aufderheide TP, Lurie KG. Death by hyperventilation: A common
Ahamed H. Idris, MD, FACEP, FAHA, is professor and direc- Emerg Med. 2010;17(9):926–931. and life-threatening problem during cardiopulmonary resusci-
tor of Emergency Medicine Research in the Department of Emer- 8. Nagao T, Kinoshita K, Sakurai A, et al. Effects of bag-mask versus tation. Crit Care Med. 2004;32(9 Suppl):S345–S351.
gency Medicine at UTS Medical Center. He can be contacted at advanced airway ventilation for patients undergoing prolonged
ahamed.idris@utsouthwestern.edu. cardiopulmonary resuscitation in pre-hospital setting. J Emerg
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1510jems_67 67 9/25/15 10:54 AM

LAST WORD
THE UPS & DOWNS OF EMS
SCHOOL CPR CERTIFICATION

About a year ago, New Jersey state law-
makers signed into law that every K–12
school must have a defibrillator on site, an emer-
gency action plan in place and at least five CPR-
trained staff members. But the Pascack Valley
Regional High School District decided that wasn’t
enough. Instead, the district helped CPR-certify all
of its 2,000 students, teachers and staff.
“In 2014, we had a track runner at one of our
high schools collapse in cardiac arrest,” the district’s
Director of Curriculum Barry Bachenheimer, PhD,
EMT, said. “Thanks to the quick reaction and imple-
mentation of CPR and an AED by students, coaches,
the trainer and local EMS, the student had a full
recovery. As a result, we as a district, supported by
our board of education, decided that every one of
our students, faculty and staff would not only be Pasack Hills High School health teacher and CPR instructor Andrea Padelsky works with a high school
trained, but also certified in CPR every year.” sophomore to get her certified in CPR. Photo courtesy Barry Bachenheimer
The mass certification was so impressive that
even the American Heart Association took notice. We give a thumbs up to the Pascack Valley They’ve set an excellent example, and hopefully
It gave the school district an award for promoting Regional High School District for their commitment other schools around the country will soon fol-
the “chain of survival.” to the safety and wellness to their community. low suit.
COUNTERFEIT TOURNIQUETS are authentic. of South Australia is trying to remind others

As first responders, we often rely “These counterfeit tourniquets are being of the dangers of EMS.
on various equipment and materials made with inferior materials and design. They The “Keep Your Hands Off Our Ambos”
to aid us in our lifesaving work. When that also are not being made with the high stan- campaign aims to educate the public about the
equipment can’t be trusted, the consequences dard quality control processes used in making violence EMS workers can face, a threat that
are serious. Unfortunately that’s exactly what CATs,” the company said in a press release. most people are unaware of. A video released
happened in New Hampshire. “Some counterfeits have catastrophically failed by South Australia’s department of health
Emergency responders from Woodsville Res- during actual lifesaving applications. There are depicts a severely injured patient’s friend push-
cue Ambulance were treating an injured motor- several counterfeit medical devices on the mar- ing an EMT. The video makes the point, “I
cyclist. When a knock-off combat application ket sold by online vendors on eBay, Amazon can’t fight for your mate’s life if I’m fighting
tourniquet (CAT) was applied to the man’s leg, and Alibaba. It’s essential for agencies to know for mine.” It’s been seen by millions of people
the windlass rod snapped, rendering it useless. they are buying authentic and quality medical across the world.
Thankfully, there were other non-faulty prod- devices. They want to be sure that the tour- The best part? The campaign seems to be
ucts onboard, and the patient was transported niquet they buy will work when it is needed.” working. Australian emergency workers have
safely to the hospital. However, this incident We give a thumbs down to the peddlers seen a 45% decrease in attacks since the cam-
prompted the state to alert medical profession- of these fake tourniquets. They’ve made the paign launched, though officials say they won’t
als that counterfeit tourniquets were being sold unethical choice to value a quick buck over be completely satisfied until the number of
illegally, and that patients’ lives could be at risk. people’s lives. attacks drops to zero.
The maker of CATs, North American Res- We give a thumbs up to the South Austra-
cue, suspects the fakes are being made in China PROTECTING PROVIDERS lian government for shining a light on a seri-
and being sold for about a third of the price. Violence against first responders is a ous issue many people don’t know about. Their
The company encourages medical personnel scary truth that often gets forgotten, effective efforts are making first responders, and
to contact them to make sure their tourniquets which is why one social media campaign out the communities they serve, much safer. JEMS
JEMS (Journal of Emergency Medical Services), ISSN 0197-2510, USPS 530-710, is published 12 times a year (monthly) by PennWell Corporation, 1421 S. Sheridan Road, Tulsa, OK 74112; phone 918-835-
3161. Copyright © 2015 PennWell Corporation. SUBSCRIPTIONS: Send $44 for one year (12 issues) or $74 for two years (24 issues) to JEMS, P.O. Box 3425, Northbrook, IL 60065-9912, or call 888-456-5367.
Canada: Please add $25 per year for postage. All other foreign subscriptions: Please add $35 per year for surface and $75 per year for airmail postage. Send $20 for one year (12 issues) or $35 for two years
(24 issues) of digital edition. Single copy: $10.00. POSTMASTER: Send address changes to JEMS (Journal of Emergency Medical Services), P.O. Box 3425, Northbrook, IL 60065-9912. Claims of non-receipt
or damaged issues must be filed within three months of cover date. Periodicals postage paid at Tulsa, Oklahoma and at additional mailing offices. Advertising information: Rates are available at www.jems.
com/about/advertise or by request from JEMS Advertising Department at 4180 La Jolla Village Drive, Ste. 260, La Jolla, CA 92037-9142; 800-266-5367. Editorial Information: Direct manuscripts and queries
to JEMS Editor, 4180 La Jolla Village Drive, Ste. 260, La Jolla, CA 92037-9142. No material may be reproduced or uploaded on computer network services without the expressed permission of the publisher.
JEMS is printed in the United States. GST No. 1268113153.
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TABLE OF CONTENTS
FEBRUARY 25-27, 2016 GENERAL EVENT INFORMATION
Schedule of Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Baltimore, Maryland
General Info . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
www.EMSToday.com
JEMS (Official publication of EMS Today) . . . . . . . . . . . . . . . . . . . . . . 4
Sponsors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Let Us Help You Attend EMS Today . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
CONFERENCE INFORMATION
Program Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
CONTACTS Continuing Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Conference Detail (Track key) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
REGISTRATION DEPARTMENT Wednesday: Pre Conference Workshops At A Glance . . . . . . . . . . . . 10
Direct P: 918-831-9160 Thursday: Conference At A Glance . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Toll-Free: 1-888-299-8016 (US Only) Friday: Conference At A Glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Registration@Pennwell .com Saturday: Conference At A Glance . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Pre Conference Workshops Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
EXHIBIT & SPONSORSHIP SALES Opening Ceremonies/Keynote . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Sue Ellen Rhine, Exhibit Sales Manager
Conference Program Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-44
NETWORKING/SPECIAL EVENTS
P: 918-831-9786
Faculty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45-50
SueEllenR@Pennwell .com
EXHIBITOR SERVICES
Rod Washington, Exhibit Services Manager Co-Located Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
P: 918-831-9481 Networking Opportunities/Special Events Overview . . . . . . . . . . . . . . . . . 52-53
RodW@Pennwell .com EMS10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
JEMS Games . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
CONFERENCE & SPEAKERS Offsite Networking Reception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Debbi Boyne, CMP, Conference Manager
Exhibit Floor Giveaway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
P: 918-832-9265
EXHIBITING & SPONSORSHIP INFORMATION

DBoyne@Pennwell .com
EVENT INFORMATION & LOGISTICS 2015 Attendee Demographics & Survey Results . . . . . . . . . . . . . . . . . . . . . . . 58
Amanda Wilson, Senior Event Operations Manager 2015 Exhibitor Demographics & Survey Results . . . . . . . . . . . . . . . . . . . . . . . . 59
P: 918-831-9523 Exhibit/Sponsor Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
AmandaW@Pennwell .com 2016 Exhibitor List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
2016 Floor Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62-63
Jennifer Lindsey, Senior Event Operations Manager
P: 918-832-9313 TRAVEL & REGISTRATION INFORMATION
JenniferL@Pennwell .com
Gain Approval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
EVENT MARKETING Scholarship Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Amanda Brumby, Marketing Manager Hotel Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
TRAVEL & REGISTRATION INFORMATION
P: 918-831-9455 Baltimore Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

AmandaB@Pennwell .com Registration Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
REGISTER BEFORE JANUARY 15, 2016!
2016EMST_preconBRO_1 1 9/2/15 4:01 PM

SCHEDULE OF EVENTS
TUESDAY, FEBRUARY 23, 2016 FRIDAY, FEBRUARY 26, 2016

Registration Open 1:00 PM – 5:00 PM Registration Open 7:30 AM – 4:30 PM
Exhibitor Target Move-In 1:00 PM – 5:00 PM Speaker Ready Room 7:30 AM – 5:00 PM
Exhibitor Services Center 1:00 PM – 5:00 PM Conference Information Desk 7:30 AM – 5:15 PM
Conference Sessions 8:00 AM – 5:15 PM
WEDNESDAY, FEBRUARY 24, 2016 Exhibitor Services Center 8:00 AM – 5:00 PM
Registration Open 7:00 AM – 5:00 PM Exhibit Hall OPEN 10:00 AM – 5:00 PM
Speaker Ready Room 7:30 AM – 5:00 PM Learning Center Sessions 11:45 AM - 4:45 AM
Conference Information Desk 7:30 AM – 5:00 PM JEMS Games Finals 5:30 PM – 8:00 PM
Pre-Conference Workshops 8:00 AM – 5:00 PM
Exhibitor Services Center 8:00 AM – 5:00 PM SATURDAY, FEBRUARY 27, 2016
Exhibitor Move-In 8:00 AM – 5:00 PM Registration Open 7:30 AM – 1:00 PM
Speaker Ready Room 8:00 AM – 3:30 PM
THURSDAY, FEBRUARY 25, 2016 Conference Information Desk 8:00 AM – 4:30 PM
Registration Open 7:30 AM – 7:00 PM Conference Sessions 8:30 AM – 4:30 PM
Speaker Ready Room 7:30 AM – 5:00 PM Exhibitor Services Center 9:00 AM – 3:00 PM
Conference Desk 7:30 AM – 2:45 PM Exhibit Hall OPEN 9:00 AM – 1:00 PM
JEMS Games Preliminaries 8:00 AM – 5:00 PM Continental Breakfast 10:00 AM – 11:00 AM
Exhibitor Services Center 8:00 AM – 5:00 PM Awards Ceremony 10:00 AM – 10:30 AM
Exhibitor Move-In 8:00 AM – 3:00 PM Learning Center Sessions 11:00 AM – 12:15 PM
Conference Sessions 8:00 AM – 2:45 PM Exhibit Floor Giveaway 12:45 PM
Exhibitors Complete Set Up 3:00 PM Exhibitor Move-Out 1:00 PM – 8:00 PM
Opening Keynote 3:00 PM – 5:00 PM Exhibit Hall CLOSED 1:00 PM
Exhibit Hall OPEN 5:00 PM – 7:30 PM
Networking Reception – Exhibit Hall 6:00 PM – 7:30 PM
Offsite Networking Event; Sponsored by: 8:00 PM
PBR at Power Plant Live
* Schedule subject to change; check website for latest information.
2016 REGISTRATION OPEN!

REGISTER NOW TO SAVE $100!
2 EMS TODAY 2016 CONFERENCE PROGRAM www.emstoday.com

GENERAL INFORMATION

ON-SITE REGISTRATION HOURS LEARNING CENTER
Tuesday, February 23 1:00 PM – 5:00 PM Friday, February 26 11:00 AM – 4:45 PM
Wednesday, February 24 7:00 AM – 5:00 PM Saturday, February 27 11:00 AM – 12:15 PM
Thursday, February 25 7:30 AM – 7:00 PM
Friday, February 26 7:30 AM – 4:30 PM HOUSING DESK
Saturday, February 27 7:30 AM – 1:00 PM Tuesday, February 23 1:00 PM – 5:00 PM
Wednesday, February 24 8:00 AM – 5:00 PM
EXHIBIT HALL HOURS Thursday, February 25 8:00 AM – 7:00 PM
Thursday, February 25 5:00 PM – 7:30 PM Friday, February 26 8:00 AM – 5:00 PM
Friday, February 26 10:00 AM – 5:00 PM Saturday, February 27 8:30 AM – 1:00 PM
Saturday, February 27 9:00 AM – 1:00 PM
COAT/LUGGAGE CHECK
EXHIBIT HALL SET UP AND DISMANTLE Wednesday, February 24 7:00 AM – 5:15 PM
Wednesday, February 24 8:00 AM – 5:00 PM Thursday, February 25 7:30 AM – 8:00 PM
Exhibitor Move-In (all booths) Friday, February 26 7:30 AM – 8:00 PM
Thursday, February 25 8:00 AM – 3:00 PM Saturday, February 27 7:30 AM – 5:00 PM
Exhibitor Move-In (all booths) * Schedule subject to change
MUST BE SET UP BY 3:00 PM
Saturday, February 27 1:00 PM – 8:00 PM
Exhibitor Move-Out
NETWORKING OPPORTUNITIES
EMS Today offers a variety of networking opportunities to maximize your experience with other EMS professionals.
For specific details, see pages 50 – 51.
CONFERENCE INFORMATION DESK HOURS SPEAKER READY ROOM HOURS

Wednesday, February 24 7:30 AM – 5:00 PM Wednesday, February 24 7:30 AM – 5:00 PM
Thursday, February 25 7:30 AM – 2:45 PM Thursday, February 25 7:30 AM – 5:00 PM
Friday, February 26 7:30 AM – 5:15 PM Friday, February 26 7:30 AM – 5:00 PM
Saturday, February 27 8:00 AM – 4:30 PM Saturday, February 27 8:00 AM – 3:30 PM
www.emstoday.com CONFERENCE PROGRAM EMS TODAY 2016 3

OFFICIAL PUBLICATION OF EMS TODAY
ASK US ABOUT
OUR SHOW GUIDE
SPECIALS!
Celebrating 35 years of dedicated

service to the EMS community.
Join the “conscience of EMS” online! facebook.com/JEMSfans @JEMSconnect
www.JEMS.com

SPONSORS AS OF AUGUST 24, 2015

PLATINUM SPONSOR
GOLD SPONSOR SILVER SPONSOR BRONZE SPONSOR
WALL WRAP SPONSOR BADGE HOLDER SPONSOR CUSTOM BRANDING PACKAGE SPONSOR
OFFICIAL APPAREL SPONSOR CUSTOM BRANDING PACKAGE SPONSOR OPENING NIGHT RECEPTION SPONSOR
SUPPORTING SPONSOR/ JEMS GAMES SUPPORTING SPONSOR EXHIBIT HALL GIVEAWAY SPONSOR
OPENING NIGHT RECEPTION SPONSOR
CONFERENCE SESSION SPONSORS
ACTIVE SHOOTER SIMULATION WORKSHOP SPONSORS

LET US HELP YOU ATTEND EMS TODAY 2016!
What Program Works Best For You?

AUTHORIZED BUYER PROGRAM
Are you an ambulance buyer? Are you an ambulance manufacturer?
We have launched a new program this year for YOU!
• Discounted registration • Special VIP perks onsite
For more information, contact Amanda Brumby at AmandaB@Pennwell.com
FREE BUS TRANSPORTATION

Let us provide the transportation for you and 34 others to and from
Baltimore, MD for FREE!
You purchase your Gold Passport registration and we will pay for the gas.
CREW PRICING
Interested in sending your crew to EMS Today?
Have a group from your crew that will be attending EMS Today?
Register together and get a discount! The more you send, the
more you save!
SCHOLARSHIP
If the price of registration is keeping you from attending EMS Today for the
first time, we have the answer for you – APPLY FOR A SCHOLARSHIP!
Exhibitors donate unused conference registrations so that you can attend for FREE. And we are kicking
off the scholarship fund by donating 35 registrations so there will be plenty to go around.
For more information, visit our website: emstoday.com/attend/scholarship-application
EARLY BIRD
Regis,t2e0r16 The best way to save is to register EARLY! Take advantage of the Early Bird
by Jan. 15 Discounts by registering before January 15, 2016.
and Save! To register, visit our website: emstoday.com/register

PROGRAM PLANNING COMMITTEE
PennWell and EMS Today wish to express our thanks to the 2016 program committee.
As a part of this committee, these individuals share their knowledge, time and experience
to ensure a high-quality and successful EMS Today conference program.
A.J. Heightman Carolyn Gates, EMT-P

Conference Chair – EMS Today Paramedic, San Diego Fire Department
Committee Member since 2013 Geoffrey Shapiro
Editor-in-Chief – JEMS Director, EMS & Operational Medical Training,
PennWell Corp. Christian Griffin, NRP Emergency Health Svcs. Program,
Director, Baltimore County Fire Department, George Washington University
Emergency Medical Services Committee Member since 2015
Debbi Boyne, CMP Committee Member since 2013
Dominic Silvestro, EMT-P, EMS-I
Conference Manager, EMS Today
PennWell Corp. Troy M. Hagen, MBA Firefighter/Paramedic,
Immediate Past President, NEMSMA, Richmond Heights (Ohio) Fire Department
CEO, Care Ambulance Service Committee Member since 2011
Committee Member since 2013
Joelle Simpson, MD, MPH
Allison J. Bloom, Esq. Theresa Harp, NRP Assistant Professor, Medical Director of
Attorney, Law Office of Allison J. Bloom Battalion Chief, Baltimore City Fire Department Emergency Preparedness,
Committee Member since 2013 Committee Member since 2014 Children’s National Health System
Committee Member since 2012
Scott Bourn, PhD, RN, EMT-P Walter A. Kerr, MS-REMT-P, FP-C
VP of Clinical Practices & Research, MDSP Aviation Command Corey M. Slovis, MD
American Medical Response / Envision Healthcare Professor and Chairman, Department of
Committee Member since 2013 Mike McEvoy, PhD, NRP, RN, CCRN Emergency Medicine,
EMS Coordinator, Saratoga County, New York Vanderbilt University Medical Center
Jonathan Bratt, MS, CEM, CCEMT-P Committee Member since 2014 Committee Member since 2013
Regional Administator-Region V,
Maryland Institute for EMS Systems (MIEMSS) Jason T. McMullan, MD E. Reed Smith
Committee Member since 2012 Associate Professor of Emergency Medicine, Operational Medical Director,
University of Cincinnati Arlington County Fire Dept.
Chad Brocato, JD, DHSc Committee Member since 2015 Committee Member since 2015
Retired Fire Chief/Attorney,
Murphy and Brocato Law Jeremy Mothershed, HRP Walt Alan Stoy, Ph.D., EMT-P
Committee Member since 2013 Paramedic, Havre de Grace Ambulance Corps Professor and Director,
Committee Member since 2013 University of Pittsburgh/
Brent Bronson, NREMT-P Center for Emergency Medicine
Vice President, North American Rescue LLC Brent Myers, MD, MPH, FACEP Committee Member since 2014
Committee Member since 2015 Chief Medical Officer & Exec. V.P. for
Medical Operations, Evolution Health; Lawrence E. Tan, Esq., NRP
Diana Clapp, RN, CCRN, CE, BSN, NREMT-P Associate Chief Medical Officer, AMR Chief, New Castle County (DE) EMS
Quality Improvement Coordinator, Committee Member since 2013 Committee Member since 2013
R Adams Cowley Shock Trauma Center
Committee Member since 2013 Jerry Overton Melissa Trumbull
Chair, IAED Industry Relations Manager, NAEMT
Edward T. Dickinson, MD, FACEP, NREMT-P Committee Member since 2010 Committee Member since 2013
Professor, Emergency Medicine,
Perelman School of Medicine, Univ. of Penn. David Page, MS, NREMT-P Mark Van Arnam
Committee Member since 2010 Paramedic Instructor President, American Emergency Vehicles
Committee Member since 2013 Committee Member since 2013
Mark R. Fletcher, NRP
Deputy Chief #5, Baltimore City Fire Department Richard Patrick, MS, CFO, EMT-P, FF Jonathan D. Washko, MBA, NREMT-P, AEMD
Committee Member since 2012 Director (Acting), Office of Health Affairs Assistant Vice President
U.S. Dept. of Homeland Security Center for EMS, SkyHealth,
Gregory R. Frailey, DO, FACOEP Committee Member since 2013 North Shore - LIJ Health System
Medical Director, Committee Member since 2014
Susquehanna Regional EMS Marcia Pescitani, BS, EMT-I, EC
Committee Member since 2014 Regional Coordinator, Steve Wirth, JD, EMT-P
Northern Virginia EMS Council Founding Partner, Page, Wolfberg & Wirth LLC
Steven Frye, BS, NREMT-P Committee Member since 2014 Committee Member since 2013
ALS Program, Univ. of Maryland,
Maryland Fire Rescue Institute (MFRI) Richard Schenning, BSN, NRP Matt Zavadsky, MS-HSA, EMT
Committee Member since 2008 Director, Baltimore County Fire Department Director of Public Affairs,
Infection Control, Risk Management Medstar Mobile Healthcare
Chad Gainey, NREMT-P, FP-C Committee Member since 2011 Committee Member since 2013
Flight Paramedic
Maryland State Police Aviation Command Kevin Seaman, MD, FACEP Diane Zuspan, BS, NREMT-P
Committee Member since 2015 Executive Director, Division Chief,
Maryland Institute for EMS Services Montgomery County Fire and Rescue Services
Committee Member since 2015 Committee Member since 2011

CONTINUING EDUCATION
NEED CEH?
YOU CAN EARN 32+ CEH WHILE AT EMS TODAY 2016.......
and just before the March 31st deadline!
Continuing Education is earned on a one unit per hour basis.
For example, a 1.5 hour session will give you 1.5 CEH.
CECBEMS
Continuing Education Hours will be applied for through the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS). CECBEMS is
an organization established to develop and implement policies to standardize the review and approval of EMS continuing education activities.
SPONSORING ORGANIZATIONS OF CECBEMS

American College of Emergency Physicians National Association of EMS Educators
American College of Osteopathic Emergency Physicians National Association of State EMS Officials
American Heart Association National Association of State EMS Officials/Education &
National Association of Emergency Medical Services Physicians Professional Standards Council
National Association of Emergency Medical Technicians National Registry of Emergency Medical Technicians
NREMT
The re-registration process under the National Standards for NREMT calls for completion of either a formal refresher course or continuing education structured
around the content of the National Refresher. For more information on NREMT refresher requirements, please visit NREMT.org or call 614.888.4484.
Each session on the program is marked to indicate which NREMT category it satisfies. If no category is given, the session qualifies as EMS CEH only.
New Jersey, Pennsylvania & Virginia EMS Professionals

The Penn. EMS Office will accept CECBEMS accredited sessions, so there is no need to verify that EMS Today sessions will be accepted. For N.J. and Va. Please
check the EMS Today Website to verify which sessions have been approved by your state office.
WE MAKE IT EASY TO EARN 32+ CEH WHILE AT EMS TODAY 2016

STEP 1: STEP 3:
Register for EMS Today as a Full Conference Delegate Attend EMS Today and the courses you need for CEH.
We will scan your badge at the entrance to every class
STEP 2: you attend so that you receive credit.
Check the program for the courses needed and plan
your course schedule STEP 4:
After the conference, you will be sent an email with
instructions on how to download a PDF of your certificate.
National EMS Management Association EMS Supervising Officer Certification
Sessions bearing the “National EMS Management Association Accredited”

logo have been reviewed by NEMSMA and will contribute to the pre-requisites
for certification testing for EMS Supervising Officer credentialing.

CONFERENCE PROGRAM DETAIL
NEW THIS YEAR:

We have organized the conference program by Session Tracks (rather than by day) in
order to make it easier for you to find what sessions fit your area of interest/need for
accreditation. When you are onsite at EMS Today, the event guide will be broken down
by day for easier navigation during the event.
We have developed track icons for easier recognition. Each time you see the icon,
it represents when a session is associated with that track.
CONFERENCE TRACKS
Advanced Clinical Practice – For advanced-level practitioners, presenting the
latest information on advanced patient assessment, clinical care, research,
equipment innovations and more.
Basics of Clinical Practice – Topics for all emergency providers; presenting
information that will benefit all responders.
Community Paramedicine – A preconference workshop and main conference

topics that focus on the development, delivery, funding and integration of
programs with the rest of healthcare. All sessions will deliver important
assessment and patient care practices to prevent hospital readmissions, keep
patient conditions from reoccurring or deteriorating and prevent unnecessary
illness or injuries from occurring.
Dynamic & Active Threats – Topics include MCI, active shooter, tactical, special
operations and terrorism operations, preparedness and best practices.
EMS COMPASS – The EMS COMPASS Summit and EMS COMPASS main
conference sessions will assist emergency response agencies in assessing the
performance of their EMS systems and prepare for the future through data,
outcome measurement and a healthcare process-driven approach.
Leadership – For managers, supervisors, administrators and executives, these
sessions present the latest information to assist agencies and departments. This
track includes management and operations topics along with strategies for
navigating the rapidly changing healthcare system.
Special Topics – These are topics of interest to all emergency response
professionals, regardless of their certification level or employer, including
special focus, operations, safety and wellness programs, stress management and
suicide prevention, legal issues and career planning.
KEY TO NREMT CATEGORIES

Each session is marked with the NREMT topic category it satisfies. A guide to NREMT requirements may be found at NREMT.org.
ABC – Airway, Breathing, Cardiology OB/PEDS – Obstetrics and Pediatrics

MED – Medical Emergencies OT – Operational Tasks
TRAUMA ELECTIVE

WORKSHOPS-AT-A-GLANCE
WANT TO ADD A WORKSHOP TO YOUR REGISTRATION? Half-Day (4 hr): $125 early/$150 reg
It’s simple, if you haven’t registered yet, simply select which pre-conference workshop you would Full-Day (8 hr): $215 early/$240 reg
*unless otherwise noted
like to attend and the price of the workshop will be added to your registration.
Already registered? Easy - just email registration at registration@pennwell.com and let them Lunch included with two 4-hr workshops
know what pre-conference workshop you would like to add. They will bill you for the difference. or one 8-hr workshop.
8:00 AM - 5:00 PM 8:00 AM - 12:00 PM 1:00 PM - 5:00 PM

WEDNESDAY, FEBRUARY 24 PRE-CONFERENCE WORKSHOPS
Cadaver Lab
Advanced Clinical Practice
EMT “Design it Yourself” EMT (“Design it Yourself”)

Refresher Workshop Refresher Workshop
Basics of Clinical Practice
Community Paramedicine Workshop
Payment Strategies Panel
Innovations
Roundtable of Community Paramedics
Active Shooter Simulation Lab Self Defense Tactics for Self Defense Tactics for
EMS Providers EMS Providers
Emergency Medical Response

to the Active Shooter
Dynamic & Active Threats
Boosting Your Organization’s Recruitment, Boosting Your Organization’s Recruitment,

Retention & Reputation Retention
& Reputation
NEMSMA Pressing Topics in EMS
Management
Leadership
EMS Compass Town Hall Meeting: How

Performance Measures Could Transform
EMS
Introduction to the EMS Compass

Initiative & Its Importance
EMS Compass
Understanding Performance Measurement
How EMS Compass Works
Calculating & Displaying Measures
Benchmarking Measures

CONFERENCE-AT-A-GLANCE
Advanced Clinical Basics of Clinical Community Dynamic & Active Leadership Special Topics
Practice Practice Paramedicine Threats
THURSDAY, FEBRUARY 25 CONFERENCE SESSIONS

8:00 AM - 5:00 PM JEMS Games Preliminary Competition (No CEH is given.)
8:00AM - 9:00AM Rise of the Machines: Latest Drugs of Abuse/ Accredited Point of Lessons Learned From Creating a Leadership Path Using No More BLS/ALS—
Mechanical CPR and Testing of EMS Care Testing: Why Washington Navy Yard the NEMSMA Seven Pillars of EMS Just EMS
What the Studies Don’t Personnel for Marijuana Should I Care? Active Shooter Incident Officer Competencies
Tell You Coping with the Stress
HOT Patients: The Many Conducting Incident Investigations: of EMS
Faces of Hyperthermia Will Your Agency Win in Court?
National Registry of
Improving Traumatic Proving We Make a Difference: EMT’s 2016 Update
Brain Injury (TBI) Care Why Every EMS Practitioner Needs
2016 ALS Therapy - The Arizona EPIC to Understand the Value of Data
Update Project and Performance Measures
Management and
Assessment of
Penetrating Trauma and
How to Pack Wounds
8:00 AM - 12:00 PM Cadaver Lab
9:15AM - 10:15AM Pediatric Pain Active Compression/ From Start to Finish: Chemical Suicides Risk Management for EMS National Continued
Management Decompression CPR Learn How North Shore Competency Program
- LIJ CEMS Developed (NCCP)
Excited Delirium Creating Clinical Leaders and
Real-world Cardiac a Successful Mobile
Syndrome and Law Mentors
Science: What’s Working Integrated Healthcare Suicide Prevention in
Enforcement Toxicology
– What’s Not and (MIH) Program and the EMS
Ambulance of the Future
Where We Might Be Future It Holds for EMS
Going CECBEMS
Accreditation: Is It
Shock Trauma: Point of Right for Your
Care Testing in the Field Organization?
ALS Assessment Tricks
10:30AM - 12:00PM Management and Understanding Shock: The Future of Red Light or Green Light: Your Best EMS Self: Practicing Crisis Communica-
Assessment of Blunt 2016 Paramedicine in Our ICS for Rescue Task Force Proactive Professionalism tion: Using the Digital
Force Trauma Hands Through Operations in Warm Lifesaver
Self-regulation? Zones Data Dichotomy in the New EMS
Field and ECMO Center Payer Landscape
Products to Improve
Treatment of Massive Dynamic & Active Threats
the Way You Deliver
Pulmonary Embolism Panel
Care in the Field
(A Personal Experience)
Noninvasive Positive
Pressure Ventilation:
Changing the Respiratory
Prehospital Paradigm of
Ventilation and
Intubation
12:00 PM - 1:30 PM Prehospital Care Research Forum Oral Presentation Luncheon (CEH is given)
1:30PM - 2:45PM Flash Pulmonary Edema PCRF Research Arlington County Applying The Joint Rescue Thinking Outside the Box: Emergency Medical
- Drowning in Dogma or Roundtable Advance Practice Task Force Model Implementing Best Practices From Service Response to
Death-Defying in Paramedic Program Other Industries Sports Concussion
Discovery? Close Up and Personal:
Child Abuse and Neglect
for the Prehospital Legal Issues With Body Customer Service When the Patient Incorporating
The Most Important Provider Cameras and Other New is Not the Customer Real-time Feedback to
Published Articles for Imaging Devices in EMS Improve Patient
EMS Providers Outcome
Change Management in Emergency
2015-2016
Services: Leading the Charge for
Paramedic
Change
Important Psychomotor
Considerations When Competency Portfolio
Choosing Ventilation (PPCP)
Devices
3:00 PM - 5:00 PM Opening Ceremonies and Keynote

The Spirit of Adventure - Brian O’Malley

FRIDAY, FEBRUARY 26 CONFERENCE SESSIONS

8:00 AM - 10:00 AM Lightning Round: Ask the Eagles
8:00 AM - 10:00 AM Community Paramedicine

One-on-One Roundtable
Discussions
8:30 AM - 10:00 AM Saving Exsanguinating Spinal Trauma Update Pediatric Issues When Normalization of Deviance; Decision Fatigue: Too Tired to
Trauma Patients With Unconventional Weapons What It Is and What to Do Think Straight
Hypothermia and Geriatric Trauma: When Are Involved About It
Cardiopulmonary Grandma Got Hurt To Thine Own Self Be True:
Bypass Active Shooter How to Prevent Your EMS Aligning Educational
Preparedness: How to System From Failing Objectives and Competencies
How Capnography is Integrate Police, Fire and With the Actual Needs of Our
Saving Lives EMS Responses Patients and Providers
Show Me the Money!: FLSA

Update - Using Cell Phones,
Smartphones and Email Off-duty
10:15 AM - 11:45 AM Considerations for Field A Regional Approach to Emerging Trends and EMS A Guide for Using Product Innovations at EMS
Amputations: A Community Paramedicine Implications From the Joint Performance Measures: Case Today
First-hand Perspective Counter Terrorism Studies From the Real World
Awareness Workshop Series What’s Killing Our Medics?
(JCTAWS)
Using Data and Technology

to Improve Operations and
Clinical Care
1:15 PM - 2:15 PM Why Mechanical CPR Behavioral Medicine in Case Studies in Hospice Using Data to Increase Mental Health of EMS
Use Makes Sense EMS 2016 Care: What Has Happened Performance in Volunteer Providers: The Ottawa Model
When the Squad Shows up Rescue and EMS Agencies
Implementation of a in the Home of a Hospice Infection Control Training
Prehospital Evidence-based Patient Now You Have All of This Issues in Emergency Services
Guideline Data, What Do You Do With
It? Measurement for
Management and
Improvement of EMS Systems
2:30 PM - 3:30 PM Traumatic Fractures and What a Mess: Precepting: Is it a Privilege Incorporating Social Media
Dislocations Managing the Mangled or a Right? into EMS Education: Kicking It
- Assessment, Extremity With Your FOAMies
Management and Pitfalls Performance Improvement:
Destination Dilemmas A Systematic Method of The New Enhanced Role of
Rethinking Our in Pediatric Trauma Improving Performance of the Public in EMS Response
Approach to Ventricular Transport People
Fibrillation
Alaska: A Primer on “Remote”
Recognizing and Dealing EMS
What the New AHA
with Intractable Problems,
Guideline Changes
Wickedness and Messes
Mean for EMS
3:45 PM - 5:15 PM EMS TXA in the 2016 State-of-the-art: The Best Making the Business Case How to Select Providers for PIO or Publicist - Keeping Is Prehospital Endotracheal
USA Research From the 2016 for MIH-CP – What You Tactical EMS Your Organization Intubation Elemental or
NAEMSP Annual Meeting Need to Know for (Favorably) in the Public Eye Detrimental?
Discussions with Your When Responders Become
Healthcare Partners Victims The Emerging Era of Choice, Don’t Call Me Sweetheart
Transparency and - Ten Steps to Better Bedside
The Whole Community Plan
Technology - EMS and the Manner
for a Biologic Disaster
EMS Pearls on Healthcare Retail
Hydration, Cooling and Revolution Fleet 101 - Three Points in the
Recovery in Rehab Healthcare Association Cycle of Care
Infections: How EMS Will be
The Hardest Call:
Affected by This Area
Education for the Field
Termination of
Resuscitation in Children
(The COPE Project)
5:15 PM - 8:00 PM JEMS Games Finals Competition
FRIDAY, FEBRUARY 26 LEARNING CENTER Located in the Exhibit Hall Sessions are available for .5 credits each.
11:00 AM - 11:30 AM 11:45 AM - 12:15 PM 12:30 PM - 1:00 PM 1:15 PM - 1:45 PM

NEMSMA Credentialing ALS Assessment Tricks Spinal Trauma Update Tips to Remember Mini-segment
of EMS Officers
2:00 PM - 2:30 PM 2:45 PM - 3:15 PM 4:15 PM - 4:45 PM

Ten Steps to Better Bedside Manner Rehab Revised Pediatric C-spine Update

SATURDAY, FEBRUARY 27 CONFERENCE SESSIONS

8:30 AM - 9:45 AM Direct Laryngoscopy Spinal Cord Injury Creating Community Creating Active Creating a Social EMS Culture: A Into the Real World:
and Video Assessment and Care Capital: Developing Bystanders Balanced Approach to Social Media Developing a
Laryngoscopy: Is There a From One of Our Own Non-traditional Standardized Scenario
Difference? Partnerships in EMS Program
What Did You Know and When Did
You Know It?: Improving Quality and
Innovations in Safety While Reducing Legal Risk Strategies for Staying
Out-Of-hospital on Your Emotional
Management of Track
Pediatric Asthma
Ethical Dilemmas in
EMS
How Internal Thoracic
Pressure Changes
Enhance the
Resuscitation of Cardiac
Arrest Patients
10:00 AM - 10:30 AM Awards Ceremony - Exhibit Hall
11:00 AM -12:30 PM That Doesn’t Belong Reconstructing the Implementing an EMS Culture of
There: Misadventure in Ambulance Safety: Near-miss Analysis
Prehospital Procedures Mid-response: The
Financial Artificial Intelligence: Bridging
Ventilation 2016 – The Considerations When Human Decision-making and
Good, the Bad and the Implementing Technology in EMS
Ugly of O2 Community Paramedic/
Alternative Care
Programs
12:45 PM - 1:00 PM Floor Giveaway - Exhibit Hall
1:00 PM - 2:00 PM MCI’s Involving Senior Life in the Fast Lane! Stress Test Your System: Conflict Resolution in EMS EPIC Medics Injury
Citizens Rapid-fire Highlights Preparing for “Mini” Prevention:
from the 2016 NAEMSP Mass Casualty Events The Role for EMS in
Annual Meeting Health Information Exchange: A Population Wellness
No-brainer Concept That Keeps and Prevention
Generating Seizures
Mental Health of EMS
Do Your Employment Practices Providers: The Ottawa
Behavioral Medicine in Scream Out, “Hey, Sue Me!” Model
EMS 2016
Getting Over the
Important Tales from Emotional Hurdle of
Children’s Cribs Bad Calls?
Common Sense EMS:

Eases for the Little Ones’
Wheezes
2:15 PM - 3:15 PM He Has a Through the Eyes of a Emergent Response: A Dangerous Drinking Alcohol?
“Who-What-Where”? Cadaver Epidemic in EMS Just Say KNOW!
The ABC’s of Managing
the Technology
Overdose by Designer Dealing with Requests for Patient
Dependent Patient
Drugs: Death in Teens/ Information from Law Enforcement,
Young Adults - A New Attorneys, Family Members and
Public Health Threat Others
Pediatric C-spine
Update
3:30PM - 4:30PM Speed Bumps and First Responder Stress Artificial Intelligence: Bridging What’s Killing Our
Roadblocks on the Resiliency: How to Human Decision-making and Medics?
Journey to Pre-hospital Reduce Stress That Can Technology in EMS
Analgesia Lead to Provider Suicide
The Profession of EMS; The
Human Sex Trafficking Fundamental Next Step
SATURDAY, FEBRUARY 27 LEARNING CENTER Located in the Exhibit Hall Sessions are available for .5 credits each.
11:00 AM - 11:30 AM 11:45 AM - 12:15 PM

Common Sense EMS: Eases for the First Responder Stress Resiliency:
Little Ones’ Wheezes How to Reduce Stress That Can Lead
to Provider Suicide

PRE-CONFERENCE WORKSHOP DETAIL
WEDNESDAY, FEBRUARY 24
Advanced Clinical Practice Community Paramedicine
Teleflex Cadaver Lab Preconference Workshop 8:00 AM – 5:00 PM

NREMT: ABC
1:00 PM - 5:00 PM
8:00 AM – 9:00 AM 1:00 PM - 2:00 PM
Session Description: The purpose of this session, presented by
Teleflex, is to provide a unique opportunity to review relevant Welcome Innovations – Part II
anatomy associated with critical care and lifesaving emergency
procedures. Participants will enhance their understanding of the This fast-paced and information-packed workshop will Panel Moderator: Gary Wingrove, The Paramedic
various procedures and the associated risks and benefits through the feature a group of Mobile Integrated Health-Community Foundation
handson practicum. The relevant review of the anatomy will include Paramedicine agencies and providers currently operational
airway, chest cavity and vascular access landmarks. Key Opinion Panelists: Matt Zavadsky, Director of Public Affairs,
and serving patients in their community.
Leaders, nationally known EMS Medical Directors, and Emergency Medstar Mobile Healthcare
Medical Services Providers will serve as faculty for this program. Two
9:00 - 11:00 AM Dan Swayze, DrPH, MBA, MEMS, Vice President
sessions will be offered at EMS Today 2016; space is limited.
for the Center for Emergency Medicine (CEM) in
Under expert instruction, participants will have the opportunity to
Pittsburgh
practice the following procedural skills: basic airway management, Payment Strategies – Panel
direct and video laryngoscope intubation, intraosseous access, and Peter Carlson, Community Paramedic Supervisor,
various other emergency procedures. The participants will have the Panel Moderator: Gary Wingrove, The Paramedic North Memorial Healthcare
opportunity for anatomical exploration as it relates to these Foundation
Peter O’Meara, LaTrobe University, Australia
procedures providing a unique appreciation of the anatomy and the
impact of the disease process. An analysis of the unnecessary risk and Panelists: Matt Zavadsky, Director of Public Affairs, Kevin Munjal, Mt. Sinai/NYC
the potential for complications when these procedures are performed Medstar Mobile Healthcare
in suboptimal conditions will be explored. Session Description: This session will focus on specific programs
Dan Swayze, DrPH, MBA, MEMS, Vice President for the and you will learn about innovations they are using to better
serve their communities as well as their progress and specific
Center for Emergency Medicine (CEM) in Pittsburgh challengers or pitfalls they have overcome.
Peter Carlson, Community Paramedic Supervisor, North
Basics of Clinical Practice Memorial Healthcare 2:00 PM - 4:00 PM
Session Description: This session will focus on payment strategies.

Each faculty member will describe their system, the gaps they are Roundtable of Community Paramedics
EMT (“Design it Yourself”) filling, and how they are integrated with other parts of healthcare Panel Moderator: Gary Wingrove, The Paramedic
Refresher Workshop and the budget options and funding alternatives they are using or
Foundation
planning to make their program sustainable.
NREMT: ABC, TRAUMA, MED, OB/PEDS
Panelists: Peter Carlson, Community Paramedic
8:00 AM - 12:00 PM 1:00 PM - 5:00 PM 11:00 AM - 12:00 PM
Supervisor, North Memorial Healthcare
Candice Thompson, Captain, Coordinator, Centre for Peter O’Meara, LaTrobe University, Australia
Emergency Health Science, Bulverde Spring Branch (Texas) Innovations – Part I Shane Cooper, Snohomish County WA Fire
Emergency Medical Services Panel Moderator: Gary Wingrove, The Paramedic Christie Cornelius, Community Paramedic and Program
Session Description: Are you tired of educators telling you what you Foundation Assistant for Emed Health and the CONNECT
need to know as you approach recertification? Do you feel that
conference topics are too focused on material that was in an EMS
Community Paramedic Program in Pittsburgh
Panelists: Kevin Collopy, Clinical Education Coordinator,
textbook? This innovative, EMT Refresher Workshop will break that AirLink/VitaLink Critical Care Transport Kevin Creek, Eagle County, Colorado
mold. Whether you are embarking on your very first certification
renewal, or are a veteran EMT, it’s likely you have at least one topic Jonathan Washko, North Shore-LIJ Center for EMS Session Description: This session will be a roundtable of
you’ve always wished someone would have taught you or presented John Sponholtz, RN, AEMT, Unity Hospice, Tisch Mills Fire Community Paramedics who will talk about the work they do
to you in another way. Join EMS educator Candice Thompson for a every day and provide case studies of patients they have
Department, United States
discussion on topics and learning points designed just for you and treated.
your classmates. When you register for one of the two, four-hour EMS Session Description: This session will focus on specific programs and
Today preconference workshops, Candice will contact you and ask you will learn about innovations they are using to better serve their
you to submit what you want to learn about during this energetic and communities as well as their progress and specific challengers or
refreshing “Design it Yourself” EMT Refresher workshop. You’ll get a pitfalls they have overcome.
lot of CE credits and enjoy the way Candice presents important, new
and updated material to you.
Half-Day (4 hr): $125 early/$150 reg

Full-Day (8 hr): $215 early/$240 reg
*unless otherwise noted
Lunch included with two 4-hr workshops or one 8-hr workshop.

Dynamic & Active Threats Leadership
Active Shooter Simulation Lab Self Defense Tactics for EMS Boosting Your Organization’s
NREMT: ABC, TRAUMA Providers Recruitment, Retention & Reputation
8:00 AM – 5:00 PM NREMT: OT 8:00 AM - 12:00 PM 1:00 PM - 5:00 PM
Session Description: This one day educational experience is an 1:00 PM – 5:00 PM Rich Wehie, Business Coach, Grand Blanc, Michigan
8-hour session. This interactive experience consists of multiple
educational stations focusing on basic and advanced airway Chad Gainey, Sergeant, Maryland State Police Jeff Yorke, President, Patriot Ambulance in Flint (Genesee
procedures, gross anatomy, vascular access, hemorrhage control, Aviation Command County) Michigan
and best practices in scene management and tactical patient care
associated with active shooter situations. Non-embalmed cadavers Session Description: Emergency responders are on occasion Session Description: When Patriot Ambulance Service owner, Jeff Yorke,
are exposed to allow the student the best visual experience with placed or find themselves in situations where the scene began working with organizational coach Rich Wiehe in 2012, Patriot
safety and their personal safety are compromised. This Ambulance employed 30 people. Today, Patriot has more than 70
relation to ballistic injuries to enhance the session. Paragon’s
experienced EMS educators bring the cadaver stations to life with pre-conference workshop discussion and practical employees and has grown and built a reputation as being one of
critical care procedures, tricks of the trade, and state of the art application will assist the responder in identifying potential America’s most desirable ambulance companies to work for. This
tools and techniques. Special permission from donors allow threats to their own safety, crew safety and safety of their workshop will show you how Patriot Ambulance has made this happen
replication of low, medium, and high velocity ballistic and blast patients. Instructors will demonstrate techniques if providers and strengthened their competitive advantage through use of “DISC”
injury replication to give the student insight to mechanism of injury find themselves in a self-defense situation and assist them in personality assessments, employee pairing and key organizational
related to these hostile MCI events. their own protection and retrieval from the threat. processes which include:
• Two organizational assessments designed specifically for Patriot’s needs
In the second half of this session, students will engage in best
• A Culture Declaration Statement about who they are, what they believe
practice concepts related to emerging threats discussed in the Emergency Medical Response and how they act;
didactic portion of the morning session. These applications will be
facilitated in an integrated simulation experience. With interactive to the Active Shooter • Use of “DISC” Personality Assessments (see below);
• Attributes and Adjectives that are at the foundation of their staff’s
scenarios, team dynamics will be challenged with EMS, fire service NREMT: TRAUMA, OT behavior;
and law enforcement working together while in the “warm-zone”
1:00 PM – 5:00 PM • The value of setting short, medium and long-term goals;
with focus on forced protection, sifting and sorting, triage/
• Fully developed Patriot Customer Service Values;
treatment/transport and utilizing best practice treatment
modalities with cadavers, simulators and live actors embedded
Jody Heckman, Faculty, Tac-Med • Periodic “360” assessments, designed specifically for the needs at
various levels of responsibility at Patriot;
within the experience. Joel Rutkowski, Faculty, Tac-Med, LLC
• A Leadership Through Life Skills curriculum for those viewed as leaders
Ryan Williams, Faculty, Tac-Med, LLC within the organization; and
Self Defense Tactics for EMS David Neubert, MD, Medical Director, Tac-Med, LLC • On-going “Culture Meetings” which gather valuable employee feedback
and reinforce the behavior necessary to stay in first place.
Providers Session Description: Because of Federal recommendations
NREMT: OT for closer EMS involvement in active shooter responses, The DISC personality assessment process has been an effective tool since
particularly into “warm zones” with law enforcement 1920 to help organizations further develop their organization’s leadership,
8:00 AM – 12:00 PM officers, more EMS and fire agencies are looking for the utilize the talents of their staff, recruit and retain staff, and maximize their
process they should follow to get trained and integrated organizational effectiveness. DISC helps individuals and teams minimize
Chad Gainey, Sergeant, Maryland State Police Aviation into active shooter teams and oriented on the EMS roles conflict, increase engagement, boost morale, and collaborate more
Command and responsibilities. This four-hour workshop, designed for effectively by teaching people to recognize different DISC styles and adapt
street medical providers and law enforcement personnel their own behavior to better align with others. It helps people understand
Session Description: Emergency responders are on occasion
that first respond to these events, will help you do this. This their own behavior styles and recognize why other people behave in
placed or find themselves in situations where the scene safety
workshop will feature didactic and hands on training in the different ways.
and their personal safety are compromised. This pre-conference
medical response to dynamic threat incidents such as This dynamic workshop will teach you how to understand your own
workshop discussion and practical application will assist the
active shooters, provide background on active shooter personality type, recognize other people’s styles and use this process to
responder in identifying potential threats to their own safety,
incidents and the “Hartford Consensus” recommendations, improve the recruitment, deployment and retention of their career and/or
crew safety and safety of their patients. Instructors will
and discuss forward (warm zone) urgent medical care that volunteer crews. It will address and help you understand the four
demonstrate techniques if providers find themselves in a
should be provided to victims. It will also cover important components that comprise a person’s DISC style:
self-defense situation and assist them in their own protection
and retrieval from the threat. aspects and tactics for EMS response to explosives-based • Dominance: How assertive and results-focused the person is;
incidents. • Influencing: How sociable and people-focused the person is;
• Steadiness: How reliable and team-focused the person is; and
• Conscientiousness: How analytical and accuracy-focused the person is
The workshop will also teach you how you and your staff can flex your
behavior to increase engagement with others and develop more constructive
workplace relationships.
NEMSMA’s Pressing Topics in

EMS Management
8:00 AM - 12:00 PM
Michael Touchstone, President of NEMSMA and Regional
Director, Philadelphia Regional Office of EMS
Troy Hagen, Immediate Past President, NEMSMA
Vince Robbins, FACHE, President & Chief Executive Officer of
MONOC, New Jersey’s largest EMS and mobile healthcare
shared-service hospital cooperative
Session Description: The National EMS Management Association
(NEMSMA) believes in developing inspired leaders to better serve their
communities. Attendees will be better equipped to handle a multiple of
situations facing their organizations today. This high energy workshop will
present current and pressing topics in EMS Management and Leadership
and engage the audience in identifying the most promising solutions. The
topics will be presented by the facilitators to give you the best picture and
discussions to generate the right solution. Learn from both the presenters
and your audience members alike.

PRE-CONFERENCE WORKSHOP DETAIL
EMS Compass
EMS Compass Town Hall 8:30 AM – 9:30 AM 11:00 AM – 12:00 PM

Meeting: How Performance Opening Session & Welcome How EMS Compass Works
Measures Could Transform EMS Dia Gainor, Executive Director, NASEMSO Robert Bass, MD, FACEP, Chair, EMS Compass Steering
Nick Nudell, MS, NRP, EMS Compass Committe, NASEMSO
8:00 AM - 5:00 PM
Initiative Project Manager David Williams, PhD, Executive Director, Medic Health
The EMS Compass initiative is a national effort by EMS Nick Nudell, MS, NRP, Chief Data Officer, PrioriHealth
providers that is not simply about designing Introduction to the EMS Compass Initiative & its Partners, LLP.
performance measures for the present but will create importance.
a process for the continual design, testing and Session Description: EMS Compass leaders will describe the EMS
Session Description: Supporting the use of data to measure and Compass process, from how the initiative is incorporating the
evaluation of EMS performance measures—and improve EMS systems is a priority of the NHTSA Office of EMS and its
guidance for how local systems can use those community’s input to the structure of its working groups to how a
federal partners, and EMS Compass is one of the most significant performance measure is designed. They will also share lessons learned
measures to improve—with the goal to help EMS pieces of that effort. Project leaders will present a brief history of how along the way that will help shape the future of EMS Compass and
systems measure and improve the quality of care at the EMS Compass initiative was born, including how it builds on the other national EMS initiatives.
the local, regional, state and national levels. creation of the National EMS Information System (NEMSIS), what EMS
Compass is—and is not—and why it is critical to every member of the 1:30 PM – 2:30 PM
Efforts to improve patient care and the patient EMS community.
experience, operational efficiency, and other aspects of Calculating & Displaying
an EMS system are more successful if leaders can 9:30 AM – 10:30 AM
Measures
benchmark current performance and assess the impact Understanding Performance
of changes. EMS Compass will help EMS systems use Todd Hatley, MBA, MHA, CEO of Integral Performance
data in a meaningful way to improve performance and Measurement Solutions and is an experienced Six Sigma Instructor
provide the highest-quality patient care to their David Williams, PhD, Executive Director, Medic Health
communities. The initiative is funded by the National Session Description: Using some of the EMS Compass measures,
Highway Traffic Safety Administration (NHTSA) and Alex Garza, MD, MPH, Associate Dean and Professor in attendees will work through the calculation of performance measures,
Epidemiology at the St. Louis University College of Public from where to find the data to how to use that data to quantify the
managed by the National Association of State EMS measure. This session will also discuss the importance of how a
Officials (NASEMSO) as part of a two-year cooperative Health and Social Justice
measure is displayed, and how different ways of displaying data can
agreement. Performance measures are more than just calculations and lead to different interpretations of the results.
EMS Compass is one of the largest initiatives ever percentages. In this session, you’ll learn more about the
different types of performance measures, the importance of 2:30 PM – 3:30 PM
funded by NHTSA’s office in EMS, with more than 50
experts involved in developing a process to select, developing patient-centered and evidence-based measures, Benchmarking Measures
design and test evidence-based performance and how EMS Compass is designing measures using a
process that models itself on the best practices used by Mic Gunderson, National Director for Clinical Systems in the
measures. This engaging “give and take” meeting is Quality and Health Information Technology Division of the
your chance to ask questions about the status of the healthcare experts and performance scientists.
American Heart Association
initiative, see the process used to develop and
maintain EMS performance measures, find out what Scott Kier, field operations paramedic with New Castle
measures have been designed and which are in the County (DE) EMS
pipeline, and learn how the measures will assist your Session Description: Many EMS systems and other members of the
efforts to use your data to improve quality in your healthcare community are already using performance measurement to
agency. evaluate and improve patient care and operations. This segment will
allow attendees to learn from others (including international
The EMS Compass Town Hall Meeting will provide you examples) who are using standardized measures for benchmarking
with the opportunity to hear from, and interact directly purposes and the important impact the standardized measures are
with, experts who are leading this historic EMS having on performance and patient outcomes.
initiative. You’ll also learn how the EMS Compass
performance measures will impact the entire EMS 4:00 PM – 5:00 PM
community and your EMS system in the future by Closing Session
attending the EMS Compass Town Hall Meeting!
Moderator: Jonathan Washko, Assistant Vice President,
North Shore-LIJ Center for EMS
Session Description: In the closing session, a panel of EMS Compass
experts and attendees will participate in a conversation about the
vision for the future of EMS Compass. Don’t miss your chance to share
your ideas, ask questions and contribute to this critical effort to help
EMS systems improve.

OPENING CEREMONIES/KEYNOTE
OPENING CEREMONIES
KEYNOTE SESSION
EVENT EMCEE AWARDS PRESENTED
A.J. Heightman
- James O. Page/JEMS Leadership Award
Conference Chair – EMS Today
Editor-in-Chief – JEMS - EMS10 Innovators in EMS Awards
PennWell Corp.
Brian O’Malley
Keynote Speaker
An adventurer and award-winning photographer, Brian O’Malley’s expeditions
have taken him to South America, North America, the Himalayas and Africa. Brian’s
career experiences include work as a paramedic/firefighter, police officer, SWAT
team member and a wish grantor for the Make A Wish foundation. Brian is also
the author of “The Secret of the Mountains”, an adventure book for children.
Thursday, February 25
3:00 PM – 5:00 PM THE SPIRIT OF ADVENTURE
Today’s ever-changing EMS world requires you to go where you have never been before. Drawing on his experiences
as a mountain guide, Mt. Everest climber, and retired EMS professional, Brian O’Malley will take you on a journey to
explore your personal summits. By applying the skills of an adventurer, you will gain a new perspective on your life
and your service on the street. (1.0 CEH)
Sponsored by:

Advanced Clinical Practice Track
Track Description: For advanced-level practitioners, presenting the latest information on advanced patient assessment,
clinical care, research, equipment innovations and more.
Rise of the Machines: Mechanical CPR Management and Assessment of Penetrating Trauma
and What the Studies Don’t Tell You and How to Pack Wounds
NREMT: ABC NREMT: TRAUMA
DATE: 02/25/2016, TIME: 8:00 AM - 9:00 AM DATE: 02/25/2016, TIME: 8:00 AM - 9:00 AM
Michael Levy, MD, Medical Director, Anchorage Fire Department Andrew Dennis, DO, FACS, FACOS DME, Senior Trauma and Burn
Session Description: The use of mechanical CPR is increasing, yet the science Surgeon, Cook County Trauma and Burn Unit, Chicago, IL
seems to state that it is no better than manual CPR. There are an increasing Session Description: Penetrating trauma presents a tremendous challenge to
number of claims of patient survival after prolonged periods (sometimes hours) of prehospital EMS providers because of the need for the accurate assessment, triage
mechanical CPR, yet these “miracles” are not reflected in the large published trials. and transport of these patients to a trauma center rapidly. Join Andrew Dennis,
This session will focus on how to ask the right questions as you consider if your DO, FACS, FACOS, a trauma Burn surgeon at Cook County (Ill.) Hospital’s elite
system would benefit from mechanical CPR technology and on how to properly Trauma Burn Unit, one of the largest and highest volume trauma and Burn units
implement their use to maximize compression fraction and minimize pauses as in the United States, as he discusses the management and assessment of
well to consider how they can change the way we approach cardiac arrest, penetrating trauma. Dr. Dennis will also address the recommendation by the
specifically refractory ventricular fibrillation and PEA. These machines may very nationally recognized Hartford Consensus document that EMS personnel be
well be a key component to improving outcomes from cardiac arrest in your trained to pack wounds when necessary and feasible. He will review the proper
hospital and EMS system as well as improve rescuer safety, but they may have just procedure for packing in the field in this powerful, information-packed trauma
the opposite effect without careful planning and training on your part. session.
2016 ALS Therapy Update Teleflex Cadaver Lab

NREMT: ABC NREMT: ABC
DATE: 02/25/2016, TIME: 8:00 AM - 9:00 AM DATE: 02/25/2016, TIME: 8:00 AM - 12:00 PM
Jeremy Brywczynski, MD, assistant professor of emergency medicine Session Description: The purpose of this session, presented by Teleflex, is to
at Vanderbilt University Medical Center in Nashville; medical director, provide a unique opportunity to review relevant anatomy associated with critical
Vanderbilt LifeFlight aeromedical EMS division; assistant medical care and lifesaving emergency procedures. Participants will enhance their
director of the Nashville Fire Department understanding of the various procedures and the associated risks and benefits
Session Description: Join Jeremy Brywczynski, MD, as he discusses the current through the handson practicum. The relevant review of the anatomy will include
and future status of cardiac therapy and medications. This informative session will airway, chest cavity and vascular access landmarks. Key Opinion Leaders,
focus on: nationally known EMS Medical Directors, and Emergency Medical Services
Providers will serve as faculty for this program. Two sessions will be offered at
• Pulmonary edema: The 2016 role of CPAP, Lasix and Morphine, along with NTG and EMS Today 2016; space is limited.
bronchodilators; Under expert instruction, participants will have the opportunity to practice the
• Treating Afib in the field; when is too much, too much? following procedural skills: basic airway management, direct and video
• IO therapy: Is it really effective in making patients better in shock, or cardiac arrest? laryngoscope intubation, intraosseous access, and various other emergency
procedures. The participants will have the opportunity for anatomical exploration
• Wide complex tachycardias: Are we saving or killing the patients with the right or as it relates to these procedures providing a unique appreciation of the anatomy
wrong therapy? and the impact of the disease process. An analysis of the unnecessary risk and the
• Left Ventricular Assist Devices (LVADs): Problems and solutions for the EMS provider potential for complications when these procedures are performed in suboptimal
conditions will be explored.
Pediatric Pain Management

NREMT: OB/PEDS
DATE: 02/25/2016, TIME: 9:15 AM - 10:15 AM
Lisa A. Drago, DO, FAAP, Assistant Professor of Pediatrics and Emergency
Medicine, Cooper Medical School of Rowan University, Pediatric Medical
Director Division of EMS, Disaster, and Transport Medicine Department
of Emergency Medicine Cooper University Hospital
Session Description: This session will review pediatric pain physiology and tools
that can be used to assess pain in this important patient population. Barriers to
providing adequate pain relief to pediatric patients in the prehospital setting will
be addressed along with pharmacologic and non-pharmacologic interventions
EMS providers can use to reduce pediatric pain.

Real-world Cardiac Science: What’s Working – Field and ECMO Center Treatment of Massive
What’s Not and Where We Might Be Going Pulmonary Embolism (A Personal Experience)
NREMT: ABC NREMT: ABC
Jeremy Brywczynski, Assistant Professor of Emergency Medicine, Joseph Ornato, MD, Professor of Surgery, University of
Vanderbilt University Medical Center; Medical Director, Vanderbilt Maryland
LifeFlight Aeromedical EMS Division; Assistant Medical Director, Session Description: This session will review the pathophysiology and clinical
Nashville Fire Department features of how patients with a massive pulmonary embolism present in the
Session Description: This fast-paced lecture will focus on the lack of efficacy of field. Emphasis will be placed on the unique, telltale clues that will alert EMS
epinephrine in cardiac arrest, the current ineffectiveness of some aspects of the providers to suspect the problem early in their assessment. The speaker has a
ACLS algorithms and what systems are doing to improve their resuscitations unique perspective in that, within the last year, he suffered a sudden,
because of this, and take a look at the up and coming literature on VSE unexpected massive pulmonary embolus at home and received state-of-the-art
therapy (vasopressin/steroids/epi) in cardiac arrest as well as antibiotics treatment in the field, during transport, and at his regional tertiary care
post-ROSC to improve survival. medical center where the diagnosis was quickly confirmed with
echocardiography, he was immediately bolused with tPA and heparin, he was
placed on extracorporeal membrane oxygenation (ECMO) in the emergency
Shock Trauma: Point of Care Testing in the Field department, and brought emergently to the operating room for an open
NREMT: TRAUMA embolectomy. In this session, the speaker will review the “do’s and don’ts” of
DATE: 02/25/2016, TIME: 9:15 AM - 10:15 AM field management of such patients and will describe the state-of-the-art
Pratik Das, Clinical Researcher, BS, NRP regional system that he helped put in place in Richmond, Virginia that literally
Session Description: Learn about how Shock Trauma’s Point of Care Testing saved his life.
(POCT) study is focusing on the use of tissue oximetry and lab values such as
lactate, base excess, glucose, and hemoglobin to predict the need for a blood
Noninvasive Positive Pressure Ventilation
transfusion or other life-saving interventions for a patient in hemorrhagic shock
in the field. The POCT present goal of the study is to demonstrate the Changing the Respiratory Prehospital of
feasibility of POC testing and tissue oximetry for adults in an aeromedical Ventilation and Intubation
environment. The study is currently utilizing three of the MSP Trooper NREMT: ABC
Aeromedical helicopters to test the iStat device and StO2 detector devices to DATE: 02/25/2016, TIME: 10:30 AM - 12:00 PM
find indicators of patient severity and predict patient outcome. Randy Budd, EMS Captain, Mesa Fire and Medical
Session Description: Noninvasive Positive Pressure Ventilation (NPPV) has been
ALS Assessment Tricks successfully applied to many different respiratory illnesses in the out of hospital
NREMT: ABC, MED setting: this includes COPD, pneumonia, HF, asthma, bronchitis and the DNR
DATE: 02/25/2016, TIME: 9:15 AM - 10:15 AM patient. The impact that this modality has had on the health care system is
Twink Dalton, RN, EMS Education Coordinator, Mountain View Fire larger than many anticipated. Mesa has been following up with their receiving
hospitals to collect patient outcomes throughout their stay at the hospital until
and Rescue
discharge and will present their data at this session. A case study will be
Session Description: Ever wonder why some people seem to know what’s
presented and comparing the old paradigm of intubation VS the application of
wrong with the patient even though you heard the same information and
NPPV. This powerful session will present the most up to date patient outcomes
didn’t have a clue? A lucky guess? Maybe, but it’s more likely due to a finer
from the application of NPPV in Mesa Arizona’s progressive EMS system. This
knowledge of the significance of certain assessment findings in relation to
will include how many prehospital elective intubations have been prevented
body systems. This innovative presentation looks at assessment in terms of
and why Mesa crews have selected to provide NPPV over CPAP. A case study
how the body reacts and ties that into our assessment tools, such as ECG
will be presented and comparing the old paradigm of intubation VS the
findings, EtCO2, description of pain or discomfort and even the effect of
application of NPPV. In addition, a proven off-line algorithm that can be
common home meds on the response of the body to other diseases or
modified to meet your agency’s needs pending medical directors support will
conditions. Come to this session and you’ll never look at assessment the
be shared.
same way again!
Management and Assessment of Blunt Force

Trauma
NREMT: TRAUMA
DATE: 02/25/2016, TIME: 10:30 AM - 12:00 PM
Andrew Dennis, DO, FACS, FACOS, DME, Senior Trauma and Burn
Surgeon, Cook County Illinois Trauma Unit
Session Description: Join Dr. Andrew Dennis, a trauma and burn surgeon at
Cook County (Ill.) Hospital’s elite Trauma Burn Unit, one of the largest and
highest volume trauma and burn centers in the United States, as he discusses
the management and assessment of blunt force trauma patients. Coming
from such a busy and prestigious trauma center, you won’t want to miss Dr.
Dennis’ dynamic lecture!

Flash Pulmonary Edema - Drowning in Dogma or Saving Exsanguinating Trauma Patients with
Death-defying in Discovery? Hypothermia and Cardiopulmonary Bypass
NREMT: ABC NREMT: ABC, TRAUMA
DATE: 02/25/2016, TIME: 1:30 PM - 2:45 PM DATE: 02/26/2016, TIME: 8:30 AM - 10:00 AM
Jeffrey Goodloe, MD, Medical Director, Medical Control Board, EMS Samuel Tisherman, MD, Professor of Surgery, University of Maryland
System for Metropolitan Oklahoma City/Tulsa Session Description: Trauma patients who exsanguinate to the point of cardiac
Session Description: In recent years, prehospital CPAP and Bi-Level PAP, collective arrest almost never survive, despite aggressive resuscitative efforts, including
NIPPV, have proven to be excellent tools in treating our patients with CHF airway management, fluid resuscitation and ED thoracotomy. Surgeons often
exacerbation-related acute pulmonary edema. Yet, how many of us are still can’t stop the bleeding in time. Now, Emergency Preservation and Resuscitation
administering furosemide and/or morphine, and administering doses of (EPR), utilizing rapid cooling, has been developed to buy time for the surgeon to
nitroglycerin more appropriate for an angina patient than someone who is control bleeding. Cardiopulmonary bypass would then be used for delayed
profoundly hypertensive and drowning in their own fluids? This presentation will resuscitation. Attend this cutting-edge session to learn how Dr. Tisherman and his
examine the safety and efficacy of more aggressive dosing of nitroglycerin: colleagues at the world-renowned RA Cowley, Shock Trauma Center are working
sublingually, in intravenous infusions, and yes, even boluses with a syringe. If to develop EPR and enable us to save trauma patients that would otherwise die
you’re still squirting one spray of nitro under your patient’s tongue every 3-5 from their injuries.
minutes and wondering why your patient isn’t responding, this presentation is
for you. How Capnography is Saving Lives
NREMT: ABC
The Most Important Published Articles for EMS DATE: 02/26/2016, TIME: 8:30 AM - 10:00 AM
Providers 2015-2016 Mike McEvoy, RN, EMT-P, PhD, EMS Coordinator, Saratoga County,
NREMT: ELECTIVE New York
DATE: 02/25/2016, TIME: 1:30 PM - 2:45 PM Session Description: Capnography has been used to monitor placement of
Corey Slovis, MD, Professor, Emergency Medicine, Vanderbilt endotracheal tubes, determine the effectiveness of CPR and assess bronchospasm
University Medical Center in asthmatics. However, this case-based presentation will illustrate use of
Session Description: Dr. Slovis will review recently published articles from the waveform end-tidal CO2 monitoring to rule out pulmonary embolism, assess
peer reviewed literature that are either practice changing and/or important to cardiac output, evaluate ventilator asynchrony, recognize DKA and titrate
know about for EMS providers. Ten to 20 articles will be discussed and non-invasive ventilation such as CPAP or BiPap. This fast-paced session will help
commented upon. you better understanding how capnography waveforms can help you improve
care for critically ill patients.
Important Considerations When Choosing Ventilation
Why Mechanical CPR Use Makes Sense
Devices NREMT: ABC
NREMT: ABC
DATE: 02/26/2016, TIME: 1:15 PM - 2:15 PM
DATE: 02/25/2016, TIME: 1:30 PM - 2:45 PM
Joe Holley, MD, EMS Medical Director, Memphis Fire Department &
Randy Budd, EMS Captain, Mesa Fire and Medical
Director, Paragon Medical Education Group
Session Description: In this information-packed session you will be presented
Session Description: The era of calling codes after 20 minute of resuscitative
with information to help you determine what type of device will best fit the
efforts is over, with many cases of successful resuscitation of cardiac arrest
needs of your EMS system. This will include a non-bias evaluation form that can
patients for more than two hours, from crew arrival to final resuscitation in the
be utilized in the selection of ventilation devices. This will includes different
cardiac catherization lab at a specialty center. Resuscitation data is beginning to
modes and capabilities, size, weight, battery life, etc. You will also be presented
show that traditional, manual CPR is no longer able to produce the same results
with a general review of mechanical ventilator terminology/physiology and what
as machines on scene, during patient packaging and transfer, and while in moving
all these modes and technologies are used for. This will give you a better idea of
ambulances. This session will explain how the Memphis Fire Department and
what is best suited for your budget and training abilities. You will leave
many other EMS/fire agencies are using mechanical CPR devices to not only
prepared to select a device that should best fulfill your needs for many years.
improve their return of spontaneous circulation (ROSC) results but also the
Projecting the evolution of NPPV should also be considered when selecting new
number of patients discharged with little or no neurological deficit.
ventilation devices as well as the benefits of providing training in segmented
role outs; first Invasive/CPAP then NPPV. If you are considering prehospital
ventilation please attend. Traumatic Fractures & Dislocations - Assessment,
Management and Pitfalls
NREMT: TRAUMA
DATE: 02/26/2016, TIME: 2:30 PM - 3:30 PM
Edward Dickinson, MD Professor, Emergency Medicine, Perelman
School of Medicine, University of Pennsylvania
Session Description: Join JEMS Medical Editor and board-certified emergency
physician Ed Dickinson for a close up look at traumatic fractures and dislocations.
Learn how to assess and treat these often gruesome and complicated injuries
from the perspective of a seasoned field provider, emergency physician and EMS
and Aeromedical program medical director who sees them on a daily basis in the
field and in the ED at a busy trauma center.

Rethinking Our Approach to Ventricular Fibrillation Direct Laryngoscopy and Video Laryngoscopy:
NREMT: ABC Is There a Difference?
DATE: 02/26/2016, TIME: 2:30 PM - 3:30 PM NREMT: ABC
John Freese, MD, Director of Prehospital Research, Fire DATE: 02/27/2016, TIME: 8:30 AM - 9:45 AM
Department of New York Kevin High, RN MPH MHPE EMT, Vanderbilt Dept of Emergency
Session Description: As systems look to implement the 2015 AHA Guidelines, Medicine/LifeFlight, Nashville, TN
it’s important to remember that they are “guidelines” and not the Session Description: Video laryngoscopy (VL) has emerged as a leading
unquestionable standard of care. And when it comes to the patients most technology in EMS; yet many EMS providers continue to use conventional
likely to survive – those who present in ventricular fibrillation (VF) – that direct laryngoscopy (DL) to perform intubation. There are a myriad of devices
distinction is important. In this cutting-edge session, the mechanics,
on the market along with differing techniques needed for each; all the while
electrophysiology and current treatment recommendations for ventricular DL continues to be used with varying efficacy. The debate of the value of video
fibrillation will be reviewed. Then, Dr. Freese will answer additional questions in laryngoscopy when compared with conventional direct laryngoscopy rages;
an open discussion of VF treatment options. Should EMS-witnessed VF always which is better? Is there a difference in success? This presentation will review
be immediately defibrillated? Are there patients for whom CPR prior to the skill set, currently available devices and how/why you should consider
defibrillation might be beneficial? Does the quality of CPR provided change VF? implementing VL into your own practice.
What is the difference between refractory and recurrent VF? Is the VF
“algorithm” too simple? This important session will present the latest
Innovations in Out-of-hospital Management of
information about VF and leave you with common sense ways to apply this
knowledge to improve patient outcomes. Pediatric Asthma
NREMT: ABC
What the New AHA Guideline Changes DATE: 02/27/2016, TIME: 8:30 AM - 9:45 AM
Robert Silverman, MD, Associate Professor of Emergency Medicine,
Mean for EMS
Hofstra University School of Medicine, Long Island Jewish Medical
NREMT: ABC
Center
DATE: 02/26/2016, TIME: 2:30 PM - 3:30 PM
Manish Shah, MD, Assistant Professor in Pediatrics, , Baylor College
Joseph Ornato, MD, Medical Director, Richmond Ambulance
of Medicine
Association and Professor & Chairman, Dept. of Emergency
Andrew Stevens, MD, Assistant Professor of Clinical Emergency
Medicine, Virginia Commonwealth University
Session Description: This session will review the new American Heart Medicine, Indiana University School of Medicine
Association basic and advanced life support guidelines as they pertain to EMS Session Description: Asthma-related respiratory distress is one of the most
care. Special emphasis will be placed on reviewing the scientific evidence commonly encountered pediatric medical emergencies in the out-of-hospital
behind each of the major guideline issues and changes. There will be a setting. It’s the third leading cause of hospitalization for children under the age
description of the evidence-based process used to develop these guidelines as of 15, accounting for more than 600,000 emergency department visits and
well as the system used to describe the strength of the evidence. Topics include billions of dollars in health care costs. A panel of leading researchers in EMS,
the science behind the current recommendations on what constitutes high pediatric emergency medicine and current EMS for Children Targeted Issue
quality CPR, controversies in ACLS drug therapy including the use of grantees will discuss innovations in pediatric out-of-hospital asthma care.
epinephrine, prehospital therapeutic hypothermia strategies, and state-of-the- Specifically, the panelists will engage the audience in a well-rounded discussion
art use of capnography. on the management of asthma from the development and implementation of
evidence-based guidelines, to early administration of oral steroids and the
development and implementation of a pediatric community paramedicine
EMS TXA 2016 in the USA program to identify gaps in pediatric asthma care, reduce ED recidivism,
NREMT: ABC, TRAUMA improve pediatric health outcomes, and enhance paramedic provider roles in
DATE: 02/26/2016, TIME: 3:45 PM - 5:15 PM the delivery of patient care.
Jeffrey Goodloe, MD, Medical Director, Medical Control Board,
EMS System for Metropolitan Oklahoma City/Tulsa He Has a “Who-What-Where?” The ABC’s of
Session Description: Tranexamic acid (TXA) is increasingly finding a role in the
Managing the Technology Dependent Patient
EMS management of traumatic hemorrhagic shock resuscitation. Whether you
NREMT: ABC
are discovering TXA or already using it as standard of care, this session will be
of interest in updating the latest discoveries of its uses and addressing its DATE: 02/27/2016, TIME: 2:15 PM - 3:15 PM
potential controversies. Dr. Goodloe will address the basics of TXA, cover the Dana Clarke, RN, BSN, CFRN, EMT-P, EMS Faculty, Houston
landmark research responsible for its growing adoption in EMS medicine, and Community College
discuss the latest in evidence-based recommendations for TXA that are Session Description: What do you do when you arrive on scene for a “routine”
relevant to EMS professionals. Bring your TXA related questions for a rousing patient, only to find that he has “gadgets,” lines or machines that you’ve never
round of Q&A that will give you empowering answers. seen? This lecture will assist you in taking some of the stress out of managing
the technology-dependent patient. Managing tracheostomies, central lines and
(everyone’s favorite) cardiac assist devices, just to name a few, will be
discussed. Dana Clarke will also review some care techniques or concerns
unique to these types of patients. The purpose of this lecture is to raise your
awareness and increase the comfort level of the EMS professional rendering
aid to these patients. There will be actual devices at this session that you will
be able to touch and examine to gain a better understanding of how they
work (and how to operate them when necessary.

Ventilation 2016 – The Good, the Bad and MCI’s Involving Senior Citizens
the Ugly of O2 NREMT: OT
NREMT: ABC DATE: 02/27/2016, TIME: 1:00 PM - 2:00 PM
DATE: 02/27/2016, TIME: 11:00 AM - 12:30 PM David Miramontes, MD, Medical Director, San Antonio Fire
Michael Gooch, Flight Nurse and Instructor in Nursing, Vanderbilt Department
University, Nashville Session Description: Join San Antonio Fire Department Medical Director David
Session Description: Oxygen is good. Oxygen is bad, Can it be ugly? The answer Miramontes, MD, for an interesting and thought-provoking review of an MCI at
depends on the patient and the scenario. From day one of EMT class we were all the Wedgwood Senior Apartments in Castle Hills, Texas early on a cold December
taught the importance of oxygen. But does every patient need a supplemental morning in 2014. Dr. Miramontes will discuss important considerations such as
supply of it? How and why should we change old habits when guidelines now call assessment, transportation, evacuation center operations, retrieval and return of
for less oxygen being delivered to our patients and the use of pulse oximetry and medications and possessions, as well as temporary shelter medical care and
capnography to adjust delivery to our patients? During this presentation, the community medicine response.
concept of apneic oxygenation (nasal oxygen delivery during intubation), delayed
sequence intubation, and the newest evidence regarding the risk of hyperoxia in Common Sense EMS: Eases for the Little Ones’
patients with ischemia will be reviewed. In addition, the importance and role of Wheezes
capnography and its implications in prehospital care and transport will be NREMT: OB/PEDS
discussed.
DATE: 02/27/2016, TIME: 1:00 PM - 2:00 PM
John Freese, MD, Director of Prehospital Research, Fire Department of
How Internal Thoracic Pressure Changes Enhance New York
the Resuscitation of Cardiac Arrest Patients Session Description: As one of the most frequent pediatric medical emergencies,
NREMT: ABC childhood asthma is a disease encountered by BLS and ALS providers in all
DATE: 02/27/2016, TIME: 8:30 AM - 9:45 AM systems. Yet, in many of those systems the care that EMTs and paramedics can
David Miramontes, MD, Medical Director, San Antonio Fire provide is limited to inhaled medications such as albuterol. This session will review
Department the physiology of pediatric asthma and, based upon an understanding of that, will
Session Description: This cutting-edge resuscitation session will explain how to suggest a common sense approach to treatment strategies for prehospital
harness the body’s internal pressure to increase cardiac perfusion and decrease pediatric asthma care including alternative inhaled medications, corticosteroids,
intracranial pressure – both critical features in the resuscitation of cardiac arrest epinephrine and others. These treatments will be considered, including indications
and trauma patients. Dr. Miramontes will explain how this occurs in the body and and contraindications, in an interactive session utilizing real cases as the
how impedance threshold devices (ITDs) such as the ResQPod and ResQGuard foundation from which to discuss the science behind prehospital care for such
assist in making this happen in conjunction with quality, consistent, uninterrupted patients. In addition, data will be presented from an on-going EMS-C grant-
compression CPR. Dr. Miramontes will also show how the FDA-approved ResQ funded program that seeks to apply this type of common sense approach to
PUMP can now assist in this process and can increase ROSC results. You’ll be pediatric asthma care in one of the country’s busiest EMS systems.
amazed at how much positive impact changes in internal body pressure can
produce Overdose by Designer Drugs: Death in Teens/Young
Adults – A New Public Health Threat
That Doesn’t Belong There: Misadventures in NREMT: MED
Prehospital Procedures DATE: 02/27/2016, TIME: 2:15 PM - 3:15 PM
DATE: 02/27/2016, TIME: 11:00 AM - 12:30 PM Panelists: Benjamin Lawner, MD, Assistant Professor, University of
Kevin High, RN MPH MHPE EMT, Vanderbilt Dept of Emergency Maryland School of Medicine
Medicine/LifeFlight, Nashville, TN Matthew Levy, MD, Medical Director, Howard County (MD)
Session Description: Needles, catheters and tubes sometimes end up in places Department of Fire and Rescue
where they don’t belong. How do they get there? What clinical and educational Kevin Seaman, MD, Executive Director,
techniques can we use to prevent things like this from occurring in the field? This Maryland Institute for EMS Services
important presentation focuses on actual patient cases, supported by clinical Session Description: Electronic dance music is the most prevalent genre of music
images and video, where a device was used improperly. Each case will present you being booked at concert venues across the country. The audience that attends
with teaching points around indications, contraindications and cause analysis. these concerts is primarily ages 16 – 24. Concert goers seek a psychedelic/
Special focus will be placed on system/education error management to prevent hallucinatory experience and have turned to “designer drugs” including:
such errors in the future. methamphetamines (MDMA/ecstasy and derivatives), hallucinogens (LSD, NBOMe,
etc.) and Molly. In addition to the hallucinatory effect, these compounds cause an
excited delirium characterized by life-threatening fever, agitation, tachycardia,
hypertension. At least 10, and possibly more, patients have died at these concert
events nationwide. Correct EMS treatment is critical and time dependent.
Evidence-based best practice strategies for EMS treatment will be discussed as
well as the experience of EMS crews at concert venues in Maryland that involved
two fatalities. The panel will discuss actions to prevent further mortality including
primary prevention as well as standardized evidence-based treatment protocols.

Speed Bumps and Roadblocks on the Journey to

Prehospital Analgesia
NREMT: TRAUMA, MED
DATE: 02/27/2016, TIME: 3:30 PM - 4:30 PM
Keith Wesley, MD, Medical Director, HealthEast Medical
Transportation
Session Description: Pain is one of the most common reasons why people
request EMS. So what should your goal be? How much pain relief is sufficient?
How do you measure a patient’s level of pain? What medications should you use
and by what route? What if you suspect the patient is a “seeker”? Don’t vital
signs change with pain? What if the patient refuses your medication offer?
Under what conditions should you withhold analgesia? Can the medications do
more harm than good? What do you say to ED staff who chastise you for giving
pain meds and “masking” symptoms? These and many others important
questions will be addressed in this presentation by Dr. Wesley as he explains his
successful implementation of pre-hospital analgesia processes and procedures in
his St. Paul service.
Basics of Clinical Practice Track
Track Description: Topics for all emergency providers; presenting information that will benefit all responders.
Latest Drugs of Abuse/Testing of EMS Personnel HOT Patients: The Many Faces of Hyperthermia
for Marijuana NREMT: MED
NREMT: MED DATE: 02/25/2016, TIME: 8:00 AM - 9:00 AM
DATE: 02/25/2016, TIME: 8:00 AM - 9:00 AM Twink Dalton, RN, EMS Education Coordinator, Mountain View Fire
Christopher Colwell, MD, FACEP, Medical Director, Denver and Rescue
Paramedic Division and Denver Fire Dept.; Chief of Emergency Session Description: Heat-related emergencies are not always clear cut and
Medicine, Denver Health Medical Center; and Vice Chair, when combined with other factors, such as underlying medical issues or
trauma, treatment can be a balancing act. This insightful presentation by
Emergency Medicine, University of Colorado School of Medicine
veteran educator Twink Dalton will present these factors through a variety of
Session Description: As people in the communities we serve search for the
case presentations where knowledge of past medical history and assessment
ultimate high, experimentation with new forms of intoxicating drugs continues
findings made all the difference to patient outcome.
to challenge EMS providers to find ideal management and treatment
strategies. This discussion will review the latest drugs of abuse, the impact
these drugs have on the patients we are caring for, and recommended
approaches to treatment. This lecture by Denver physician and medical director
Chris Colwell will also include the challenges Colorado has faced in this area
with the legalization of marijuana, and the approach to testing of EMS
personnel for what are now legal but still potentially altering substances.

Improving Traumatic Brain Injury (TBI) Care - The Prehospital Care Research Forum Oral Presentation
Arizona EPIC Project Luncheon
NREMT: TRAUMA NREMT: ELECTIVE
DATE: 02/25/2016, TIME: 8:00 AM - 9:00 AM DATE: 02/25/2016, TIME: 12:00 PM - 1:30 PM
John Tobin, Captain, Mesa Fire/Medical Department Baxter Larmon, PhD, UCLA Center for Prehospital Care & Research
Session Description: The Centers for Disease Control & Prevention reports Forum
Traumatic Brain Injury as a major health problem that is affecting young and old Session Description: The Prehospital Care Research Forum will present an
alike. It is also a major issue with military veterans returning from combat after overview of its annual research program showcasing important EMS topics
being exposed to roadside bombs. Identification of TBI can be much more elusive through poster presentations. Four of the top abstracts submitted to PCRF will be
for EMS providers than previously thought. You have most likely run onto many presented by their authors. Note: Lunch will be provided to the first 75 people
more TBI’s than you ever imagined. The Arizona EPIC Project is a NIH funded, scanned in at the door. CEH is given for this lunch.
statewide initiative to implement the Brain Trauma Foundation guidelines and
track the results. In this interactive session you will learn how to identify a possible PCRF Research Roundtable
TBI patient and provide the most current, Evidence-based treatments. Many
NREMT: ELECTIVE
treatments we have done for years get thrown out the window! You’ll also learn
DATE: 02/25/2016, TIME: 1:30 PM - 2:45 PM
how Arizona implemented this program to over 10,000 EMS providers state-wide.
Baxter Larmon, PhD, UCLA Center for Prehospital Care & Research
Forum
Active Compression/Decompression CPR Session Description: The Prehospital Care Research Forum annually presents
NREMT: ABC posters on important research at EMS Today. In this session, this year’s poster
DATE: 02/25/2016, TIME: 9:15 AM - 10:15 AM presenters will each give a 5-minute report on the results of their research. Note:
Jeffrey Goodloe, MD, founder, Chief Medical Officer and Chairman of Before the session, please review the posters on display in the lobby so you can
the Board of Advanced Circulatory Systems and a practicing cardiac discuss the authors’ research.
electrophysiologist
Keith Lurie, MD, founder, Chief Technical Officer, Child Abuse and Neglect for the Prehospital Provider
ZOLL Medical and a practicing cardiac electrophysiologist NREMT: OB/PEDS
Session Description: Advances in sudden cardiac arrest resuscitation are some of DATE: 02/25/2016, TIME: 1:30 PM - 2:45 PM
the most exciting discoveries in the practice of EMS medicine. Active Lisa A. Drago, DO, FAAP, Assistant Professor of Pediatrics and
compression/decompression CPR helps us to better understand the perfusion
Emergency Medicine Cooper Medical School of Rowan University
challenges we face in bringing the suddenly dead back to neurologically intact life
Pediatric Medical Director Division of EMS, Disaster, and Transport
and to better overcome those challenges. Dr. Keith Lurie, renowned cardiologist
and the leading researcher in intrathoracic pressure regulation in EMS Medicine Department of Emergency Medicine Cooper University
resuscitation, and Dr. Jeffrey Goodloe, medical director for America’s initial Hospital
adopter of Active Compression/Decompression CPR in addition to the use of an Session Description: EMS providers are often in a unique position to observe
impedance threshold device (ITD) during cardiac arrest resuscitations, will discuss children in their home environment and can provide critical information to
the science and street use of this exciting new CPR adjunct. Come prepared to hospital and law enforcement personnel that’s necessary to identify children at
learn about these emerging discoveries that will equip you with real answers for risk for child abuse and neglect. This presentation will identify risk factors and
your cardiac arrest patients. injury patterns concerning for abuse. We will discuss common mimics that are
often mistaken for abuse. The audience will review cases and discuss the
appropriate approach and management of these children.
Understanding Shock: 2016
NREMT: TRAUMA
DATE: 02/25/2016, TIME: 10:30 AM - 12:00 PM
Bryan Bledsoe, DO, FACEP, FAAEM, Professor of Emergency Medicine,
University of Nevada
Session Description: Nineteenth-century trauma surgeon Samuel Gross once
described shock as “the rude unhinging of the machinery of life.” Today we know
that shock is not a single syndrome but a complex pathophysiological process that
involves an oxygen supply/demand imbalance that can have various causes. This
presentation by EMS textbook author Bryan Bledsoe will review the current
understanding of shock from the emergency perspective with an emphasis on
early prehospital recognition.

Lightning Round: Ask the Eagles Considerations for Field Amputations: A First-hand
NREMT: ELECTIVE Perspective
DATE: 02/26/2016, TIME: 8:00 AM - 10:00 AM NREMT: TRAUMA
Panel Moderator: Paul E. Pepe, Professor and DATE: 02/26/2016, TIME: 10:15 AM - 11:45 AM
Regional Director, Out-of-hospital Mobile Care Systems, Melissa Kohn, MD, MS, FACEP, EMT-PHP, is a Pennsylvania certified
University of Texas Southwestern Medical Center at Dallas prehospital physician and emergency department physician at
Panelists: Christopher Colwell, Chief of Emergency Medicine, Einstein Medical Center in Philadelphia, PA.
Denver Health Medical Center, Vice Chair, Emergency Medicine, Session Description: Field amputations are rarely the role of prehospital
University of Colorado School of Medicine providers; they are usually performed by physicians dispatched to the scene
from trauma centers. But, when the need for a field amputation is thrust upon
Jeffrey Goodloe, Medical Director, Medical Control Board, EMS
your crews, EMS supervisors and incident commanders, things have to happen
System for Metropolitan Oklahoma City/Tulsa fast and in a coordinated manner: Where do you rapidly obtain an amputation
Joe Holley, EMS Medical Director, Paragon Medical Education team?; How will they be dispatched and escorted rapidly to the scene?;
Group What equipment will the team bring with them?; What equipment will they
David Miramontes, MD FACEP NREMT, Medical Director San need from EMS/fire/rescue when they arrive?; How will the amputation be
Antonio Fire Department, Assistant Clinical Professor, University of orchestrated and performed; and What will be the role of on scene EMS
personnel and rescuers during the procedure? A systematic approach is
Texas Health Science Center- San Antonio
necessary for the patient to survive. Join seasoned prehospital physician,
Michael Levy, MD, Medical Director, Anchorage Fire Department Melissa Kohn, also an emergency medicine physician at Einstein Medical
Joseph Ornato, Virginia Commonwealth University Center in Philadelphia as she addresses these areas, and more, using her
personal experience in the performance of a field amputation on a section of
Corey Slovis, Professor, Emergency Medicine,
railroad tracks in Philadelphia – in the dark at 2:45 AM – and in 100 degree
Vanderbilt Univ. Med. Center heat in late July 2015.
Peter Taillac, Medical Director, Bureau of EMS and Preparedness,
Utah Department of Health Behavioral Medicine in EMS 2016
Session Description: Major Metropolitan EMS Medical Directors Consortium NREMT: MED
(“EAGLES”) panelists are some of the nation’s most influential medical DATE: 02/26/2016, TIME: 1:15 PM - 2:15 PM
directors. In this super session they will present new trends and controversies in
David Glendenning, Education Coordinator, New Hanover
prehospital medicine and allow for plenty of time for audience questions.
Regional EMS
Session Description: EMS providers are dealing with a new crisis in healthcare.
Spinal Trauma Update Behavior management is moving quickly to the top as one of the most
NREMT: TRAUMA underestimated needs in our patient population and from within our own
DATE: 02/26/2016, TIME: 8:30 AM - 10:00 AM ranks. This presentation will take you into the history of behavioral medicine,
Bryan Bledsoe, DO, FACEP, FAAEM, Professor of Emergency challenges EMS providers are being faced with in the field in managing and
Medicine, University of Nevada finding care sites for patients with behavioral problems and where we need to
Session Description: Spinal injuries can be devastating. During this be headed today and in the future.
presentation EMS textbook author, Bryan Bledsoe, DO, we will review the
anatomy and physiology of the spine and associated structures. He will Implementation of a Prehospital Evidence-based
then discuss the more commonly encountered spinal injuries and their Guideline
treatment. Particular emphasis will be placed on changes in prehospital and
NREMT: ELECTIVE
emergency department care with reduced emphasis on the use of
DATE: 02/26/2016, TIME: 1:15 PM - 2:15 PM
spineboards in the field.
Peter Taillac, MD, Medical Director, Bureau of EMS and
Preparedness, Utah Department of Health
Geriatric Trauma: When Grandma Got Hurt Session Description: Evidence-based EMS clinical guidelines (EBGs) are being
NREMT: TRAUMA developed which will give EMS providers “best practice” protocols that are
DATE: 02/26/2016, TIME: 8:30 AM - 10:00 AM based on the current literature and which have been subjected to expert
Twink Dalton, RN, EMS Education Coordinator, Mountain View Fire review. The implementation of these guidelines can be a challenge. This lecture
and Rescue will review the experience of implementing a new EBG in five states with a
Session Description: The geriatric population is growing as the “baby variety of EMS infrastructures. The challenges to implementation and the best
boomers” age. This population group has specific characteristics that alter practices for adopting these innovative practices will be discussed. These
their ability to compensate and ability to recognize what’s going on and lessons learned can be used by EMS agencies to facilitate the adoption of new
impacts our treatment decisions. This session will address the characteristics of EBGs as they become available.
aging, the impact of pre-existing conditions, the overall impact on
compensatory mechanisms and assessment, and finally how all that affects our
treatment decisions. This will be a fun and interesting inter-active
presentation.

What a Mess: Managing the Mangled Extremity EMS Pearls on Hydration, Cooling and Recovery in
NREMT: TRAUMA Firefighter Rehab
DATE: 02/26/2016, TIME: 2:30 PM - 3:30 PM NREMT: MED
Raymond Pensy, MD, Associate Professor, University of Maryland DATE: 02/26/2016, TIME: 3:45 PM - 5:15 PM
School of Medicine Mike McEvoy, RN, EMT-P, PhD, EMS Coordinator, Saratoga County,
Session Description: The management of patients with mangled extremities New York
following trauma can be challenging. Often these patients have ongoing Session Description: A revised version of NFPA 1584: Standard on the
hemorrhage, pain and associated injuries beyond their extremity injury. This Rehabilitation Process for Members During Emergency Operations and Training
presentation outlines the overall management and treatment of these patients Exercises published in 2015 this session will review the fire service rehab
including managing hemorrhage, realignment and stabilization and specific experience and developments in sports medicine that have changed our
techniques aimed at maximizing the chance for limb salvage. Three patient cases understanding of hydration, nutrition, cooling and exercise physiology.
with accompanying clinical images will be used to highlight management and Understand shifting emphasis away from sports drinks, the reintroduction of
treatment techniques. It is paramount that EMS clinicians be prepared to manage caffeine and a new ban on use of energy drinks by firefighters. Gain important
and treat these injuries in the setting of multiple trauma. insight into new evolving strategies for passive cooling of firefighters and practical
methods for rest and recovery in rehab. Learn about changes in vital signs and
Destination Dilemmas in Pediatric Trauma Transport new assessment parameters for use in rehab.
NREMT: OB/PEDS
DATE: 02/26/2016, TIME: 2:30 PM - 3:30 PM The Hardest Call: Education for the Field Termination
Jennifer Anders, Attending Physician, Pediatric Emergency Medicine, of Resuscitation in Children (The COPE Project)
Johns Hopkins Hospital NREMT: OB/PEDS
Kathleen Brown, Medical Director, Emergency Department, Children’s DATE: 02/26/2016, TIME: 3:45 PM - 5:15 PM
National Medical Center Peter Taillac, MD, Medical Director, Bureau of EMS and Preparedness,
Joelle Simpson, Physician, Children’s National Medical Center Utah Department of Health
Jennifer Fishe, Pediatric Emergency Medicine Fellow, Johns Hopkins Session Description: Dealing with the unexpected death of a child in the field is
Hospital one of the nightmare scenarios for EMS. The COPE (Compassionate Options for
Session Description: A child has fallen off monkey bars and has an obvious severe Prehospital Education) project is a federally funded project to provide specific
fracture, but this does not fit into your local pediatric trauma protocol. A toddler pediatric end-of-life training for prehospital care providers to better equip them to
with multiple chronic medical problems struck her head but is stable. Should she deal with these rare and stressful situations. This lecture will provide an overview
go to the closest local facility or to the pediatric center where all her specialists are of pediatric termination of resuscitation concepts, a brief overview of the legalities
located? This interactive workshop and panel, as well as an active Q&A session, involved, and introduce the COPE training modules, which will be provided to
will address dilemmas in applying the CDC trauma triage guidelines to pediatric EMS agencies free of charge.
patients. Led by a panel of pediatric emergency medicine physicians from Johns
Hopkins and Children’s National Hospital, this interactive session offers practical Spinal Cord Injury Assessment and Care from
solutions for you and your patients. Through a small group workshop, participants One of Our Own
will engage each other and the panel to resolve hypothetical scenarios. A Q&A
NREMT: TRAUMA
session with the panel will answer any questions you have about how to get
DATE: 02/27/2016, TIME: 8:30 AM - 9:45 AM
children “the right care, at the right time, when it counts.”
Andrew Ecker, Paramedic, Virtua Health, New Jersey
Session Description: Join Andrew Ecker for a lecture you will never forget. A
State of the Art: The Best seasoned EMS provider and spinal cord injury survivor, Andrew will teach you
Research From the 2016 spinal cord injury assessment and care from a first-hand perspective. A paramedic
NAEMSP Annual Meeting with Virtua Health in New Jersey, Andrew suffered a C5 burst fracture and instant
NREMT: ELECTIVE paralysis from a traumatic spinal cord injury (spinal hemitransection) in a diving
DATE: 02/26/2016, TIME: 3:45 PM - 5:15 PM accident when he was 18-years old. He was suffering from textbook neurogenic
Jon Rittenberger, MD, Associate Professor, University of Pittsburgh, shock, making the prospect of spinal fusion surgery risky and terrifying. During
surgery, he went into cardiac arrest but was revived and had his C4–C6 fused
Department of Emergency Medicine
successfully. After a long road to recovery, including extensive rehabilitation,
Paul Rostykus, MD, MPH, EMS Medical Director for Jackson County
suffering multiple pulmonary embolisms and having multiple seizure episodes, he
(Oregon) EMS Agencies spent six months as a complete quadriplegic, but he never gave up. After a year
Session Description: The National Association of EMS Physicians (NAEMSP) annual of hard work Andrew recovered to a point that he was considered a medical
meeting has become one of the premier venues for EMS researchers to present miracle. He went on to become a paramedic and obtain his FP-C and CEN, and
their current work. This session will highlight the top-rated and most impactful eventually earning his bachelors in EMS management from George Washington
original EMS research presented at the 2016 NAEMSP Annual Meeting. Since University. Two years ago he became an RN and is now pursuing his masters as a
there is a significant lag time (in some cases more than a year!) from a study nurse practitioner. Despite suffering from Brown-Séquard syndrome and deficits
being completed until it is actually in print in a peer-reviewed journal, this to both hemispheres of his body, Andrew is a vital part of the Virtua EMS System
presentation offers a sneak peek at some of the most significant new EMS science and serves as a member of the Virtua JEMS Games team. You won’t want to miss
prior to publication. his compelling lecture on spinal cord injury and management from the other side
of the stretcher.

Life in the Fast Lane! Rapid Fire Highlights First Responder Stress Resiliency: How to Reduce
From the 2016 NAEMSP Annual Meeting That Can Lead to Provider Suicide
NREMT: ELECTIVE NREMT: ELECTIVE, OT
DATE: 02/27/2016, TIME: 1:00 PM - 2:00 PM DATE: 02/27/2016, TIME: 3:30 PM - 4:30 PM
Jon Rittenberger, MD, Associate Professor, University of Pittsburgh, Philip Callahan, Professor Emeritus, University of Arizona
Department of Emergency Medicine Session Description: You have read the headlines, “NIOSH: Police officers,
Paul Rostykus, MD, MPH, EMS Medical Director for Jackson County firefighters have highest rate of suicide.” First responders are immersed in
(Oregon) EMS Agencies suffering and loss. The expectation that we will not be changed is unrealistic.
Session Description: This fast-paced and informative presentation by key We can, however, manage this change and the inherent stresses. Resiliency is
officials from NAEMSP (National Association of EMS Physicians) will deliver the not the elimination of stress, but the development of the skills needed to
essential take-home messages from each of the non-research sessions from the manage stress in an optimal way. This session will look at how an organization
NAEMSP January 2016 annual meeting. can become a resilient community.
Behavioral Medicine in EMS 2016 Human Sex Trafficking

NREMT: MED NREMT: OT, ELECTIVE
David Glendenning, Education Coordinator, New Hanover Raymon Mollers, EMS Program Manager, DHS, OHA
Session Description: Human trafficking is a form of modern slavery where
Regional EMS
people profit from the control and exploitation of others. It is estimated that
Session Description: EMS providers are dealing with a new crisis in healthcare.
after drug dealing, trafficking is tied with the illegal arms industry as the
Behavior management is moving quickly to the top as one of the most
second largest criminal industry in the world today...bringing in more money
underestimated needs in our patient population and from within our own
annually than Google, Starbucks and Nike combined! Many times as EMS
ranks. This presentation will take you into the history of behavioral medicine,
providers, we are encountering patients who are being trafficked and don’t
challenges EMS providers are being faced with in the field in managing and
even realize the situation. The patients are treated, released and then forced
finding care sites for patients with behavioral problems, and where we need to
right back into a horrible situation. This presentation will shine some light on a
be headed today and in the future.
practice that is silent, but devastating.
Important Tales from Children’s Cribs

NREMT: OB/PEDS
DATE: 02/27/2016, TIME: 1:00 PM - 2:00 PM
Michael Gooch, Flight Nurse and Instructor in Nursing, Vanderbilt
University, Nashville, TN
Session Description: Pediatric patients make up only a small portion of the
patients EMS providers are dispatched to assist. However, these little patients
often present big nightmares and challenges for some EMS providers. Tales
from the Children’s Crib will cover common respiratory, GI, and other medical
problems that may be encountered and offer many assessment and care tips.
The goal of this session is to lessen those nightmares and bring peace from the
crib instead.
Pediatric C-spine Update

NREMT: OB/PEDS
DATE: 02/27/2016, TIME: 2:15 PM - 3:15 PM
Kathleen Brown, MD, Medical Director, Emergency Department,
Children’s National Medical Center
Joelle Simpson, MD, Physician, Children’s National Medical Center
Session Description: This session will provide updates on research on pediatric
c-spine injuries, immobilization and imaging. The lecture will focus on the
current Evidence-based practices and ongoing research in the area. It will
highlight controversies in pediatric c-spine management in the prehospital
setting and highlight recommendations for the management of children (at all
ages) with suspicion of c-spine injuries.

Community Paramedicine Track
Track Description: Topics that focus on the development, delivery, funding and
integration of programs with the rest of healthcare. All sessions will deliver important assessment and patient care practices to prevent
hospital readmissions, keep patient conditions from reoccurring or deteriorating. and prevent unnecessary illness or injuries from occurring.
Accredited Point of Care Testing: Arlington County Advance Practice

Why Should I Care? Paramedic Program
Kevin Collopy, Clinical Education Coordinator, Reed Smith, Operational Medical Director, Arlington
AirLink/VitaLink Critical Care Transport County Fire Department
Session Description: Mobile Point of Care Testing allows prehospital transport Kathleen Keller, PA-C, Assistant Medical Director,
teams to optimize patient care. Building POCT program takes time and Arlington County Fire Department
coordinated effort. This session discusses how a transport team can work Session Description: Arlington County Fire Department embarked into the world
cooperatively with a hospital’s lab to build a POCT program that provides both the of Mobile Integrated Health Care with a program called Advanced Practice
transport team and the accepting hospital unit with timely and valuable lab data Paramedics. This session will discuss the operations, training, implementation and
that can be used to impact patient care. Kevin Collopy will also discuss the process lessons learned in this particular model. Several of our APPs will give their first
of becoming accredited by the College of American Pathologists. Achieving lab hand experiences as pioneers of this program.
accreditation opens doors for your program including increased reimbursement,
patient cost savings in downstream care, the ability to share lab results with
hospitals, and increased reliability in lab data results.
One-on-One Roundtable Discussions
From Start to Finish: Learn How North Shore - LIJ CEMS DATE: 02/26/16; TIME: 8:00 AM - 10:00 AM
Session Description: Come and spend valuable time at this special 2-hour Super
Developed a Successful Mobile Integrated Healthcare Session where you will be able to choose fourof the eight topics offered by
(MIH) Program and the Future It Holds for EMS Community Paramedicine program experts and rotate to one of them every 30
DATE: 02/25/2016, TIME: 9:15 AM - 10:15 AM minutes during the 2-hour timeframe. This unique conference offering will allow
Jonathan Washko, Assistant Vice President, North Shore-LIJ Center you to get highly-focused education in an informal setting. Have your burning
for EMS, United States questions answered by MIH/CP leaders where you can ask questions you may not
Session Description: Learn the details surrounding a 2 year MIH pilot program want to ask in a large forum.
between two North Shore - LIJ service lines (EMS and Care Management), their results,
Specific topics/themes
and a glimpse of what this will mean for the future of mobile healthcare delivery.
(You select the 4 you want to go to; one every 30 minutes):
The Future of Paramedicine in Our Hands Through 1. Funding models (“What does it cost to provide these services and what are the
ways EMS agencies are being paid for these services?)
Self-regulation?
DATE: 02/25/2016, TIME: 10:30 AM - 12:00 PM 2. Making the business case for hospitals, 3rd party payers, hospice agencies & home
Michael Nolan, Chief, Paramedic Service, Renfrew County, Canada health (“How do I make the business case to payers for this service line?”
Gary Wingrove, President, The Paramedic Foundation 3. “How can I work together with other EMS agencies to create regional solutions for
Peter O’Meara, Professor, La Trobe University, Australia potential payers?”)
Session Description: In the U.S. and Canada the ‘medical direction’ model is the
dominant approach used to ensure optimal patient outcomes in paramedic service 4. Partnerships for regional solutions (“How do I engage in the conversation with
delivery, while in countries such as the U.K., Australia and New Zealand a potential payers in my local community?”)
combination of professional registration and clinical governance programs are 5. Provider Selection & Training (“How do I pick and train the right people for this role?”)
preferred. Evidence supporting the effectiveness of ‘medical direction’ in the
6. Continuing Education (“What’s being done to keep MIH/CP staff current and
peer-reviewed literature is scant, with limited rationale or empirical evidence
expand their skills/services?”)
presented. Nor are comparisons made with paramedic systems that emphasize a
systems approach with responsibility for safety and quality shared between 7. National Credentialing Models (“What’s being uses and what’s working”)
regulators, paramedics, managers and expert advisors. The lack of evidence 8. “A Day in the Life” of a Community Paramedic (“What is the typical day like for a
supporting ‘medical direction’, a key element of the paramedic system in North Community Paramedic?”)
America, raises questions about how the paramedic services in the future should be
led and managed. One associated question is whether paramedicine can become an Faculty:
autonomous self-regulated health profession while under medical direction? Gary Wingrove, President, The Paramedic Foundation
Kevin Collopy, Clinical Education Coordinator, AirLink/VitaLink Critical Care Transport
Jonathan Washko, Assistant Vice President, North Shore-LIJ Center for EMS
John Sponholtz, RN, AEMT, Unity Hospice, Tisch Mills Fire Department
Matt Zavadsky, Director of Public Affairs, Medstar Mobile Healthcare
Dan Swayze, PhD, Vice President, Center for Emergency Medicine of Western
Pennsylvania, Inc.
Peter Carlson, Community Paramedic Supervisor, North Memorial Healthcare
Peter O’Meara, Professor, La Trobe University, Australia
Kevin Munjal, Mt. Sinai/NYC
Brian LaCroix, President of Allina Health EMS, St. Paul, MN

Community Paramedicine Track
A Regional Approach to Community Creating Community Capital: Developing

Paramedicine Non-traditional Partnerships in EMS
DATE: 02/26/2016, TIME: 10:15 AM - 11:45 AM DATE: 02/27/2016, TIME: 8:30 AM - 9:45 AM
Christie Cornelius, Program Assistant, Center for Emergency Suzanne Prentiss, BA, MPA, NREMT-P, Manager of EMS/Deputy
Medicine of Western PA Mayor, Concord Hospital - City of Lebanon
Dan Swayze, PhD, Vice President, Center for Emergency Session Description: Learn about the three elements of Community Capital
Medicine of Western Pennsylvania, Inc. and how you can leverage these to benefit your EMS organizations and the
Session Description: This session will review the operations and outcomes of population you serve. This session challenges you to think differently about
the CONNECT Community Paramedic program in Pittsburgh. This unique your partnerships and how to bring new individuals and groups to the table.
program involves patients from 45 EMS agencies, 15 hospitals and 2 health “Give something, get something” relationships as well as long term strategies
insurance providers. Learn what it takes to operate a successful community are investigated during this session. Attendees are encouraged to think about
paramedic program in a highly competitive and fragmented healthcare who is at their table, who is missing and how to get the right people-groups
there for the long haul! Real time model communities will be identified and
market.
participants will actively plan to create Community Capital.
Case Studies in Hospice Care: What Has
Happened When the Squad Shows up in Reconstructing the Ambulance
the Home of a Hospice Patient Mid-Response: The Financial Considerations
DATE: 02/26/2016, TIME: 1:15 PM - 2:15 PM When Implementing Community Paramedic/
John Sponholtz, RN, AEMT, Unity Hospice, Tisch Mills Fire Alternative Care Programs
Department DATE: 02/27/2016, TIME: 11:00 AM - 12:30 PM
Session Description: This class will review common hospice procedures and Robert Nadolski, Clinical Administrator for Emory Healthcare and
practices including medications, standing medication orders, durable medical Emory School of Medicine in Atlanta, Georgia and Public Safety
equipment, and past interactions between EMS agencies and hospice providers. and Healthcare Professional specializing in EMS systems
Session Description: Community Paramedic or alternative models of care
Making the Business Case for MIH-CP – programs require EMS leaders to consider financial measurements and metrics
What You Need to Know for Discussions differently than in the traditional fee for service model. Physician group
practices, insurance companies, employer groups and healthcare / hospital
with Your Healthcare Partners systems each have specific financial aims with implementing such programs.
DATE: 02/26/2016, TIME: 3:45 PM - 5:15 PM This presentation will explore the financial considerations from the perspective
Matt Zavadsky, Director of Public Affairs, Medstar Mobile of both the EMS organization offering the program and the targeted
Healthcare purchaser.
Brian LaCroix, President, Allina Health EMS, St. Paul, MN
Brenda Staffan, MIH Program Project Director, REMSA (Reno
Emergency Medical Services Authority), Reno, NV
Dan Swayze, PhD, Vice President, Center for Emergency
Medicine of Western Pennsylvania, Inc.
Session Description: Learn how to properly approach and make a solid
business case with healthcare partners, as well as how to price and budget for
your EMS Mobile Integrated Health Care/Community Paramedicine services in
the new and ever-evolving health care economic environment. These Mobile
Integrated Health/Community Paramedicine leaders have successfully
approached and negotiated reimbursement or payment model structures with
healthcare partners as well as implement fiscal funding models that work for
their agencies. Join them as they share their approaches in this dynamic EMS
Today Conference session.

Dynamic & Active Threats Track
Track Description: Topics include MCI, active shooter, tactical, special operations and terrorism operations,
preparedness and best practices.
Lessons Learned from Washington Navy Yard Active Red Light or Green Light: ICS for Rescue Task Force
Shooter Incident Operations in Warm Zones
NREMT: OT NREMT: OT
Douglas Mohl, FBI Special Agent and Coordinator of the FBI’s Ofer Lichtman, NREMT-P, paramedic/firefighter and Terrorism Liaison
Operational Medicine (OpMed) Program for the Washington Officer Coordinator, Rancho Cucamonga (CA) Fire Department
Field Office Session Description: All personnel need to understand the critical roles and
Session Description: See what it is like to be an FBI tactical medic and join Special functions needed in a unified command when managing a Rescue Task Force
Agent Douglas Mohl in an interactive case study from the Washington Navy Yard operation where EMS personnel are tasked with teaming up with law
active shooter situation. Learn how the FBI prepares Washington Field Office enforcement personnel and deploying in a “Warm Zone” to provide point of
agents for response to active shooter incidents. This interactive discussion will not wound care to victims where there is an on-going ballistic or explosive potential.
only cover the dynamic portion of tactical medicine, but also the unexpected in These teams triage treat / stabilize and extract the injured while wearing Ballistic
the hours after the tactical scene transitions to a cold zone. Protective Equipment (BPE) in a rapid manner. RTF can be deployed to work at
incidents such as Active Shooter Incidents or scenes where there is, or has the
Chemical Suicides possibility of an on-going ballistic or explosive potential. In this information-
packed session, attendees will learn the roles and responsibilities of every key
NREMT: ABC, MED
position on an incident involving the deployment of a Rescue Task Force. From the
DATE: 02/25/2016, TIME: 9:15 AM - 10:15 AM Task force member providing TECC to the Rescue Group Supervisor coordinating
Christopher Colwell, MD, FACEP, Medical Director, Denver Paramedic the rescue and communicating to the Medical group every element will be
Division and Denver Fire Dept., Chief of Emergency Medicine, Denver covered. Important terminology and operational information such as the
Health Medical Center and Vice Chair, Emergency Medicine, following will be presented:
University of Colorado School of Medicine
• Green Light Condition: No direct or immediate threat to RTF and area of operation
Session Description: Chemical suicides are becoming more common, with
will be relatively safe. This is a information rich environment (all considerations in
suicidal individuals often mixing chemicals in a bucket in their car. This new
the Dynamic Risk Assessment have been met). This is a “GO” condition.
method of suicide can pose significant risk to first responders and EMS providers
because of the invisible release of chemical gas that can be inhaled and fatal • Red Light Condition: Direct and immediate threat to RTF exists. This is a very
when a home or vehicle door is opened. This important lecture by Dr. Chis Colwell information-poor environment (all considerations in the Dynamic Risk Assessment
will review the epidemiology of chemical suicides, discuss the common agents have not been met). This is a “NO GO” condition.
being used, and ways responders can recognize chemical suicide situations. The To learn more about this proven RTF process before attending this session, go to www.
need for respiratory PPE, safe approach and management of these situations and sbcounty.gov/icema/main/ViewFile.aspx?DocID=1961.
treatment options for the patient (and affected responders) will also be reviewed.
This lecture may very well help save you or your partner’s life.
Excited Delirium Syndrome and Law Enforcement

Toxicology
NREMT: MED
DATE: 02/25/2016, TIME: 9:15 AM - 10:15 AM
David Neubert, Medical Director, Tac-Med, LLC, Deputy Regional EMS
Medical Director for Montgomery County, PA
Session Description: Once a controversial theory, excited delirium is now
becoming understood as an acutely life threatening medical emergency. Initially
described by Dr. Luther Bell in 1849, it is the end result of a loss of homeostasis
from decompensated psychiatric disease, or intoxication from drugs of abuse.
Identification of excited delirium is important for EMS, fire and law enforcement
responders to help prevent in-custody deaths, and to ensure responder safety by
learning the proper techniques to interact with these patients. Topics discussed
will include identification and understanding of excited delirium, physiology and
treatment, and the novel role for intramuscular Ketamine. Also covered during the
lecture will be the physiologic effects of tasers when deployed on excited delirium
and other patients, and the expanding role of naloxone while dealing with
overdose patients.

Dynamic & Active Threats Panel Close Up and Personal: Legal Issues with
NREMT: OT Body Cameras and Other New Imaging
DATE: 02/25/2016, TIME: 10:30 AM - 12:00 PM Devices in EMS
Panelists: William Fabbri, MD, Director of Operational Medicine, DATE: 02/25/2016, TIME: 1:30 PM - 2:45 PM
Federal Bureau of Investigation Steve Wirth, Founding Partner, Page, Wolfberg & Wirth LLC
Douglas Mohl, FBI Special Agent and Coordinator of the FBI’s Douglas Wolfberg, Partner, Page, Wolfberg & Wirth LLC
Operational Medicine (OpMed) Program for the Washington Field Session Description: Since the Ferguson case and riots, great attention has
Office been placed on the use of body cameras as a deterrent to bad behavior by
Terry Nichols, Director of Curriculum Development, Texas State public safety officers. The improved technology and low cost now make body
University – ALERRT (Advanced Law Enforcement Rapid Response cameras a viable option for many EMS agencies. Body cameras and other
Training) and co-author of “Active Shooter Events and Response” imaging devices used at the scene and in the ambulance can help improve
scene safety, provide real time documentation of a scene, and be used for
Geoffrey Shapiro, Director, EMS & Operational Medical Training,
quality improvement. If used properly, digital cameras can be an effective
Emergency Health Services program, George Washington
adjunct in EMS operations. But there are ethical, privacy and other legal
University considerations that must be addressed before putting body cameras in the
Reed Smith, MD, Operational Medical Director, Arlington field. This dynamic session led by experienced EMS attorneys will address the
County (VA) Fire Department, Attending Physician and legal issues from balancing employer and employee rights to the balance
Associate Professor of Emergency Medicine at George between patient privacy and EMS operations.
Washington University
Session Description: This Super Session will feature an expert panel on Pediatric Issues When Unconventional
Dynamic & Active threats, addressing incidents EMS, fire and police responders Weapons Are Involved
are responding to, and may be called on to manage in the future. In addition
NREMT: OT, OB/PEDS
to discussing the status of agencies adopting and implementing the concepts
DATE: 02/26/2016, TIME: 8:30 AM - 10:00 AM
and recommendations of the Hartford Consensus documents since their
introduction, the panel will discuss the importance of “warm zone” James Howson, Unit Chief for Operational Medicine, U.S.
involvement by EMS with law enforcement teams, hemorrhage control Department of State
guidelines key to the EMS adoption of the common concepts of rapid Session Description: Children are being increasingly targeted by criminal and
hemorrhage control, triage and phased evacuation with survival enhancement terrorist groups. The 2004 attack on the elementary school in Beslan, Russia,
through better integration with law enforcement at AS/MCI events. The and the 2014 kidnapping of over 200 girls from the village of Chibok, Nigeria,
panelists, all experts in this area, will discuss tools to help EMS supervisors and demonstrate that criminal and terrorist groups are increasingly attacking large
medical directors implement the concepts in the Hartford Consensus. numbers of children. This presentation will review some of the more recent
terrorist incidents involving and targeting children, and examine the
physiological, developmental and psychological issues that are of significant
Applying the Joint Rescue Task Force Model concern when responding to a critical incident or terrorist attack involving
NREMT: OT children.
DATE: 02/25/2016, TIME: 1:30 PM - 2:45 PM
Ofer Lichtman, NREMT-P, paramedic/firefighter and Terrorism
Active Shooter Preparedness: How to Integrate
Liaison Officer Coordinator, Rancho Cucamonga (CA) Fire
Police, Fire and EMS Responses
Department
NREMT: OT
Session Description: Your department has decided to finally implement a
Rescue Task Force Program where EMS personnel are tasked with teaming up DATE: 02/26/2016, TIME: 8:30 AM - 10:00 AM
with law enforcement personnel and deploying in a “Warm Zone” to provide William “Bill” Godfrey, Chief Consultant, C3 Pathways
point of wound care to victims where there is an on-going ballistic or explosive Terry Nichols, Director of Curriculum Development, Texas State
potential. So what do you do now? What are the steps necessary to implement University – ALERRT (Advanced Law Enforcement Rapid Response
a successful and premier program and how do we actually deploy the Rescue Training) and co-author of “Active Shooter Events and Response”
Task Force on these high threat calls? In this session you’ll learn the strategy Session Description: Active shooter events require a coordinated, organized
and tactics of applying the Rescue Task Force model. Ofer Lichtman, a response from EMS, police and fire responders to save the maximum number
Terrorism Liaison Officer Program coordinator instrumental in developing his of lives in the minimum amount of time. This presentation will discuss the
department’s Terrorism Awareness Program, which included implementation of provision of TECC-based medical training for law enforcement and the key role
an Active Shooter Program, will focus on the “how to” of this program that this point of wounding care plays in active shooter response. Bill Godrey &
has been vetted from a 10-year successful Rescue Task Force program. Terry Nichols will present incident command strategies using an active shooter
incident management system checklist, and illustrate the importance of staging
for law enforcement. The session will also stress the integration of fire and
EMS personnel into rescue task forces to enter warm zones and introduce a
scalable integrated response protocol which can be implemented by the
smallest community up to the largest metropolitan areas.

Emerging Trends and EMS Implications from the The Whole Community Plan for
Joint Counter Terrorism Awareness Workshop a Biologic Disaster
Series (JCTAWS) DATE: 02/26/2016, TIME: 3:45 PM - 5:15 PM
NREMT: OT Panel Faculty: Mike Beimer, Director, Hardeman County (TX) Memorial
DATE: 02/26/2016, TIME: 10:15 AM - 11:45 AM Hospital District
Geoffrey Shapiro, Director, EMS & Operational Medical Training, Michael Elliott, BS, LP, Division Chief, Austin-Travis County Emergency
Emergency Health Svcs. Program, George Washington University Medical Services
Session Description: The continuing threat of active violence events and complex Michael Lambert, Homeland Security Planner, Galveston County (TX)
attacks remains significant, and EMS providers must be ready to respond despite Office of Emergency Management
any ongoing threats and safety concerns. The Joint Counter Terrorism Awareness Michael Megna, Associate Vice-President, University of Texas Medical
Workshop Series (JCTAWS) is conducted throughout the United States by DHS/ Branch
FEMA, FBI, and NCTC, and has featured topics relating to the challenges faced by
Mitchell Moriber, Chairman, Texas Catastrophic Guidelines and Triage
EMS and the healthcare system. This presentation will provide an overview of
Committee
some the local, regional, and national trends, issues, and best-practices facing
Session Description: This session will assist your response system to be aware and
systems, identified during various JCTAWS workshops, as they prepare for
be prepared with a “Whole Community Plan” to sustain vital healthcare and
responding to these atypical emergencies.
societal functions and operate in an environment where mission critical resources
are in short supply or exhausted. This government-recommended approach
How to Select Providers for Tactical EMS presents a framework for integrating healthcare providers into regional
DATE: 02/26/2016, TIME: 3:45 PM - 5:15 PM catastrophic preparedness and response efforts, developed based on lessons
Mark Gibbons, Major (ret.), Maryland State Police learned from the 1918 influenza pandemic. This panel of experts will identify
Michael Marino, Battalion Chief, Special Operations, Prince George’s critical gaps and ways to develop a consortium of political jurisdictions, healthcare
County Fire/EMS Department coalitions, public/private sector agencies and businesses in advance of a
Session Description: Tactical Medical Support (TEMS) for High Risk Law catastrophic mass casualty or terrorism incident. In advance of attending this
Enforcement Operations has evolved into the Standard of Care within the United session, you can read the Pandemic Mitigation Catastrophic Guidelines, published
States. TEMS teams continue to provide a conduit for interagency cooperation by the Triage Committee of the Texas Department of State Health Services, at
and policies related to response to active shooter events and large scale incidents. www.preparingtexas.org/Resources/documents/2013%20Conference%20
Well trained and equipped TEMS teams have proven to reduce injuries, save lives Presentations/Pandemic%20Mitigation.pdf.
and reduce an agency’s liabilities in often high profile events. Proper selection of
personnel is imperative to ensure team and mission success. Creating Active Bystanders
DATE: 02/27/2016, TIME: 8:30 AM - 9:45 AM
This session will provide attendees an overview of Tactical Medical Support with a
focus on personnel selection, team structure and best practices. Gregg Margolis, PhD, NREMT-P, is the Director of the Division of
Healthcare Systems Policy for the Office of the Assistant Secretary of
When Responders Become Victims Preparedness and Response (ASPR) at the U.S. Department of Health
NREMT: OT and Human Services (HHS)
DATE: 02/26/2016, TIME: 3:45 PM - 5:15 PM Brendan Carr, MD MS, Director, ECCC, U.S. Department of Health and
Robert Luckritz, Director of EMS & Government. Relations, Jersey City Human Services (ASPR)
(NJ) Medical Center Kevin Horahan, Senior Policy Analyst, U.S. Department of Health and
Session Description: There has been an increase in violence and threats against Human Services (ASPR)
EMS and other providers. This presentation examines the impact on providers Session Description: School shootings, large scale events such as the Boston
when responders are injured, killed, or threatened, either accidentally or Marathon bombing, and day to day injuries that result in life and limb threats
intentionally. Participants will examine specific incidents and the physical and highlight the importance of engaging civilians as a key first link in the chain of
emotional response of EMS providers. Specifically, participants will reflect on their survival. Staff from the U.S. Department of Health and Human Services will review
actions during times of danger, and examine the true practices that surround the core mission of the Federal Emergency Care Coordination Center (ECCC), the
“Scene Safety.” Robert Lukcritz will review decisions that must be made in the Government-wide Council on Emergency Medical Care, and the recent initiative to
moment, and their long term impact on providers. He will discuss violent engage bystanders to become active rather than passive during times of individual
encounters, lifting and moving injuries, and accident death and disability. Provider or community need.
responses to each will be compared and analyzed. He will also discuss the role of
the EMS system and agency in ensuring the safety of providers both physically and
emotionally, and the resources that are available to assist. Jersey City’s purchase of
innovative, discrete, ballistic vests to match their daily uniforms, will be
highlighted..

Stress Test Your System: Preparing for a “Mini”

Mass Casualty Events
NREMT: OT
DATE: 2/27/16, TIME: 1:00 PM - 2:00 PM
Michael Levy, M.D. FACEP, FACP, Medical Director, Anchorage
Fire Department
Session Description: This session will present important considerations for
predictable disasters in your community that do not fit the common definition
of an MCI and may not be covered by your current MCI plans. Dr. Levy will
present real world examples of small multi-victim events that can overwhelm
your system either by severity or the nature of the injuries. He will also
emphasize the need for, and components of, a plan that integrates
dispatch-operations-hospitals in a dynamic and flexible real time collaboration
that seeks to deliver the right patient to the right facility despite the fog of war
associated with these events.
Leadership Track
Track Description: For managers, supervisors, administrators and executives, these sessions present
the latest information to assist agencies and departments. This track includes management and
operations topics along with strategies for navigating the rapidly changing healthcare system.
Creating a Leadership Path Using Conducting Incident Investigations:

the NEMSMA Seven Pillars of EMS Will Your Agency Win in Court?
Officer Competencies DATE: 02/25/2016, TIME: 8:00 AM - 9:00 AM
DATE: 02/25/2016, TIME: 8:00 AM - 9:00 AM Scott Matin, Vice President, MONOC Mobile Health Services
Ryan Greenberg, Executive Director, Session Description: Every day managers are asked to perform investigations
MedSpan Integrated Health as part of their job and every day more and more of these cases end up in
Session Description: Advancing your EMS leadership career can often be a court. The question is, will your investigation stand up in court and allow you
challenging and confusing road. Once in your new role as an EMS Officer, and your company to win a lawsuit? While performing an investigation doesn’t
understanding the expectations and ensuring you complete each of your daily seem very difficult, it is the thoroughness that is often called into question in
operational tasks can be as stressful. In order to help field providers understand court. Discussed will be the step by step process in performing a thorough
the path to leadership and help current EMS officers achieve success, the investigation, what questions to ask, how to perform an interview that will
National EMS Management Association has recently developed a set of core yield the answers you need to know, and how to professionally document your
competencies for supervising, managing and executive EMS Officers. This findings. Shared will be tips from law enforcement who perform investigations
session will review the Pillars of EMS Officer Core Competencies, how they can every day as well as lawyers who litigate these types of suits in court.
help guide personal career growth, define expectations of leadership and help
to strengthen your agency’s leadership team. The session will provide EMS
leadership with the tools needed to build these competencies into their
agencies’ job descriptions and develop training plans for leadership
development at each of the three levels.

Leadership Track
Proving We Make a Difference: Your Best EMS Self: Practicing Proactive

Why Every EMS Practitioner Needs Professionalism
to Understand the Value of Data NREMT: OT
and Performance Measures DATE: 02/25/2016, TIME: 10:30 AM - 12:00 PM
DATE: 02/25/2016, TIME: 8:00 AM - 9:00 AM Raphael Barishansky, Director, OEMS, Connecticut Department of
Raphael Barishansky, Director, OEMS, Connecticut Department of Public Health
Public Health Session Description: What does it mean to be a “professional?” Do you consider
yourself to be one? We consider people to be professional based on their job,
David Page, Paramedic Instructor
their accomplishments or just in the way they present themselves. In the wildly
Session Description: Anyone who’s completed a patient care report knows how
diverse world of EMS however, those parameters are not always clearly defined.
much data is being collected today in the field of EMS. But the important question
Is a universal standard of professionalism possible in an industry that ranges from
is where is that data going, and why? The EMS COMPASS initiative is designing
volunteer to career, rural to urban, municipal to hospital? Even if such a standard
performance measures that will revolutionize how we measure the impact of an
existed, EMS is a 24/7 occupation. With social media, cell phones and now
EMS system. Therefore, EMS managers and EMS providers at every level need to
drones capable of documenting our every move, how difficult is it to be a
understand why and how these measures may impact how we respond to calls,
professional at all times? Should we be? Ray will draw on his more than 25 years
treat patients, and how we get paid in the future. This important session will
in EMS and review the fundamentals of professionalism with an emphasis on
explain how measuring performance will make you a better EMS practitioner and
operating in the modern EMS environment. By offering practical advice based on
your service part of a better system of care. You’ll hear from the perspective of
real-world examples, he will give EMS providers, managers and educators a
both an EMS educator and paramedic, as well as a state EMS Director on this
renewed look at the need for professionalism in EMS and how to individually
important Federal initiative.
pursue it.
Risk Management for EMS
DATE: 02/25/2016, TIME: 9:15 AM - 10:15 AM
Data Dichotomy in the New EMS
Peter Dworsky, Corporate Director, Payer Landscape
MONOC Mobile Health Services DATE: 02/25/2016, TIME: 10:30 AM - 12:00 PM
Session Description: It is impossible to eliminate risk for EMS. It does not matter Nick Nudell, Chief Data Officer, PrioriHealth Partners, LLP.
how you look at it, how you hold it up and examine it, it is a dangerous, and a Matt Zavadsky, Director of Public Affairs,
risky job. However, new technology and new information can minimize your risk, Medstar Mobile Healthcare
to help keep you and your team safer. This program covers some of the Session Description: Today’s integrated care delivery models require a whole new
methodologies, equipment and processes that can be easily implemented within approach to proving value. Measuring outcomes for meeting the IHI Triple Aim of
an EMS system that will aid in reducing exposure and liability. Improved Care, Improved Outcomes and Reduced Costs requires EMS
professionals to collect, analyze and report data far beyond traditional
Creating Clinical Leaders and Mentors measurement techniques of response time, unit hour utilization and unit hour
costs. This session will highlight the data healthcare stakeholders will be looking
DATE: 02/25/2016, TIME: 9:15 AM - 10:15 AM
for from you to demonstrate value in MIH programs and make the case for
Ryan Greenberg, Executive Director, MedSpan Integrated Health
sustainable funding models.
Session Description: So many new employees after field training has ended are let
lose to succeed (or stumble) with little additional guidance or direction. A
successful organization that seeks longevity and teamwork from its clinical Thinking Outside the Box: Implementing Best
providers has to offer growth opportunities and ongoing guidance to their staff in Practices from Other Industries
a way that is welcoming and without fear of consequences. Creating a mentor DATE: 02/25/2016, TIME: 1:30 PM - 2:45 PM
program for staff beyond field training can help new and senior staff members Scott Matin, Vice President, MONOC Mobile Health Services
progress together and better the entire organization. Senior staff members can Session Description: While it is developing rapidly in clinical and operational
take on a new role and additional responsibilities while new staff members have a aspects, the ambulance industry is small in size compared to many industries.
consistent place to turn for direction and answers to questions. This course by Scott Matin, an “EMS-10” Innovator of the Year winner, will use the innovation
Ryan Greenberg will go through different concepts of how to set up, select and and expertise that can be learned and implemented from larger, more established
run an EMS mentor program within your organization. industries to improve your EMS operations and efficiency. This session will discuss
easy-to-adopt practices from the airline, hospitality and logistics industries that
Ambulance of the Future can be put to work in your EMS agency. He will also present case studies that
DATE: 02/25/2016, TIME: 9:15 AM - 10:15 AM have changed the way these industries do things safer, more efficiently and in a
Joe Bourgraf, President, Ferno Group Companies more cost effective manner.
Session Description: Get ahead of the curve and be prepared for implanted and
wearable device detection, drone deployment and use, flexibility in mission
response from mass casualty to critical care transport, all while providing a crash
safe, efficient, and comfortable environment for the medics and patients.
Ambulances in the future must support medic action and patient care in an
anticipatory and supportive manner. This allows medics to work safer and more
effective by focusing on patient care.

Leadership Track
Customer Service When the Patient is Not the How to Prevent Your EMS System
Customer from Failing
Brett Lyle, Business Development Manager, MedStar Mobile Robert Nadolski, Clinical Administrator for Emory Healthcare and
Healthcare Emory School of Medicine in Atlanta, Georgia
Matt Zavadsky, Director of Public Affairs, Medstar Mobile Jonathan Washko, Assistant Vice President, North Shore-LIJ Center
Healthcare for EMS
Session Description: Much attention has been focused on the PATIENT’s Session Description: In this fast paced session, Jonathan Washko & Robert
experience in healthcare. But in EMS, we have customers that are not patients. Nadolski will present the latest tips, traps and tricks associated with keeping
Hospital and skilled nursing staff, employees, community leaders and elected your EMS Systems from failing. This will include methodologies and strategies
officials are customers we should be assessing for their experience with our involving financial, operational, political, system stakeholders, system design
services. Come learn how MedStar designed and implemented a survey and much more. A special focus on smaller agency and volunteer strategies
process to assess the experience of these important stakeholders and consider will also be presented in this important management/leadership session.
designing benchmarks to measure this important metric across the industry.
A Guide for Using Performance
Change Management in Emergency Measures: Case Studies From
Services: Leading the Charge for Change the Real World
Jonathan Washko, Assistant Vice President, North Shore-LIJ Center Rob Lawrence, Chief Operating Officer,
for EMS Richmond Ambulance Authority
Robert Nadolski, Clinical Administrator, Emory Healthcare and Nick Nudell, Chief Data Officer, PrioriHealth Partners, LLP
Emory School of Medicine, Atlanta, Georgia Session Description: EMS systems now have more data than ever—dispatch
Rob Lawrence, Chief Operating Officer, Richmond Ambulance information, patient care records, fleet and personnel statistics, and more. But
Authority with so much information, and not enough resources, many EMS leaders feel
Session Description: Managing change is one of the most difficult parts of any overwhelmed and unsure of where to start in using performance measures.
improvement process in EMS. From the simplest project, like adding a new Join Nick Nudell, the project manager of the national EMS Compass initiative
piece of equipment, to complex projects like changing policies to merging and Rob Lawrence, COO of the Richmond Ambulance Authority, as they
organizations together, recognizing and incorporating the need for change present actual case studies to illustrate how this process can be implemented
management is a key denominator of any successful project. Come learn from and improve the quality and efficiency of your EMS agency. They’ll discuss
a panel of industry experts on managing change in your EMS agency. which performance measures matter, how to use NEMSIS-compliant and other
data to measure them, and how to turn those measures into better care and
Normalization of Deviance: What It Is better service for your patients and your communities.
and What to Do About It
DATE: 02/26/2016, TIME: 8:30 AM - 10:00 AM Using Data and Technology to Improve
Michael Touchstone, President of NEMSMA and Regional Director, Operations and Clinical Care
Philadelphia Regional Office of EMS DATE: 02/26/2016, TIME: 10:15 AM - 11:45 AM
Session Description: Do you remember the Challenger Disaster or when the Alexander Garza, Medical Director and Homeland Security Advisor,
Columbia broke up on reentry? The term used to describe the reasons for FirstWatch Solutions, Inc.
these two tragedies is Normalization of Deviance. It occurs when behavior that Michael Gerber, (Red Flash Group), former EMS Supervisor,
falls outside expectations has no negative consequences. As time passes, what Alexandria (VA) Fire Dept.
was once deviant becomes normal. In EMS this may be something as simple as Session Description: More than ever, EMS agencies need to take a systems-
not documenting a patient encounter with as much detail as is expected, or wide approach to quality improvement. Real-time, comprehensive, automated
waiting until the patient is in the ambulance to initiate care. During this analysis of patient care records and other data sources allows them to do just
leadership session Mike Touchstone will examine the concepts and principles that. With new technologies, EMS agencies have new ways to identify trends,
underlying this insidious and troubling turn of events. He will also discuss how prioritize quality improvement efforts, and examine their policies and processes
to reverse these problematic trends and return to behaviors and practices that to make targeted changes that improve the quality of patient care and
are within your organizational and professional policies, procedures, standards, operations. Learn how agencies like the Richmond Ambulance Authority are
and expectations. using technology to make targeted changes and provide their crews with
real-time feedback allowing for an immediate reaction - whether that means
additional training for the crew, correction of documentation errors, or
replacement of a malfunctioning device.

Leadership Track
Now You Have All of This Data, What Do You Recognizing and Dealing with Intractable
Do With It? Measurement for Management Problems, Wickedness and Messes
and Improvement of EMS Systems DATE: 02/26/2016, TIME: 2:30 PM - 3:30 PM
DATE: 02/26/2016, TIME: 1:15 PM - 2:15 PM Michael Touchstone, Regional Director, Philadelphia Regional Office
David Williams, Executive Director, Medic Health of EMS
Session Description: EMS has seen an explosion of products and services that Session Description: Have you ever noticed that some problems seem unsolvable
capture data about patient care, call demand, billing performance and more. But or intractable? There is a reason for this; some problems are so complex that they
just having data doesn’t mean you have what you need to improve results. Data cannot actually be solved. However they can and must be addressed. Every day
use in EMS has largely been about compliance and comparison and we often rely we deal with people, not widgets. Every day we are challenged with complexity.
on an in house data guru or paid expert to help us convert our data into Problem solving methods designed for the industrial world and business
knowledge. Dr. Williams is the prehospital emergency care faculty at the Institute applications are often ineffective for solving people problems or problems
for Healthcare Improvement. Join him as he shares a few simple methods used contained within complex environments, or the challenges of working within a
throughout healthcare improvement to help your entire team use any kind of data “system of systems.” Recognizing and learning to work within this landscape has
for improvement. You will never look at data the same way again. implications for strategic planning and policy development. During this session we
will discuss the characteristics of wicked problems and messes, how they differ
Using Data to Increase Performance in from tame, simple or complicated problems, and why our usual approaches to
problem solving fail when faced with such issues. We will also discuss a process
Volunteer Rescue & EMS Agencies and methods we can use to approach these problems to make improvements.
DATE: 02/26/2016, TIME: 1:15 PM - 2:15 PM
Frederick Bachner, Fire Protection Specialist, New York State Office of
PIO or Publicist - Keeping Your Organization
Fire Prevention & Control
Session Description: Nearly everything you do creates data. How you create,
(Favorably) in the Public Eye
capture, analyze, and ultimately use that data is important no matter how large or DATE: 02/26/2016, TIME: 3:45 PM - 5:15 PM
how small your agency is. Attendees in this session will learn how important data Rob Lawrence, Chief Operating Officer, Richmond Ambulance
is and that data, in its simplest form, is information that you have created. Topics Authority
will include a review of the types of data that are created by your organization, Session Description: They say it takes ten good news stories to counter one bad
data capture processes, best practices in storage, sharing, analysis, reporting and one - so are you getting your ten in the bank? Join Rob Lawrence as he passes on
visualization. Regardless of the size of your organization there is data that you are the tricks of his trade as he has managed the reputation and PR and publicity
not capturing that can increase your efficiency, your effectiveness, and your efforts for the Richmond Ambulance Authority for the last 5 years.
overall performance. Attend this session to learn how to use the data you are
collecting to the benefit of your agency and your patients. The Emerging Era of Choice, Transparency
and Technology - EMS and the Healthcare
Precepting: Is It a Privilege or a Right? Retail Revolution
NREMT: OT, ELECTIVE DATE: 02/26/2016, TIME: 3:45 PM - 5:15 PM
DATE: 02/26/2016, TIME: 2:30 PM - 3:30 PM Robert Nadolski, Clinical Administrator for Emory Healthcare and
Dana Clarke, RN, BSN, CFRN, EMT-P, EMS Faculty, Emory School of Medicine in Atlanta, Georgia and public safety and
Houston Community College healthcare professional specializing in EMS systems
Session Description: Have you ever had the field training officer (FTO) from “you Session Description: The U.S. healthcare system is in the midst of a retail
know where?” Have you ever been that FTO? Quite often, the guy who’s been revolution which is expected to disrupt the traditional economic and provider
there the longest may not be the optimal candidate to train the “New Guy.” We models. Hospitals, physician group practices and EMS organizations will be
will take an amusing and interactive look at FTO behaviors and best practices for challenged to rethink and adapt their care delivery models in response to changes
facilitating adult learning. We will also include some discussion/instruction on how in how people obtain and pay for their care. In this session, Robert Nodolski, a
to develop and maintain a good FTO program. We will also discuss appropriate clinical administrator for Emory Healthcare and Emory School of Medicine in
expected behaviors of the “trainee.” Finally, we will address better methods of Atlanta, Georgia will explore the three major themes reshaping the broader
managing a difficult training situation. healthcare delivery system and understand the implications to public, private and
non-profit EMS organizations. If you are concerned about where EMS will fit in
Performance Improvement: A Systematic the changing U.S. healthcare system, this session is for you.
Method of Improving Performance of People
DATE: 02/26/2016, TIME: 2:30 PM - 3:30 PM
Steve White, Director, Pensacola State College
Session Description: Every organization has performance issues or performance
gaps. The truly excellent organizations are those that can identify those gaps,
create effective and efficient solutions and push the boundaries of performance.
This program will teach participants how to recognize performance gaps, conduct
a cause analysis and develop interventions that will allow performance to improve.
An introduction to Human Performance Technology and its systems view of
improving organizations will be covered. These techniques can be used to improve
retention, improve patient care, develop employees and increase overall
organizational efficiency. Everyone will leave invigorated with tools to refocus
their performance on success and take their organizations to the next level.

Leadership Track
Healthcare Associated Infections: Implementing an EMS Culture of Safety:

How EMS Will Be Affected by This Area Near-Miss Analysis
DATE: 02/26/2016, TIME: 3:45 PM - 5:15 PM DATE: 02/27/2016, TIME: 11:00 AM - 12:30 PM
Katherine West, Infection Control Consultant, Infection Control Kevin Seaman, MD, Executive Director,
Emerging Concepts Maryland Institute for EMS Services
Session Description: In the new healthcare law, there was a major change in Session Description: EMS responds to ill or injured patients in their time of
terminology; Hospital Acquired infections became healthcare associated need. Patients and families count on this public safety net; EMS response and
infections. This means that more disciplines are now being brought under the responders can cause unintentional harm. Many high risk operations including
law’s umbrella. This now includes EMS. The Center for Medicare and Medicaid healthcare have implemented operational safety systems. The EMS Culture of
Services (CMS) will therefore now be widening surveillance of more healthcare Safety Project has identified a path forward toward opportunities for
disciplines to better ensure quality of care for patients. History has shown that improvement. Despite this, many EMS agencies have not yet implemented
hospitals have been a source for patient infections. So what about EMS? these proven practices. Using a discussion style presentation important
Hospitals are now not being reimbursed for patient care and extended stay for concepts of just culture, operational safety and minimizing human error will be
hospital acquired infections. As a result, medical facilities are now looking in developed. Mishap and Near-Miss systematic evaluation will be described.
the direction of EMS as a possible source for some patient infections. Is your Process analysis and focus on process improvement will be demonstrated to be
department ready? What should you have in place to assist in documenting superior to assigning individual blame. Critical take home points will be
infection control practices? This important session will explore ways for your summarized to further develop a culture of safety in EMS.
agency to document infection control compliance and improve risk
management. Artificial Intelligence: Bridging Human
Decision-making and Technology in EMS
Creating a Social EMS Culture: A Balanced DATE: 02/27/2016, TIME: 11:00 AM - 12:30 PM
Approach to Social Media Josh Davies, EMS Section Chief, Santa Clara County Emergency
DATE: 02/27/2016, TIME: 8:30 AM - 9:45 AM Medical Services
Steve Wirth Esq., Partner, Page, Wolfberg & Wirth LLC Carissa Session Description: The rapid development of autonomous systems, which
Caramanis O’Brien, President, Red Box Communications are technological systems or processes that either support or replace human
Session Description: We’ve all seen the cases of social media gone bad. Some decision-making, have a significant impact on emergency medical services.
practitioners have shown poor judgment in what they post publicly, and some EMS organizations must be ready to not only interact artificial intelligence
agencies haven’t been prepared for the changes social media brings. But as systems but leverage them to improve efficiency, reduce cost, and provide
social media evolves and new federal guidance has finally become available, greater service to those in need. This session will discuss use of the “Internet
agencies and EMS practitioners need to be prepared for the new rules of the of Things”, autonomous systems, and “self-driving cars” to provide participants
social road. Policy must evolve to meet new expectations, and just as critical, with a road map for actions that can be taken now, in the near future, and
leaders must be prepared to provide practical guidelines in addition to strategically.
restrictive policies, so that everyone knows what they *can* do, and not just
what they can’t. In this session, a seasoned EMS attorney and a social EMS Conflict Resolution in EMS
consultant join forces to share with attendees the latest in federal guidelines as DATE: 02/27/2016, TIME: 1:00 PM - 2:00 PM
well as examples of how they can be practically applied. We’ll cover: FDA, FTC
Jennifer Russell, BS, Paramedic, Central Skagit Medic One
and other guidelines and what they mean to EMS; Policy trends and
Session Description: Personality differences, failures in communication, lack of
recommendations; How to create social media policy and guidelines that fit
cooperation, competing authority, and misunderstanding responsibilities all
and grow with your organization
contribute to conflict on average EMS calls. Add in heated emotions, critically
ill patients, scene hazards, and media scrutiny, and the outcome can be
What Did You Know and When Did You Know It? disastrous. Jennifer Russell will provide you with the tools needed to manage
Improving Quality and Safety While Reducing this conflict.
Legal Risk
DATE: 02/27/2016, TIME: 8:30 AM - 9:45 AM
Matt Womble, MHA, Paramedic, Executive Director, Emergency
Medical Error Reduction Group (EMERG)
Allison Bloom, Attorney, Law Office of Allison J. Bloom
Session Description: Quality of care, patient safety, near-misses, violence
against practitioners, line of duty deaths and provider suicides are all “hot
topics” in EMS right now. Unfortunately many states do not provide adequate
confidentiality or peer review protections for EMS agencies’ quality
improvement or risk identification and reduction activities. So how is an EMS
agency supposed to perform these activities to learn and reduce legal risk in a
safe and protected space? One avenue is through the use of a Patient Safety
Organization (PSO). This informative and cutting-edge session will introduce
participants to the Patient Safety and Quality Improvement Act and how
participation in a PSO can improve quality of care and reduce the frequency of
events that adversely affect patient and provider safety. Come learn how your
agency can get ahead of the curve, use information to drive improvement, and
not let this vital information be used against you. This is one session you truly
cannot afford to miss!

Leadership Track
Health Information Exchange: A No-brainer Concept Dealing With Requests for Patient Information
That Keeps Generating Seizures from Law Enforcement, Attorneys, Family
DATE: 02/27/2016, TIME: 1:00 PM - 2:00 PM Members and Others
Greg Mears, Medical Director, ZOLL DATE: 02/27/2016, TIME: 2:15 PM - 3:15 PM
Session Description: It seems we have been hearing about Health Information Doug Wolfberg, Partner, Page, Wolfberg & Wirth, LLC
Exchange for a decade or more now. The goal is to share health information Session Description: Almost every EMS agency faces a daily challenge when they
between healthcare providers and across systems of care to improve patient care interact with the police and other law enforcement agencies who demand
and outcomes. The Affordable Care Act and the Institute for Healthcare protected health information (PHI) about the patients you serve. Another common
Improvements Triple Aim (improving population health, improving patient care, situation is dealing with attorney requests for patient information, as well as
while controlling cost) were built on a foundation of Health Information requests from patients, family members, personal representatives and others. This
Exchange. Despite almost a decade of effort, HIE is still in its infancy. Where did session will cut through some of the fog that has fallen over these areas of HIPAA
we go wrong? Was it paralyzed by HIPAA? Was it minimized by our healthcare compliance, and tell you exactly in which circumstances you can release PHI to law
business model? Was it just poorly designed? There is hope and a solution will enforcement officers, attorneys, patient representatives, and others. We’ll also tell
arrive sooner than you think. During this session, we will explore the current you how to properly document those disclosures so they can’t come back and bite
status and future of Health Information Exchange. More importantly you will leave you down the road.
this session with an understanding of how HIE is now being implemented and
how EMS will benefit. Artificial Intelligence: Bridging Human
Decision-making and Technology in EMS
Do Your Employment Practices Scream Out, DATE: 02/27/2016, TIME: 3:30 PM - 4:30 PM
“Hey, Sue Me!” Josh Davies, EMS Section Chief, Santa Clara County Emergency
DATE: 02/27/2016, TIME: 1:00 PM - 2:00 PM Medical Services
Steve Wirth, Esq., Partner, Page, Wolfberg & Wirth LLC Session Description: The rapid development of autonomous systems, which are
Session Description: Discipline and discharge of a staff member is a tough thing technological systems or processes that either support or replace human
to deal with. Far too many EMS organizations handle this delicate personnel area decision-making, have a significant impact on emergency medical services. EMS
in an inconsistent manner that is akin to inviting an employment lawsuit. Do you organizations must be ready to not only interact artificial intelligence systems but
have the right policies in place? Are staff informed of them and are the policies leverage them to improve efficiency, reduce cost, and provide greater service to
applied even-handedly? Do you use proper “people skills” in dealing with those in need. This session will discuss use of the “Internet of Things”,
behavioral issues in the EMS workplace and are grievances and complaints autonomous systems, and “self-driving cars” to provide participants with a road
handled promptly? Are your personnel actions documented in a legally defensible map for actions that can be taken now, in the near future, and strategically.
way? This session will discuss the “Top 10 Questions” you need to ask to keep
everyone in check and avoid a hasty and improper termination decision that could
land you in court.
The Profession of EMS: The Fundamental
Next Step
Emergent Response: A Dangerous DATE: 02/27/2016, TIME: 3:30 PM - 4:30 PM
Matt Womble, MHA, Paramedic, Executive Director, Emergency
Epidemic in EMS
Medical Error Reduction Group (EMERG)
NREMT: OT
Session Description: In 40 years Emergency Medical Services is now visibly taking
DATE: 02/27/2016, TIME: 2:15 PM - 3:15 PM strides to achieve formal recognition as a profession; research is becoming more
David McGowan, Consultant, ZOLL - Fleet Safety Solutions robust, education is expanding and becoming more in depth, and data is being
Session Description: Ambulance service providers are beginning to recognize the used to drive improvement. The fundamental next step is to ensure that patients
dangers associated with crashes that involve vehicles in their fleet. Scientific are provided the highest quality care and that our providers are safe. Despite our
research is showing a dangerous trend while operating ambulances. Ambulance best efforts patients and providers are harmed and even killed by avoidable errors.
crashes account for nearly 54% of the fatalities in EMS and 58% of those are Research shows that emergency care settings are the most likely place for error
while responding emergent. The costs associated with these events can cripple a and that paramedics and EMTs are three times more likely to be killed on the job
business for years. Beginning with a news investigative report, the presentation as the average worker. This session will introduce you to proven methods of how
will take a controversial look at responding lights and siren from many different to identify risks and help ensure that they don’t result in injuries or deaths.
perspectives. The presenter will provide attendees with several different strategies
to the following questions: Who’s expectation is it that EMS respond emergent? Is
the risk of responding lights and siren outweighed by the benefit of a favorable
clinical outcome for the patient? How do we re-educate EMS stakeholders on the
dangers of emergent response and the move toward less of these responses?

Special Topics Track
Track Description: These are topics of interest to all Emergency response professionals, regardless of their certification
level or employer, including special focus, operations, safety and wellness programs, stress management and suicide
prevention, legal issues and career planning.
No More BLS/ALS—Just EMS National Continued Competency

DATE: 02/25/2016, TIME: 8:00 AM - 9:00 AM Program (NCCP)
Bryan Bledsoe, Prof. of Emergency Medicine, University of Nevada DATE: 02/25/2016, TIME: 9:15 AM - 10:15 AM
Session Description: EMS practices and procedures have always been described Gabe Romero, Director of Examinations, NREMT
as either basic life support (BLS) or advanced life support (ALS). Where did this
Session Description: The NREMT introduced the National Continued
come from and what does it mean? In actuality, quality prehospital care cannot Competency Program (NCCP) in 2012 following multi-year development and
be characterized with these two archaic terms. In this discussion Dr. Bledsoe will consensus processes. The new recertification model is built on four principles
argue that terms such as BLS and ALS (and a few others) are actually holding similar to the American Board of Medical Specialties (ABMS): Maintenance of
EMS back and will make suggestions regarding new terms for what we do. Professional Standing, Cognitive Competency, Practice Performance and
Life-long Learning. The NCCP streamlines the recertification process into three
Coping with the Stress of EMS strategic categories of continuing education (CE): National, Local, and
NREMT: OT Individual. As a result, the NCCP has new total CE requirements that will begin
DATE: 02/25/2016, TIME: 8:00 AM - 9:00 AM in 2016.
Jeffrey Mitchell, Clinical Professor of Emergency Health Services at
the University of Maryland Baltimore County and Co-founder and Suicide Prevention in EMS
Senior Faculty, International Critical Incident Stress Foundation NREMT: OT
Session Description: Stress kills more people annually than guns and auto DATE: 02/25/2016, TIME: 9:15 AM - 10:15 AM
accidents combined and is associated with about 70% of hospital admissions. Jeffrey Mitchell, Clinical Professor of Emergency Health Services at
Stress also underlies many cardiac, diabetic, and stroke related deaths, costs the University of Maryland Baltimore County and Co-founder and
employees their peace of mind and costs employers billions in time lost from Senior Faculty, International Critical Incident Stress Foundation
work, accidents on the job, premature retirements, and disability claims. But Session Description: Suicide is among the top five most awful events that can
stress doesn’t have to be all bad news. Much of it can drive us to excel in happen to emergency services personnel. When a person commits suicide,
many unexpected ways, enhancing our health and performance and enrich our they leave a life sentence of unanswered questions and emotional distress for
live. Much depends on how we perceive our stress and how we decide to every person they loved and for everyone who loved them, including the
manage it. Join International stress management expert, Jeff Mitchell, PhD, as emergency responders they worked with. The suicide of a colleague also leaves
he provides practical guidance on stress awareness and on how to cope with a trail of disruption within an organization associated with the person. No one
daily stress. Dr. Mitchell will present important steps on how you can turn benefits from this horrific permanent solution to what is usually a temporary
mental and physical stress into a positive, driving, creative, and powerful force problem. Suicide experts tell us that the vast majority of suicides are
for your own good and the good of your organization preventable if the right help is available early enough. There are many things
that can be done to dissuade a person from ending their life. The most
National Registry of EMTs 2016 Update important of these is to get the person into therapy with a competent mental
Date: 02/25/2016, Time: 8:00 AM - 9:00 AM health professional. That, of course, can be easier said than done, because
Severo Rodriguez, Executive Director of the emergency personnel are notoriously resistant to accepting help from mental
National Registry of EMTs health professionals. Dr. Mitchell will present an approach to assist an
Session Description: The National Registry of EMTs (NREMT) delivers more than individual in a suicidal crisis and present ten steps to safety for a suicidal person
just a test. The organization is an active member in the EMS community.
NREMTs certification examinations are the foundation of the organization and CECBEMS Accreditation: Is It Right for Your
allow it to support and develop National EMS initiatives with its community Organization?
partners. Join the NREMT Executive Director as he reviews the agency’s DATE: 02/25/2016, TIME: 9:15 AM – 10:15 AM
initiatives: changes to the paramedic psychomotor examination, moving Bob Loftus, BS, NREMT-B, Vice Chair of the Continuing Education
recertification to a dynamic National Continued Competency Program (NCCP)
Coordinating Board for EMS (CECBEMS) board of directors
and EMS research.
Session Description: Would you like to be able to respond to the educational
needs of your employees with accredited CE that addresses refresher training
requirements, issues identified by your Q/A process, and training that provides
updates and information about research findings that change the way
prehospital care is delivered? You may find that CECBEMS accreditation provides
a way to deliver timely, cost-effective CE that will be accepted by the vast
majority of EMS state agencies and the National Registry. This will be a lively,
interactive session, so bring your questions and be prepared to participate. Also,
if you would like to be a CECBEMS reviewer or site visitor, you’ll find this
overview of the CECBEMS process helpful.

Special Focus Track
Crisis Communication: Using the Incorporating Real-time Feedback to Improve

Digital Lifesaver Patient Outcomes
DATE: 02/25/2016, TIME: 10:30 AM - 12:00 PM DATE: 02/25/2016, TIME: 1:30 PM - 2:45 PM
Jim Logan, BS, EMT-P/IC serves as an acting chief officer John Tobin, Alarm Room Captain, Mesa Fire/Medical Department
and paramedic for the Memphis Fire Department Session Description: Back in the days of Johnny and Roy all they had was a set of
Session Description: Some EMS and fire agencies have been struggling with social vitals and a three lead ECG to guide their care. Until recently, we were severely
media policies but forget the value of social media as a lightning fast and effective limited in our ability to evaluate on scene performance and our QA program
way to inform and warn the public during a serious crisis. And, traditional consisted of a chart review. This is all changing with the advent of real time
methods of communication during an emergency, such as interviews, feedback. With this technology we can see our performance and be able to
observations by the “man on the street”, and sensationalism of rumors are review quality measures to guide and improve our care and training programs. In
common during a crisis. This presentation will take a look at how agencies can this interactive session, the audience will learn about and be able to use real-time
control the message on the front end and not manage them by press feedback technologies. They will learn how to effectively employ these systems in
conferences. Jim Logan will teach you how to leverage this free form of their agencies and most importantly understand how this technology can improve
communication that society now uses as a method for breaking news and a patient outcomes.
primary means of getting their information.
Paramedic Psychomotor Competency Portfolio
Products to Improve the Way You (PPCP)
Deliver Care in the Field DATE: 02/25/2016, TIME: 1:30 PM - 2:45 PM
DATE: 02/25/2016, TIME: 10:30 AM – 12:00 PM Gabe Romero, Director of Examinations, NREMT,
Fran Hildwine, EMT-P, Life Support Educator and Simulation Session Description: The NREMT developed a portfolio of vital skills that each
Technician with the Pennsylvania College of Health Sciences, and EMS Paramedic student must master in order to qualify for the National Paramedic
Certification examination. The completed portfolio becomes a part of the student’s
Instructor with the Good Fellowship EMS Training Institute in West
permanent educational file and is a prerequisite to seeking National Paramedic
Chester, PA Certification. All students enrolled on or after August 1, 2016 are required to have
Session Description: This fast-paced session will present new and popular a completed a portfolio as part of their permanent educational file as a prerequisite
products and equipment to assess and care for patients, protect personnel, make for taking the new NRP Psychomotor examination. The NREMT will be
patients comfortable, and improve the way you immobilize their injuries and incorporating the new scenario-based NRP Psychomotor examination in several
package them. As we did last year, attendees will be eligible for multiple door phases, with Phase 1 beginning on January 1, 2017. In this phase, a total of six (6)
prizes, discounts on lots of products from session sponsors, and a special drawing skills will be tested, five (5) of which are currently evaluated and one out-of-
for many of the items shown at the session, provided by product manufacturers. hospital scenario. Each candidate will be evaluated in his/her ability to manage a
The drawings will be held on Saturday 2/27/16 at the sponsors’ booths in the EMS call, lead the team, direct all personnel and resources on scene, effectively
Today exhibit hall. communicate and maintain professionalism throughout the call.
Emergency Medical Service Response Decision Fatigue: Too Tired to Think Straight
to Sports Concussion NREMT: OT
NREMT: TRAUMA DATE: 02/26/2016, TIME: 8:30 AM - 10:00 AM
DATE: 02/25/2016, TIME: 1:30 PM - 2:45 PM Dana Clarke, RN, BSN, CFRN, EMT-P, EMS Faculty, Houston
Jeffrey Mayer, Sports Medicine and Family Practice Certified, Medstar Community College
Harbor View Sports Medicine Session Description: We all work “90 to nothing” in this industry, including 24
Session Description: CDC reports show that the amount of reported concussions hour shifts, multiple days and/or multiple jobs/agencies. It is a known and
has doubled in the last 10 years. The American Academy of Pediatrics has researched fact that decision making deteriorates the longer we are tasked with
reported that emergency room visits for concussions in kids ages 8 to 13 years old something. We will discuss the objectives and note at least some things that we
has doubled, and concussions have risen 200 percent among teens ages 14 to 19 can control to be as good at our job at 3 a.m. as we are at 3 p.m. There will be
in the last decade. Head impacts and concussions caused by contact sports are a some interactive exercises demonstrating how we think and how long our
growing epidemic among young athletes. When left undetected, concussions can attention span is at hour 14 vs. hour 4. We will also talk about decision fatigue
result in long-term brain damage and may even prove fatal. While the first hit can and how it relates/contributes to complacency. This lecture promises to make all
prove problematic, the second or third head impact can cause permanent who attend think BACK and look FORWARD. ALL of us can remember a situation
long-term brain damage. And cumulative sports concussions are shown to in which pure luck and God’s grace saved the call.
increase the likelihood of catastrophic head injury leading to permanent
neurologic disability by 39 percent. It is critical that EMS personnel are aware of
the inherent dangers and how to properly perform a concussion evaluations. This
important session will provide you with all that and more!

Special Focus Track
To Thine Own Self Be True: Aligning Educational What’s Killing Our Medics?
Objectives and Competencies with the Actual DATE: 02/26/2016, TIME: 10:15 AM - 11:45 AM
Needs of Our Patients and Providers Amy Young, EMT-P, Director of Ground Operations
DATE: 02/26/2016, TIME: 8:30 AM - 10:00 AM West CareFlite, Grand Prairie, Texas
Brent Myers, Chief Medical Officer & Executive Session Description: A 2015 survey targeting EMS providers
was responded to by 4,021 participants. The results of the
Vice President for Medical Operations, Evolution
survey show alarmingly high levels of stress, suicide contemplation and suicide
Health and Associate Chief Medical Officer, AMR
attempts among the people who responded. The survey revealed that while
Scott Bourn, VP of Clinical Practices & Research, American Medical some respondents found formal support institutions to be effective,
Response / Envision Healthcare opportunities for improvement were exposed. Cultures that didn’t support the
Session Description: Since the “white paper” in 1966 EMS has changed employees through Critical Stress had higher rates of suicide contemplation
dramatically. Our “service line” has expanded from basic care and transport to and attempts. Join researcher Amy Young for this important lecture where she
a sophisticated structured assessment, advanced-level care, prioritization, and will carefully review her survey results and present important information that
determination of destination. And the shift of the focus of healthcare delivery you can use personally and take back to your ambulance service managers so
away from the hospital to the community promises additional opportunities. that they can institute programs to recognize and mitigate stress – and suicides
Unfortunately the educational preparation of EMS professionals has not – in your EMS system.
changed substantially since the 1990’s. This dynamic, case driven program will
explore the question: Can EMS providers participate in expanding healthcare
Mental Health of EMS Providers:
opportunities with their current training & education? And, if not, what will be
required? The Ottawa Model
DATE: 02/26/2016, TIME: 1:15 PM - 2:15 PM
Show Me the Money! FLSA Update - Using Cell Marc-Antoine Deschamps, Operations Superintendent (A), Ottawa
Paramedic Service, Canada
Phones, Smartphones and Email Off-duty Session Description: The mental health of emergency responders has attracted
DATE: 02/26/2016, TIME: 8:30 AM - 10:00 AM a lot of attention over the last few years after a string of suicides within their
Allison Bloom, Attorney, Law Office of Allison J. Bloom ranks. The Ottawa Paramedic Service, in Ontario, Canada, has been pro-active
Session Description: Are you paid by the hour by your employer? Are you for several years with mental health in the workplace through a series of
eligible for overtime? Do you have an employer-issued (or sponsored) initiatives. This session will present the model that has been adopted by the
smartphone or cell phone, or a personal one which you use to check and Ottawa Paramedic Service which includes supervisor training, Employee
respond to work-related email during off duty hours? Do you log into agency Assistance Program, Peer Support and a pilot project in zoo therapy. However,
software programs to complete patient care charts, perform QA/QI functions, this implementation wasn’t done without its challenges. A significant change
or catch up on employer-required training from the comfort of your living in mentality among all layers of the organization had to be done. This session
room? As an employer, do you allow – or even encourage – your employees to will also share the various lessons that have been learned through these years
do any (or all) of the above? If so, you literally cannot afford to miss this of continuous improvement.
session! Recent FLSA cases have held that checking and responding to emails
by non-exempt employees during non-working hours equals work under the
FLSA, and employees likely need to be compensated for this time. Join
Infection Control Training Issues in Emergency
Attorney Allison J. Bloom to learn how these significant cases may impact your Services
budget and your pocketbook. DATE: 02/26/2016, TIME: 1:15 PM - 2:15 PM
Katherine West, Infection Control Consultant, Infection Control
Product Innovations at EMS Today Emerging Concepts
DATE: 02/26/2016, TIME: 10:15 AM - 11:45 AM Session Description: Ebola clearly brought out a lack of infection control and
Jeffrey Lindsey, Coordinator of bachelor and master degree disease training. Why is this still an issue today? Most departments are not
offering proper or required training required under OSHAs mandate. Is EMS
programs in emergency services at the University of Florida
getting proper infection control training? OSHA has strict requirements - are
Session Description: Don’t miss this popular session! Dr. Lindsey will facilitate
departments meeting them? This session will explore why and offer
presentations of the new products on display at the 2016 EMS Today
suggestions for corrective action.
Conference. Hear firsthand about innovative products that have launched since
last year’s conference and exposition. This is a great opportunity to find out
about a product’s features and benefits, then head over to each exhibitor’s Incorporating Social Media into EMS Education:
booth to learn all about the products you are most interested in. Attendees at Kicking It with your FOAMies
this session will be asked to select their top three products so we can get an DATE: 02/26/2016, TIME: 2:30 PM - 3:30 PM
idea of the attendees’ favorites! Keith Widmeier, EMS Educator, University of Cincinnati College of
Medicine
Session Description: Too often we hear about the consequences of social
media in education. We warn students about how to stay safe and ensure they
don’t make a mistake. What about the benefits of social media? Social media
helps keep people connected, disseminates information to the masses, and is a
fantastic PR tool. We must teach students to be safe, but we must also teach
students to take advantage of this incredible tool.

Special Focus Track
The New Enhanced Role of the Public in Don’t Call Me Sweetheart - Ten Steps to Better
EMS Response Bedside Manner
DATE: 02/26/2016, TIME: 2:30 PM - 3:30 PM NREMT: OT
Robert Luckritz, Director of EMS & Government. Relations, Jersey City DATE: 02/26/2016, TIME: 3:45 PM - 5:15 PM
(NJ) Medical Center Richard Huff, EMT, Atlantic Highlands First Aid
Session Description: This presentation examines an innovative new program, Session Description: EMS providers today are often so focused on SAMPLE
adopted from a successful model in Israel, that involves trained community questions and blood pressure figures, they completely forget the patient. In short,
members and EMS service staff in an enhanced EMS response plan. The Jersey City they lack good bedside manner. We’ve all been there when over a patient one
program, started in July 2015, involvement of bystanders in emergency care and EMT asks another about a dinner reservation or has a conversation about
critical cases by deploying public access defibrillation, public access hemorrhage something that has nothing to do with the patient on the cot. Textbooks teach
control and other treatment modalities. Some team members are also being little about bedside manner and once EMS staffers hit the street, human
deployed on motorcycles for more expeditious response in high traffic areas. communications go out the window. This class will teach attendees the lost art of
Luckritz will discuss the Jersey City program, the role of EMS in providing adequate bedside manner.
training and oversight for community response, and the emergence of structured
community responder programs both locally and abroad. Fleet 101 - Three Points in the Cycle of Care
DATE: 02/26/2016, TIME: 3:45 PM - 5:15 PM
Alaska: A Primer on “Remote” EMS Daniel Fellows, Fleet Manager, Richmond
NREMT: MED, OT Ambulance Authority
DATE: 02/26/2016, TIME: 2:30 PM - 3:30 PM Session Description: Fleet vehicles in today’s EMS environment must be able to
Michael Levy, M.D. FACEP, FACP, Medical Director, Anchorage Fire respond, provide a platform for quality patient care and transport of the patient
Department safely to definitive care as never before. The days of using identical maintenance
Session Description: Join Michael Levy, MD, on an interesting educational journey processes on every vehicle type have long past and management of fleets has
into prehospital Alaska’s remote and sometimes harsh environment. Rural become as data driven as response times and patient care. Join Dan Fellows at this
medicine occurs in areas apart from the urban hubs, but truly remote medicine session as he touches on the importance of data driven change in preventative
occurs in the vast roadless areas of Alaska. Dr. Levy’s presentation will provide maintenance, how todays fleet vehicles differ from those not so long past, why
important and surprising information on how prehospital providers operate in this geography is essential and tips to gain efficiencies in processes providing for a
remote environment, providing care to some of the sickest patients hours, and higher standard of EMS vehicle.
sometimes days, from definitive care. If you serve rural or remote areas, do not
miss this session. Dr. Levy will give you plenty of take-away messages. Into the Real World: Developing a Standardized
Scenario Program
Is Prehospital Endotracheal Intubation Elemental or DATE: 02/27/2016, TIME: 8:30 AM - 9:45 AM
Detrimental? Michael Hanley-McCarthy, Adjunct Faculty, MassBay
DATE: 02/26/2016, TIME: 3:45 PM - 5:15 PM Community College
Paul E. Pepe, Professor and Regional Director, Out-of-hospital Jacob Hanley-McCarthy, Adjunct Faculty, MassBay Community College
Mobile Care Systems, University of Texas Southwestern Kimberly Altavesta, Program Director, MassBay Community College
Medical Center at Dallas Session Description: In this interactive session, the MassBay EMS team will discuss
Session Description: While endotracheal intubation (ETI) remains the gold their challenges, best practices, and lessons learned from developing their
standard for airway management in cardiac and trauma resuscitation, evolving Standardized Scenario Program for their EMT and Paramedicine Programs.
evidence has demonstrated concerns about the use of ETI in the prehospital Providing realistic, authentic learning opportunities allows students to think
setting. Studies, including clinical trials in children and case controlled studies in critically and make decisions that have real clinical effects and consequences.
adult head injury situations, have shown the potential deleterious effects of These scenarios promote long lasting knowledge and improve performance on
prehospital ETI, including worsened outcomes. However, the worsened outcomes exams and clinical practice. You will learn about the role of standardized scenarios
may not be the result of the placement of an ETI, but rather subtle and and how these exercises scaffold students’ learning throughout the curriculum.
under-appreciated system factors, including the traditional training provided to You will learn the process to develop, revise, and implement a scenario as well the
EMS personnel, EMS system configurations and deployment strategies, and also critical role of debriefing in the learning process. The team will discuss the role of
uncontrolled ventilator technique. Specifically, the speaker will detail how, in many instructor and student feedback in the revision and implementation process.
circumstances, the design of the EMS system, the traditional lack of focus on Finally, the team will provide their best practices so you can bring their experience
emergency ventilatory techniques, and the common lack of expert supervisory back to your own programs.
personnel in most EMS systems, should all be red flags and that they may indicate
the need for more discretion and limitations in the use of prehospital ETI. In this
session, the speaker will explain the reasons why prehospital endotracheal
intubation (PHETI) has recently received a bad reputation and then delineate the
factors that are responsible for poor performance of PHETI including EMS system
configuration and ventilatory techniques employed. In the end, he will support
PHETI, but with all of the appropriate caveats to ensure the best care of patients.

Special Focus Track
Strategies for Staying on Your Emotional Track Mental Health of EMS Providers:
NREMT: ELECTIVE The Ottawa Model
Howard Woodruff, MD, Founding Partner, Advanced Crisis Marc-Antoine Deschamps, Operations Superintendent (A), Ottawa
Preparation & Intervention Paramedic Service, Canada
Session Description: Remember the excitement that electrified your body as you Session Description: The mental health of Emergency responders has attracted
responded to that very first call? As you responded, questions flooded your mind; a lot of attention over the last few years after a string of suicides within their
“What am I going to encounter?” “Will I be able to help?” and “What will be the ranks. The Ottawa Paramedic Service, in Ontario, Canada, has been pro-active
outcome?” Yet over time, as you witness the most horrendous moments in people’s for several years with mental health in the work place through a series of
lives, you began to ask yourself, “How can I survive?” On top of that, you sacrifice
initiatives. This session will present the model that has been adopted by the
your own safety to help others, you receive a less-than adequate salary and your Ottawa Paramedic Service which includes supervisor training, Employee
work seems to command less and less respect these days – causing you to sometimes Assistance Program, Peer Support and a pilot project in zoo therapy. However,
ask “Why do I do this?” Attend this important session and learn how rehearsing the this implementation wasn’t done without its challenges. A significant change
R.E.A.L. strategies (Resilient Empowering for Abundant Life), not only can we reclaim in mentality among all layers of the organization had to be done. This session
that excitement, but also allow you to experience a more satisfying life. will also share the various lessons that have been learned through these years
of continuous improvement.
Ethical Dilemmas in EMS
NREMT: OT Getting Over the Emotional Hurdle of Bad Calls
DATE: 02/27/2016, TIME: 8:30 AM - 9:45 AM NREMT: ELECTIVE, OT
Keith Wesley, MD, Medical Director, HealthEast Medical DATE: 02/27/2016, TIME: 1:00 PM - 2:00 PM
Transportation Howard Woodruff, MD, Founding Partner, Advanced Crisis
Session Description: EMS providers often encounter ethical challenges when caring Preparation & Intervention
for patients. These challenges are best met by providers who can evaluate the Session Description: You’ve just had one of the most disastrous calls of your
situation in a logical manner. This presentation will review the principles of healthcare career and, as you radio the dispatcher and place yourself available, you
ethics and apply them to actual EMS cases such as dealing with DNR designation and wonder if you really are. You know that you did everything that you could, but
suicides, medical error reporting, and release of patient care information. you just can’t get THAT call out of your mind. You go home that evening and
you isolate yourself from your family or friends but you don’t know why.
EPIC Medics Injury Prevention: The Role for Bad calls happen to each of us and, if left unaddressed, they can take their toll
EMS in Population Wellness and Prevention on us physically, psychologically, and spiritually. “Clearing the Emotional
DATE: 02/27/2016, TIME: 1:00 PM - 2:00 PM Hurdles of Bad Calls” will share with you helpful advice and proven techniques
Keith Griffiths, President, The RedFlash Group that will help you to move beyond those experiences and put you back on the
Michael Gerber, The Red Flash Group, former EMS Supervisor, track to healthy living and improved functioning.
Alexandria (VA) Fire Dept.
Paul Maxwell, Co-founder, EPIC Medics, Paramedic and educator, Drinking Alcohol? Just Say KNOW!
Rural Metro Corporation NREMT: ELECTIVE, OT
Session Description: Twenty years ago the “EMS Agenda for the Future” DATE: 02/27/2016, TIME: 2:15 PM - 3:15 PM
envisioned a time when EMS would be integrated in the healthcare system, Frank Poliafico, Director of Training, Emergency University
engaged in community health monitoring, and playing an expanded role in Session Description: It could be argued that the inappropriate consumption of
public health and prevention. It may have taken some time to get there, but in alcoholic beverages has played a large part in the need for as well as the
many communities across the U.S. that is exactly what is happening now. growth of EMS Systems around the world. Far too many calls involve the abuse
Of course, many individuals in EMS and entire EMS agencies have long taken of this legitimate, but potentially dangerous chemical. Sadly the demise of
on population wellness and injury prevention as part of their mission. And for many EMS careers can be traced to drinking alcoholic beverages at the wrong
the past 13 years, excellence in wellness and injury prevention by EMS agencies time, amount and/or place. The future of EMS lies not in only in creative care
has been recognized at EMS TODAY through the Nicholas Rosecrans Award, a techniques, but in PREVENTION! The continuing enigma of alcohol
partnership between JEMS, EPIC Medics and the RedFlash Group. consumption presents EMS with an ideal issue on which to address a major
public health and safety need, while we help our colleagues and ourselves. This
This session profiles the winner of the Nicholas Rosecrans Award, providing the interactive session will explore basic facts about alcohol use and offer a
“who, what, how, why and where” of their intervention, with lessons for creative approach to educating and motivating responsible use. This
others along the way. In addition, this session will: non-threatening/non-judgmental program will also provide guidelines for
• Highlight other successful prevention programs that have been integrated into reasonable and safe off-duty use of alcoholic beverages by EMS personnel who
EMS outreach programs, particularly innovative interventions in community choose to do so.
paramedic/MIH programs
• Provide an overview of the public health approach to wellness and prevention
and how it applies to EMS
• What you can do in your own organization to improve safety and prevent injuries
of your own personnel
The award was created in the memory of Nicholas Rosecrans, a toddler whose
drowning sparked a group of paramedics to create EPIC Medics and assume
community leadership in injury prevention.

Special Focus Track
Through the Eyes of a Cadaver What’s Killing Our Medics?

Amanda Bowen, Paragon Medical Education Group Amy Young, EMT-P, Director of Ground Operations
Session Description: Teaching is a skill all of its own; but teaching with a cadaver West CareFlite, Grand Prairie, Texas
takes things to a whole new level. Now teaching in cadaver labs has become a Session Description: A 2015 survey targeting EMS providers
key factor in training EMS personnel and assisting them in saving lives. This was responded to by 4,021 participants. The results of the
presentation will take a look into what it took to create one of the most survey show alarmingly high levels of stress, suicide contemplation and suicide
true-to-life educational experiences EMTs, paramedics, fire first responders, attempts among the people who responded. The survey revealed that while some
nurses, and physicians may ever experience related to the proper response to respondents found formal support institutions to be effective, opportunities for
terrorism. This presentation will take a “hands-on”, “minds-on” approach that improvement were exposed. Cultures that didn’t support the employees through
uses procedural cadaver labs to allow participants full access to donors to gain Critical Stress had higher rates of suicide contemplation and attempts. Join
comfort levels on high risk, low frequency skill sets related to trauma. This researcher Amy Young for this important lecture where she will carefully review
presentation will demonstrate how to think out of your comfort zone and give her survey results and present important information that you can use personally
your providers more confidence related to critical thinking and skill sets in an and take back to your ambulance service managers so that they can institute
intense learning environment with the use of human tissue. programs to recognize and mitigate stress – and suicides – in your EMS system.

FACULTY AS OF AUGUST 24, 2015
The logo represents those faculty

given the award for their achievements during 2009-2014.
Kimberly Altavesta, M.Ed., NRP, I/C Randy Budd

Program Director, MassBay Community College Is the Emergency Medical Services Captain for the Mesa Fire & Medical
Department. Budd has been involved in medical education and
Jennifer Anders biomedical repairs his entire career. His focus over the last couple of years was to
Attending Physician, Pediatric Emergency Medicine, Johns Hopkins Hospital develop and implement noninvasive ventilation in the pre-hospital setting.
Tim Burleson
Frederick Bachner
Is 27-year emergency service veteran with experience as an EMT, EMS officer, fire EMS Specialist, Mesa Fire and Medical Department
officer and fire instructor. He currently overseeing the fire officer curriculum at all
levels at the New York State Fire Academy. Philip Callahan, PhD, NREMT-P
tIs a professor emeritus at the University of Arizona as well as a
Raphael Barishansky volunteer firefighter and paramedic.
Director, OEMS, Connecticut Department of Public Health
Carissa Caramanis O’Brien, EMT-B
Robert Bass, MD, FACEP President, Red Box Communications
Served as the Executive Director of the Maryland Institute for EMS Systems. Is a
past-president of the National Association of State EMS Officials and the National Brendan G. Carr, MD, MS
Association of EMS Physicians, and a past chair of the EMS Committee of the Is the Director of the Emergency Care Coordination Center within the Office of
American College of Emergency Physicians. He has served as a medical director the Assistant Secretary for Preparedness & Response. He completed residency
for emergency medical services systems in Charleston, SC, Houston, TX, Norfolk, in emergency medicine, fellowship in trauma & surgical critical care, and the
VA, and Washington, DC. Robert Wood Johnson Foundation’s Clinical Scholars Program at the University of
Pennsylvania.
Mike Beimer
Is a Director for Hardeman County (TX) Memorial Hospital District. Beimer served Dana Clarke, RN, BSN, CFRN, EMT-P, EMS Faculty,
over 28 years in the Navy with variety of assignments to include the office of Houston Community College
Chief of Naval Operations as advisor to the Navy Surgeon General on matters
relating to CBRNE Consequence Management issues and worked at the NCIS Kevin Collopy
headquarters where he was a policy officer in the area of Anti-terrorism and Force Is the Education Coordinator for AirLink/ViaLink Critical Care Transport where he
Protection policies. oversees the program’s simulation lab, clinical rotations, continuing education,
and orientation programs. He also serves on several state and national EMS
Bryan Bledsoe, DO, FACEP, FAAEM advisory boards. He is an accomplished EMS educator and author with over 100
Prof. of Emerg Medicine, University of Nevada publications. He performs prehospital clinical research, and is a voice of change in
how we approach patient care. He currently
Allison Bloom Esq.
Is a coach, consultant, and attorney who works with EMS and fire agencies. Christopher Colwell
Allison has been certified as an EMS provider for over 25 years. Chief of Emergency Medicine, Denver Health Medical Center, Vice Chair,
Emergency Medicine, University of Colorado School of Medicine
Joe Bourgraf
Is president and CEO of the Ferno Group of Companies. Benjamin Currie
District Chief, Wake EMS
Scott Bourn, PhD, RN, EMT-P
VP of Clinical Practices & Research, American Medical Response/Envision Healthcare Twink Dalton
Is the EMS Education Coordinator for the Mountain View Fire Protection District
Amanda Bowen in Longmont, CO. She began her career as an RN in an emergency department
Paragon Medical Education Group in Omaha, Nebraska. Since that time she has served as faculty and director for
Creighton University’s EMS Program, Trauma Coordinator for a Level I trauma
center in Omaha, EMS Coordinator for the Omaha Fire Department and Clinical
Kathleen Brown MD Educator for Pridemark Paramedic Services in Boulder, CO. She is a well-known
Is an associate professor of pediatrics and emergency medicine at the George speaker and author in the field of EMS.
Washington University School of Medicine and the medical director of the
emergency department at CNMC.
Pratik Das
Clincal Researcher, BS, NRP
Jeremy Brywczynski MD
Is assistant professor of emergency medicine at Vanderbilt University Medical
Center in Nashville, Tennessee. He also serves as medical director of Vanderbilt’s Josh Davies
fixed wing and rotor wing LifeFlight aeromedical EMS division, as well as EMS Section Chief, Santa Clara County Emergency Medical Services
assistant medical director of the Nashville Fire Department.
Drew Dawson
Is the director of the Office of EMS within the U.S. Department of Transportation’s
National Highway Traffic Safety Administration.

Andrew Dennis, DO, FACS, FACOS, DME Alex Garza, MD, MPH
Is a senior trauma and burn surgeon and chairs the Division of Pre Hospital and Is the former Assistant Secretary for Health Affairs and Chief Medical Officer
Emergency Traumatology at the Cook County Trauma and Burn Unit in Chicago Il. for the U.S. Department of Homeland Security. Currently Dr. Garza serves as
He is Chairman of the Department of Surgery at Midwestern University College of Associate Dean and Professor in Epidemiology at the St. Louis University College
Osteopathic Medicine, and Associate Professor of Surgery at Rush Medical College. of Public Health and Social Justice. He is also the medical director and Homeland
Security advisor for FirstWatch, a technology company that helps public health
Marc-Antoine Deschamps and safety agencies use real-time data to improve situational awareness,
Operations Superintendent (A), Ottawa Paramedic Service operational readiness and clinical care.
Edward T. Dickinson, MD, FACEP, NREMT-P Michael S. Gerber

Is a professor of emergency medicine and director of EMS field operations in Is a paramedic in the Washington, D.C. metropolitan area with over a decade of
the department of emergency medicine at the Perelman School of Medicine, EMS experience.
University of Pennsylvania in Philadelphia. He is the medical editor of JEMS
and medical director of Malvern, Radnor and Berwyn Fire Companies (Pa.) and Mark Gibbons
Haverford Township Paramedics (Pa.). Major (ret) Maryland State Police
Lisa A. Drago, DO, FAAP David Glendenning, EMT-P

Is a pediatric emergency medicine physician who began her career in health Is the education coordinator with New Hanover Regional Medical Center
care in undergraduate school where she was an EMT in the Pennsylvania EMS Division of EMS.
system. After graduating from medical school she completed a residency in
general pediatrics followed by a fellowship in pediatric emergency medicine. Dr. William Godfrey
Drago is a pediatric attending at Cooper University Hospital Pediatric Emergency Is chief consultant for C3 Pathways, a public safety consulting, training, and
Department and serves as Pediatric Medical Director for the Division of EMS, exercise firm. Chief Godfrey is heavily involved in law enforcement-centered
Disaster, and Transport Medicine. and Active Shooter Incident Management research, training, and exercises. He
was a co-author of the “Active Shooter Incident Management Checklist” and
Peter Dworsky accompanying Help Guide, the “4 Best Practices for Active Shooter Incident
Is Corporate Director of MONOC Mobile Health Services, New Jersey’s Management”, several active shooter curricula and developed numerous
single largest EMS and mobile healthcare shared service hospital simulation systems and 2D and 3D simulations.
cooperative.
Michael Gooch
Andrew Ecker, BSRN, CEN, FP-C, EMT-P Flight Nurse and Instructor in Nursing, Vanderbilt University
Paramedic, Virtua Health
Jeffrey Goodloe
Michael Elliott, BS, LP Medical Director, Medical Control Board, EMS System for Metropolitan Oklahoma
Is a Division Chief for Austin-Travis County Emergency Medical Services and City & Tulsa
oversees the Emergency Management Division. He is a founding member of the
Austin Travis County EMS Special Operations Unit. Elliott is credentialed as a Ryan Greenberg
Plans Section Chief and Resource Unit Leader on the Texas (Capital Area) Type Is on the Executive Committee of the Board of Directors of the National EMS
3 Incident Management Team, has created medical care protocols for hazardous Management Association. He has spent 20 years working in EMS, from EMT
materials and toxic terrorism and has served on the Catastrophic Guidelines and to Chief of EMS. Ryan has focused his career on building hospital based EMS
Triage Committee since its inception. systems across the northeast while always remaining an active paramedic,
firefighter, educator and EMS advocate. Ryan received his undergraduate degree
William P. Fabbri, MD, FACEP from Babson College and his Master’s Degree from Seton Hall University.
Is the medical officer and director of emergency medical support for the Federal
Bureau of Investigation. Keith Griffiths, President
The RedFlash Group
Daniel Fellows
Fleet Manager, Richmond Ambulance Authority Mic Gunderson
Is the National Director for Clinical Systems in the Quality and Health Information
Jennifer Fishe Technology Division of the American Heart Association. Mic has served as Executive
Is a Pediatric Emergency Medicine Fellow at Johns Hopkins Hospital in Baltimore, Director for the Kent County EMS System in Grand Rapids, MI.; President of Integral
MD. Performance Solutions (IPS); National Director for Quality, Education and Research
with the Rural/Metro Corporation; and Director of Research and Education with the
John Freese, MD Office of the Medical Director in the Pinellas County, Florida EMS system.
Is the Director of Prehospital Research for the Fire Department of New York
(FDNY) and works clinically as an emergency department physician at Frisbie Troy Hagen
Memorial Hospital in Rochester, NH. Before leaving New York, he spent nearly a Is past president of NEMSMA and CEO of Care Ambulance in Orange County,
decade as one of the FDNY’s medical directors, including his appointment to the Calif. He has been involved in EMS since 1989.
role of Chief Medical Director from 2010-2013.
Michael Hanley-McCarthy, NRP, I/C
Chad Gainey, NREMT-P, FP-C Adjunct Faculty, MassBay Community College
Is an instructor/flight paramedic for the Maryland State Police Aviation Command.
Jacob Hanley-McCarthy, EMT-P, I/C
Dia Gainor Adjunct Faculty, MassBay Community College
Is the executive director and a past president of the National
Association of State Emergency Medical Services Officials.

Todd Hatley Michael Lambert
Is the CEO of Integral Performance Solutions and is an experienced Six Sigma Is the Senior Homeland Security Planner for the Galveston County (TX) Office
Instructor who has taught EMS-specific Six Sigma workshops throughout North of Emergency Management (GCOEM). Prior to joining GCOEM, Michael was
America. Todd also serves as Adjunct Faculty at the University of Mount Olive and Senior Project Coordinator with the Montgomery County (Texas) Hospital
Adjunct Graduate Faculty at Western Carolina University. He holds an Associate District where, among other initiatives, he led the team that developed the
degree in EMS, Bachelor’s degree in Business Administration, dual Masters Degrees concepts of operations for the Houston/Galveston regional EMS response to a
in Business and Healthcare Administration and is completing work on a Doctorate in massive terrorist incident (now called the “AMOPs Plan”). He also acted as the
Organizational Systems. Administrator for the team that developed the Houston/Galveston regional mass
fatality concepts of operations.
Jody Heckman
Faculty, Tac-Med, LLC Baxter Larmon, PhD, MICP
Is a professor of emergency medicine at the David Geffen School of Medicine at
Kevin High, RN, MPH, MHPE, EMT University of California at Los Angeles (UCLA) and the founding director of the
Vanderbilt Dept of Emergency Medicine/LifeFightl UCLA Center for Prehospital Care.
Fran Hildwine, EMT-P Benjamin Lawner, DO, MS, EMT-P, FACEP
Is a Life Support Educator and Simulation Technician with the Pennsylvania Is an assistant professor in the University of Maryland School of Medicine and
College of Health Sciences and a paramedic with Chester County Hospital. Fran serves as the deputy medical director for the Baltimore City Fire Department.
is also an EMS Instructor with the Good Fellowship EMS Training Institute in
West Chester, PA. He has also served as the lead columnist of the JEMS “Hand’s Rob Lawrence
On” new product review monthly column. Fran holds an Associate’s Degree in Is the chief operating officer of the Richmond (Virginia) Ambulance
Electronics Technology, a Bachelor’s Degree in Allied Health and is currently Authority.
pursuing a Master’s in Health Science Education.
Brian LeCroix
Joe Holley MD, FACEP Is the President of Allina Health EMS, St. Paul, MN, a high-performance
Is the medical director for Memphis and Shelby County, Tenn. and the State of EMS system that serves more than 100 Minnesota communities, with a total
Tennessee EMS medical director. population of one million residents, with 570 employees. The system offers a
complete range of EMS services including Community Paramedics.
Kevin Horahan
Is a Senior Policy Analyst with the U.S. Department of Health and Human Services Matthew Levy, DO, MSc
in the Office of the Assistant Secretary for Preparedness and Response (ASPR), Medical Director, Howard County Department of Fire and Rescue
Office of Policy and Planning, Division of Health System Policy.
Michael Levy M.D. FACEP, FACP
James Howson, CEM, NRP Is the first and current medical director for the Anchorage Fire Department. He
Is assistant unit chief of operational medicine at the United States Department of has recently been elected to serve on the Board of Directors of the National
State, Bureau of Diplomatic Security. Association of EMS Physicians as Physician Member at Large and is the Alaska
Principal Investigator for the Northwest Heart Rescue Project.
Richard Huff, NREMT-B
Is the former three-time chief of the Atlantic Highlands First Aid and Safety Squad. Ofer Lichtman, NREMT-P
He oversees the organization’s media and outreach efforts. Has been involved in EMS for the past 17 years. He started his career as an EMT
in Israel and now serves as a firefighter/paramedic and Terrorism Liaison Officer
Kate Keller PA-C Program coordinator for the Rancho Cucamonga (CA) Fire Department. Lichtman
Kate Keller PA-C Assistant Medical Director at Arlington County Fire Department. was instrumental in developing his department’s Terrorism Awareness Program,
Associate Clinical Faculty at the George Washington University. Works clinically which included implementation of an Active Shooter Program. He is involved in
in the Emergency Department as a Physician Assistant at The George Washington EMS education, is an active California State Fire Instructor for Technical Rescue
University Hospital, The Walter Reed National Naval Medical Center at Bethesda and a lead USAR instructor for RCFD.
and the Veteran’s Administration Hospital in Washington DC.
Jeffrey Lindsey
Scott Kier Is the coordinator of the bachelor and master degree program in emergency
Is a field operations paramedic with New Castle County (DE) EMS in New services at the University of Florida.
Castle County, Delaware. He got his start in EMS in 1993 as a cadet with
the Island Heights First Aid Squad in Island Heights, NJ. He received his Bob Loftus, BS, NREMT-B
paramedic certification and a degree in EMS Management from Springfield Is a veteran EMS provider and educator for almost 40 years and currently vice
College in Springfield, Mass. Kier spent twelve years after graduation working chair of the Continuing Education Coordinating Board for EMS (CECBEMS) board
as a paramedic and Operations Supervisor for American Medical Response in of directors.
Springfield, Mass.
Jim Logan, BS, EMT-P/IC
Melissa Kohn, MD, MS, FACEP, EMT-PHP Serves as an acting chief officer and paramedic for the Memphis Fire Department
Is a Pennsylvania certified prehospital physician and emergency department in an Emergency Management and EMS administration capacity, specializing in
physician at Einstein Medical Center in Philadelphia, PA. She also serves as a EMS Consequence Management, Emergency Preparedness, Quality Improvement,
judge for the JEMS Games, the Advance Clinical Competition held at the EMS and Education. He is also a JEMS EMS10 award winner (Top 10 most innovative
Today Conference each year. people in EMS).

Robert Luckritz David A. Miramontes, MD, FACEP, NREMT

Is the Director of EMS & Government Relations for Jersey City Medical Center. is currently the Medical Director and an Asst. Chief of Fire and EMS for the District
He has served as an EMS manager in three states, where he has overseen all of Columbia Fire and EMS Department in Washington, DC. He completed his
facets of EMS including Operations, Clinical Care, and Training. He also served as Medical Degree at the Medical College of Ohio and residency at Mercy St. Vincent
an Adjunct Professor of EMS Management at Springfield College in Springfield, Medical Center in Toledo, Ohio. Dr. Miramontes has a long career in EMS as
Massachusetts. He holds a BS in EMS Management, a Juris Doctor degree and is an EMT, Medic, Firefighter ER and ICU RN and Lifeflight Physician. He also is a
currently a candidate for a Master of Public Administration degree. Regional Deputy Chief Medical Officer for the National Disaster Medical System
and was the former Team Commander of the OHIO 1 DMAT team before coming
Keith Lurie, MD to the Nation’s Capitol in his current role.
The founder, Chief Technical Officer, ZOLL Medical. Dr. Lurie also
maintains a clinical practice as a cardiac electrophysiologist and is a Jeffrey T. Mitchell, PhD
faculty member at the University of Minnesota, and is currently a Professor of Is Clinical Professor of Emergency Health Services at the University of Maryland
Internal Medicine and Emergency Medicine. He has published over 200 peer- Baltimore County and Co-Founder and Senior Faculty, International Critical
reviewed scientific articles and is considered an international expert in the field of Incident Stress Foundation
cardiopulmonary resuscitation.
Douglas Mohl
Brett Lyle Is a Special Agent with the FBI and coordinator of the FBI’s Operational Medicine
Business Development Manager, MedStar Mobile Healthcare (OpMed) Program for the Washington Field Office
Gregg Margolis, PhD, NREMT-P Raymon Mollers

Is the Director of the Division of Healthcare Systems Policy for the Office of the EMS Program Manager, DHS, OHA
Assistant Secretary of Preparedness and Response (ASPR) at the US Department
of Health and Human Services (HHS). He was Principal Investigator for the revision Mitchell R. Moriber
of the Paramedic and EMT-Intermediate: National Standard Curricula (1995). He Is Chairman of the Catastrophic Guidelines and Triage Committee. A practicing
has served with the Committee on Accreditation of Educational Programs for Emergency Medicine and EMS Physician, he is Medical Director for numerous
the EMS Professions, the National Association of EMS Educators, the National Public Safety Departments in West Texas. He served in Regional Advisory
Association of EMTs, and the Prehospital Care Research Forum. Committee/Trauma Service Areas U and D, is Chairman of the Taylor County
Local Emergency Planning Committee, served on the Governors’ EMS and Trauma
Michael Marino, M.S., NRP Advisory Council (GETAC) Medical Directors Committee, been Pediatric Liaison,
Battalion Chief, Special Operations, Prince George’s County Fire/EMS Department and presently is on the GETAC Disaster/Emergency Preparedness Committee.
Scott A. Matin Brent Myers

Is the vice president of clinical, education & business services for Is the Chief Medical Officer & Executive Vice President for Medical
MONOC Mobile Health Services in Wall Township, New Jersey. Operations, Evolution Health and Associate Chief Medical Officer,
AMR Robert Nadolski is a senior associate at Washko & Associates, LLC and a
Jeffrey Mayer director of clinical operations with Emory University/Emory Healthcare in Atlanta.
Sports Medicine and Family Practice Certified, Medstar Harbor View Sports
Medicine Robert Nadolski
Is a Clinical Administrator for Emory Healthcare and Emory School of Medicine
Paul Maxwell in Atlanta, Georgia. He also serves as a public safety and healthcare professional
Is a veteran paramedic from San Diego County and is the president and cofounder specializing in EMS systems.
of EPIC Medics.
David Neubert
Mike McEvoy, PhD, NRP, RN, CCRN Medical Director, Tac-Med, LLC
Is the EMS coordinator for Saratoga County, NY, a nurse clinician in the cardiac
surgical ICU at Albany Medical Center, the chief medical officer and a paramedic/ Terry Nichols
firefighter for West Crescent Fire Department and a paramedic supervisor for the Is Director of Curriculum Development for the Texas State University ALERRT
Clifton Park & Halfmoon Ambulance. (Advanced Law Enforcement Rapid Response Training) program and co-author of
the book “Active Shooter Events and Response”.
David McGowan
Consultant, ZOLL - Fleet Safety Solutions Michael Nolan, MA, Dip. Ed., CCP(F)
Is chief of the paramedic service and director of emergency services in Renfrew
Greg Mears, MD County, Canada.
Is the Medical Director for Zoll.
Nick Nudell
Mike Megna Is the project manager of the national EMS Compass initiative and Chief Data
Is retired from the University of Texas Medical Branch (UTMB) Galveston, and Officer, PrioriHealth Partners, LLP
has served as Hospital Executive Director, Administrator of the UTMB TDCJ prison
hospital and Associate Vice-President for Facilities and Operations. He currently Peter O’Meara, PhD
serves on the Texas Department of State Health Services Catastrophic Guidelines Is the professor of rural and regional paramedicine, head of the Department of
and Triage Committee. Paramedicine and Chair of the research committee in the LaTrobe Rural Health
School in Bendigo, Victoria, Australia.
Joseph Ornato, MD
Professor & Chairman, Dept of Emergency Medicine, Virginia
Commonwealth University

David Page, MS, NREMT-P Joel Rutkowski
Is Director of the Prehospital Care Research Forum at UCLA, a field Faculty, Tac-Med, LLC
paramedic and instructor at Allina EMS, in Minneapolis/St. Paul
and JEMS research columnist Kevin G. Seaman, MD, FACEP
Is the executive director of the Maryland Institute for EMS Services.
Paul E. Pepe, MD, MPH, FACEP, MACP, FCCM Prior to this, he was the medical director for Howard County (Md.)
Is a Professor of Surgery, Medicine, Pediatrics, Public Health and the Department of Fire and Rescue.
Riggs Family Chair in Emergency Medicine as well as the Regional Director
of Out-of-Hospital Mobile Care Systems and Event/Disaster Preparedness at the Manish Shah
University of Texas Southwestern Medical Center in Dallas: he is also the City of Assistant Professor in Pediatrics, Baylor College of Medicine
Dallas Director of Medical Emergency Medical Services for Public Safety, Public
Health and Homeland Security and coordinator of the Metropolitan Municipalities
EMS Medical Directors (“Eagles”) Coalition. Geoffrey Shapiro
Is the Director of the EMS & Operational Medical Training, Emergency Health
Services Program at George Washington University in Washington, DC.
Frank Poliafico, RN
Director of Training, Emergency University
Robert Silverman
Associate Professor of Emergency Medicine, Hofstra University School of Medicne,
Sue Prentiss, BA, MPA, NREMT-P Long Island Jewish Medical Center
Is the Manager of EMS at Concord (NH) Hospital. Sue has held leadership
positions in public safety and healthcare at the national, state, regional and
local levels. Sue served as the State of NH’s Trauma System Coordinator and Joelle N. Simpson, MD, MPH
Chief of EMS at NH’s Department of Safety In 2014 Sue was selected to attend Is a pediatric emergency physician at Children’s National Medical Center.
the Harvard Kennedy School of Government’s Senior Officials in State and Local
Government. Sue has been elected to public office four times as a City Councilor Corey Slovis, MD, FACP, FACEP, FAAEM
in Lebanon, NH and Deputy Mayor. Is a professor of emergency medicine and medicine and chairman of the
department of emergency medicine at Vanderbilt University Medical Center in
Jon Rittenberger, MD, FACEP Nashville. He serves as the medical director of the Nashville Fire Department, the
Is an associate professor of emergency medicine at the University of Pittsburgh NFD Paramedic/EMS Bureau and Nashville International Airport.
and serves as the program chairman and serves on the board of directors for the
National Association of EMS Physicians. E. Reed Smith, MD, FACEP
Is the operational medical director of the Arlington County (Va.)
Vincent D. Robbins, FACHE Fire Department, attending physician at Virginia Hospital Center,
Is President-Elect of NEMSMA and President and Chief Executive Officer of and associate professor of emergency medicine at the George Washington University.
MONOC, New Jersey’s single largest EMS and mobile healthcare shared service
hospital cooperative. He has also served in the administration at Temple John Sponholtz
University Hospital in Philadelphia and with the New Jersey State Department of Is a firefighter/AEMT with the Tisch Mills, WI Fire Department as well as a board
EMS. certified RN/Case Manager with Unity Hospice and Palliative Care of Green Bay,
WI. He has over 25 years of Emergency response experience including fire, EMS,
Severo Rodriguez and hazardous materials response.
Is the Executive Director of the National Registry of EMTs. Prior to becoming
the Executive Director of the NREMT, Severo was an Assistant Professor at the Brenda Staffan
University of Texas Health Science Center in San Antonio; Associate Dean at Is the Mobile Integrated Health Program Project Director for REMSA (Reno
Broward College, Manager of Quality and Risk Assessment at Sunny Brook Health Emergency Medical Services Authority), a high-performance EMS System based
Science Center and the Director of the South West Ontario Regional Base Hospital in Reno, NV that offers a full range of BLS, ALS, Aeromedical, Helicopter and
Program. Severo has been a paramedic for over 20 years and been involved in Community outreach programs including a well-developed Community Paramedic
EMS related research for over a decade co-authoring numerous peer-reviewed program.
publications.
Andrew Stevens
Gabe Romero, MBA, NRP Assistant Professor of Clinical Emergency Medicine, Indiana University School of
Is the director of examinations for the National Registry of EMTs and is Medicine
responsible for cognitive and psychomotor examination development and
deployment. Mr. Romero holds a bachelor’s in English Writing from the University Dan Swayze, DrPH, MBA, MEMS
of Colorado and Masters in Business Administration from Regis University, VIs the vice president for the Center for Emergency Medicine (CEM)
Denver, CO. in Pittsburgh.
Paul Rostykus, MD, MPH Peter Taillac, MD, FACEP

Is the EMS Medical Director for Jackson County (Oregon) EMS agencies, the Medical Director, Bureau of EMS and Preparedness, Utah Department of Health
current NAEMSP program chair, an affiliate assistant professor in emergency
medicine at the Oregon Health & Science University, and a research scientist with
Candice Thompson
the Pacific Northwest HeartRescue Project.
Is a Captain and licensed paramedic at Bulverde Spring Branch (Texas) Emergency
Medical Services. She is an Advanced Coordinator with the Texas Department
Jennifer Russell, BS, EMT-P of State Health Services and Training Center Coordinator with the American
Is a paramedic in Skagit County, Washington. A Field Training Officer, Medical Heart Association. Her primary duties include curriculum design and education
Support Officer, and education consultant, Jennifer’s most recent projects involve standards at the Centre for Emergency Health Sciences, a division of Bulverde-
studying EMS leadership skills, developing Quality Assessment and Improvement Spring Branch Emergency Medical Services.
projects, and creating field training programs for new providers and new field
training officers.

Samuel Tisherman, MD Rev. Dr. Howard T. Woodruff

Is the Director, Center for Critical Care and Trauma Education Director, Surgical Is the Lead Pastor of Elm Park Church in Scranton, PA. A second career pastor,
ICU, RA Cowley, Shock Trauma Center Howard became a certified as an EMT at the age of sixteen and an EMT Instructor
and, at the age of eighteen, the youngest certified Paramedic in PA. He had a
John Tobin distinguished career in EMS as a career Paramedic in Central Pennsylvania, a
Alarm Room Captain, Mesa Fire/Medical Department Paramedic Instructor and served as Affiliate Faculty for the AHA ACLS program.
Michael Touchstone Jeff Yorke

Is President of the National EMS Management Association and Director of the Is a military veteran and President of Patriot Ambulance in Flint (Genesee County)
Philadelphia Regional Office of EMS. Michigan. A retired deputy sheriff/paramedic, Yorke has developed his company
from a one ambulance/rented office, to a fleet of state-of-the-art ambulances
operating from a 14,000 square foot company-owned headquarters and enjoying
Jonathan Washko a reputation as being one of America’s most desirable ambulance companies to
Is the assistant vice president for the Center for Emergency Medical Services work for.
with North Shore - Long Island Jewish Health System in New York City and Long
Island, New York.
Amy Young, EMT-P
Is Director of Ground Operations West CareFlite in Grand Prairie, Texas.
Keith Wesley
Medical Director, HealthEast Medical Transportation
Matt Zavadsky, MS-HAS
Is the director of healthcare and community integration at MedStar
Katherine West Mobile Healthcare, the exclusive emergency and non-emergency EMS
Infection Control Consultant, Infection Control Emerging Concepts provider for Fort Worth and 14 surrounding cities in North Texas.
Steve White
Director, Pensacola State College
Keith Widmeier, BA, NRP, FP-C

Is an EMS Educator for the University of Cincinnati College of Medicine. He is an
accomplished EMS provider, author, and EMS educator. He’s responsible for all
initial, continuing and community education.
Rich Wiehe
Is the owner of “Coaching By Rich” in Grand Blanc, MI, a company that provides
organizational, executive, and personal coaching to organizations as well as a
wide variety of assessment tools, workshops and curriculum for individuals, teams
and organizations.
David M. Williams, PhD

Is an experienced consultant, researcher and founder of the international
consultancy Medic Health an improvement advisor and faculty for the Institute for
Healthcare Improvement.
Gary Wingrove
Is director of strategic affairs for Gold Cross/Mayo Clinic Medical Transport in
Minnesota and Western Wisconsin.
Steve Wirth, JD, EMT-P

Is a founding member of the national EMS law firm Page, Wolfberg, & Wirth LLC.
He has more than 35 years’ EMS experience as an EMT, paramedic, EMS instructor
and service administrator in rural and urban areas. He also has extensive experience
in labor relations and represents EMS management in labor negotiations, grievance
hearings and unfair labor practice proceedings before the NLRB.
Doug Wolfberg, JD, EMT

Is a founding member of Page, Wolfberg & Wirth LLC, a national EMS, ambulance
and medical transportation industry law firm. Doug spent years in EMS as a
provider and administrator, working as an EMS official at the county, state and WANT TO
federal levels. Doug is a longtime JEMS and EMS Insider columnist.
SPEAK AT EMS
TODAY 2017?
Matt Womble
Is a paramedic, former hospital administrator and dedicated advocate for patient
and provider safety. Through his work he promotes the advancement of safety
cultures to help ensure that our patients receive the best care possible and that all
our medics go home at the end of their shifts.
Be sure to talk to the Conference Manager on-site at EMS
Today 2016 and submit an abstract to be considered.

For more details on these co-located
CO-LOCATED EVENTS events please visit EMSToday.com
There are several events that have partnered with EMS Today
to hold their meetings. See the co-located events below:
Guiding You to Success on Your Transport Certification Exam
Critical Care Transport Certification Review Course
7:00 AM – 6:00 PM
Geriatric Education For Emergency Medical Services

2nd Edition Provider Course
8:00 AM – 5:00 PM
______________________________________________________________
ASTM International Committee F30 on Emergency Medical Services
(open to all attendees)

Certified Emergency Manager (CEM ®)/
Associate Emergency Manager Exam Preparatory Course
8:00 AM – 1:00 PM
Certified Emergency Manager (CEM)/

2:00 PM – 4:00 PM Associate Emergency Manager Exam
THURSDAY, FEBRUARY 25
Guiding You to Success on Your Transport Certification Exam
Critical Care Transport Certification Review Course
7:00 AM – 6:00 PM
FRIDAY, FEBRUARY 26
Certified Critical Care Paramedic, Certified Flight Paramedic
and Tactical Paramedic Certification Examinations
8:00 AM – 10:30 AM

What’s In Store For You

At EMS Today 2016!
OPENING RECEPTION Sponsored by:
Thursday, February 26 | 6:00 – 7:30 PM

Registration: No Charge; Open to all attendees
HELP US OPEN THE EXHIBIT HALL!
Immediately following the keynote session, join us at the opening reception in the exhibit hall on Thursday, February
26. Enjoy complimentary refreshing drinks and networking with an international assembly of EMS professionals.
RIDEALONGS & TOURS

Regional agencies and hospitals will offer tours,
ridealongs and observations during the event. To
find a list of participating agencies, visit
EMSToday.com/Special-Events/Ride-alongs.
PRODUCT INNOVATIONS
Friday, February 26 | 10:00 – 11:30 AM
SEE THE LATEST INNOVATIONS IN EMS!

Don’t miss this popular session
by Dr. Jeffrey Lindsey!
He facilitates presentations of all of the
LEARNING CENTER
new products showcased at EMS Friday, February 26 | 11:00 AM – 4:45 PM
Today 2016!
Saturday, February 27 | 11:00 AM – 12:15 PM
EARN CEH WHILE ON THE EXHIBIT FLOOR!

The Learning Center features sessions on a variety
of topics – all attendees will be able to obtain CEH
from all sessions. See pages 12-13 for a list of all sessions.
52 EMS TODAY 2016 PRELIMINARY EVENT GUIDE www.emstoday.com

KEEP AN EYE
OUT FOR A SPECIAL
CONTEST INVOLVING
PAUL COMBS SIGNING AJ HEIGHTMAN IN THE
DECEMBER ISSUE
Meet Paul Combs and have him sign the exclusive OF JEMS!
MS!
EMS Today illustration and/or tshirt.
Also keep an eye out on social media for a
special contest involving the Paul Combs tshirt!
AWARDS CEREMONY
Saturday, February 28 | 10:00 – 10:30 AM
YOU’RE INVITED!
Be sure to be in attendance as we award the following awards:
- Prehospital Care Research Forum Awards
- 14th Annual Nicholas Rosecrans Awards
- 13th Annual JEMS Games Medals Ceremony
EXHIBIT FLOOR GIVEAWAY
Saturday, February 28 | 12:45 PM
Walk away from EMS Today a winner! We are giving

away an all expenses paid trip, an iPad and cash!
S&S
Sponsored by: Medical
Products
COMPLIMENTARY
CONTINENTAL BREAKFAST
Saturday, February 28 | 10:00 – 11:00 AM
Open to all attendees
LET US TREAT YOU TO BREAKFAST!

Stop by on your way to the awards ceremony to grab some
free breakfast on the last day of EMS Today.
www.emstoday.com PRELIMINARY EVENT GUIDE EMS TODAY 2016 53

EMS10 AWARDS
JEMS, with support from Physio-Control Inc., is proud to sponsor the EMS10: Innovators in EMS
awards. Now in its 8th year, the awards recognize individuals who have contributed to EMS in an
exceptional and innovative way.
Ten outstanding EMS professionals/programs were recognized at the 2015 EMS Today Conference
as the “EMS 10: Innovators in EMS” for 2014. Their efforts are an inspiration and a challenge to
the rest of the EMS community.
Presented by: Sponsored by:
2014 AWARD RECIPIENTS, AWARDED IN 2015:

Scott Matin and Peter Dworsky Kevin Collopy
Bill Lang Douglas Kupas
Peter Antevy Keith Lurie
Randy Budd Rachel Phillips
Dan Swayze Wayne Zygowicz
KNOW SOMEONE WHO HAS MADE A SIGNIFICANT

CONTRIBUTION TO THE EMS INDUSTRY?
Nominate them at JEMS.com/ems10
DEADLINE FOR NOMINATIONS: NOVEMBER 30, 2015

THE EXCLUSIVE JEMS GAMES
EARN CEH WHILE WATCHING THE GAMES!!

WATCH THE ACTION! See the top 3 teams compete in this A PennWell Event, Sponsored by:
fast-paced, action-filled simulation of an EMS call and earn
1.5 CEH while watching the Final Competition.
Or if you think your crew has what it takes….
sign up to compete in the games!
The objective of the JEMS Games is to create a fun, challenging and educational
Competition Schedule:
experience for emergency medical personnel that results in them being better prepared
for the myriad challenges they may encounter in the field. More importantly, it’s a goal
CHECK IN:
of the JEMS Games to enlighten and invigorate EMS personnel from all over the world
Wednesday, February 24 | 3:00 PM – 5:30 PM
to deliver the same quality and compassionate care to all patients they encounter after
participating in the JEMS Games competition. TEAM MEETING WITH COURSE
Cost to participate: $100 per team WALK-THROUGH/ORIENTATION:
Wednesday, February 24 | 7:00 PM
Team Prizes: PRELIMINARY COMPETITION
(open to all attendees)
GOLD - $1,000 Thursday, February 25 | 8:00 AM – 5:00 PM
SILVER - $750 FINAL COMPETITION (open to all attendees)

Friday, February 26 | 5:30 PM – 8:00 PM
BRONZE - $500 AWARDS CEREMONY (open to all attendees)
Saturday, February 27 | 10:30 AM – 11:00 AM
*EMS equipment and prizes donated
to the top three teams as well.
Entry requirements, competition information and registration forms are available at EMSToday.com
or you may contact Ryan Kelley at 858.638.2625 or at RKelley@Pennwell.com.
Teams include 3 members and 1 alternate (optional). Entry is limited to the first 25 teams. Team fee is $100.
SPACE IS LIMITED AND FILLING UP FAST - BE SURE TO SIGN UP SOON TO SECURE YOUR SPOT!
DEADLINE TO ENTER: JANUARY 8, 2016

OFFSITE NETWORKING RECEPTION
A PENNWELL EVENT SPONSORED BY:
1 DRINK
Stop by ZOLL Booth #3905
1
to pick up your two free drink tickets. DR
IN
K
#ZOLLSHOCKFEST

EXHIBIT FLOOR GIVEAWAY
Win at EMS Today 2016!

st TRIP OF
1 YOUR
CHOICE
(UP TO $5,000)
2 nd
IPAD AIR
EXHIBITING
NETWORKING/SPECIAL
& SPONSORSHIP INFORMATION
rd
EVENTS
3
$250 GIFT CARD
Three lucky delegates will walk away from EMS Today winners!
All delegates are eligible to enter the drawing once they visit the sponsors’ booths. For complete
rules, regulations and participating sponsors, visit EMSToday.com.
WANT TO BE A SPONSOR
OF THE GIVEAWAY?
Exhibit Floor Giveaway - TO ENTER: Visit all sponsoring companies’ booths and have the Contact Sue Ellen Rhine to discuss your options.
official entry form stamped by representatives of those companies. The entry form can be found at P: 918.831.9786
registration or at the PennWell Booth. Return your stamped entry form to the PennWell Booth by E: SueEllenR@Pennwell.com
12:15 p.m. on February 27, 2016. A random drawing from completed entries will be held
at 12:45 p.m. on Saturday, February 27 at the PennWell Booth.
THANK YOU EXHIBIT FLOOR GIVEAWAY SPONSORS AS OF AUGUST 24, 2015
S&S
Medical
Products

2015 ATTENDEE DEMOGRAPHICS & SURVEY RESULTS
27 COUNTRIES
REPRESENTED!
of attendees said that

%
91 important to their career
visiting the exhibit hall is
Austria Finland India Kuwait Saudi Arabia United States

Australia France Ireland Mexico Singapore United States Minor
Canada Georgia Israel Netherlands Turkey Outlying Islands
China Germany Italy Norway Uganda
Denmark Iceland Japan New Zealand United Kingdom
2015 ATTENDEE SURVEY RESULTS
WHICH BEST DESCRIBES YOUR EMPLOYER? WHAT DISCIPLINE BEST DESCRIBES WHAT IS YOUR ROLE IN PURCHASE OF
YOUR PROFESSION? PRODUCTS AND SERVICES?
37.8% Fire Dept./Rescue Squad
15.2% Private Ambulance 27% EMT-B/First Responder 43% Others involved, my opinion equal
12.5% Third Serv./Municipal Agency 23% Administrator/Supervisor/EMS Chief/ 23.2% Others Decide
13.7% Hospital Other Chief or Medical Director 18.6% Others involved, my opinion most
10.4% Educational Institution 18% Paramedic/EMT-1/EMT important
7.3% Other 16% Instructor/Trainer/Coordinator 15.2% Final decision is mine
3.0% Industrial Commercial 6% Captain
6% Other
3% Emergency Management/Public Safety

2015 EXHIBITOR SURVEY RESULTS
EMS TODAY EXHIBITORS GET RESULTS!

We are more than 70% rebooked from the 2015 event and with this momentum we are
on-point for a successful EMS Today 2016!
CONTACT SUE ELLEN RHINE TO BOOK YOUR SPACE TODAY!

P: 918.831.9786 | E: SueEllenR@Pennwell.com
EMS Today offers vendors a variety of options to interact with existing and potential
customers. Additionally, the support of the staff is outstanding, they take the time to insure
as a customer you are completely satisfied with the experience. I personally have attended
the event for over 12 years and it continues to get better every year! Thank you!
- Kris Bordnick, Vice President EMS Sales North America, Quantum EMS Solutions
We from S&S Medical Products were more than pleased with the show. This event well exceeded
our expectations. We are excited about coming back next year and many years to come!
- Steve Wenclewicz, Director of Logistics and Sales, S&S Medical Products
PLEASE INDICATE YOUR COMPANY’S REASONS

FOR EXHIBITING AT EMS TODAY
49.2% Services provider

38.1% Monitor activity of competitors
25.4% Establish new business contacts
17.5% Establish a presence in a new market
14.3% Sell products/services in short term
12.7% International business opportunities
EXHIBITING
TRAVEL & REGISTRATION
9.5% Support local agent or existing clients
6.3% This is a must attend event
& SPONSORSHIPINFORMATION
70%
95%
INFORMATION
OF EXHIBITORS SAID THE QUANTITY OF

ATTENDEES EXCEEDED OR MET THEIR
EXPECTATIONS.
85% OF EXHIBITORS AT
EMS TODAY 2015 REBOOKED
OF EXHIBITORS ARE REPEAT EXHIBITORS
ONSITE FOR EMS TODAY 2016
OF EMS TODAY.

EXHIBIT & SPONSORSHIP OPPORTUNITIES
WITH SUCH POSITIVE RESULTS IN 2015 AND SPACE

FILLING UP FAST, YOU WILL WANT TO BOOK YOUR
SPACE NOW TO SECURE YOUR LOCATION!
COST TO EXHIBIT:
Exhibit space rate is $24.00 per square feet Ask about our advertiser’s discount
For Premium Space (corner booths and island booths), if you advertise in JEMS!
add $2.00 per sq. ft.
FOR ALL EXHIBIT & SPONSORSHIP INFORMATION, CONTACT

SUE ELLEN RHINE | P: 918-831-9786 | E: SueEllenR@PennWell.com
2016 SPONSORSHIP OPPORTUNTITIES
WHAT’S YOUR GOAL

BOOTH TRAFFIC
GENERATION
BRANDING NETWORKING DIGITAL MEDIA
TRACTION
CONFERENCE
DELEGATE ATTENTION
ATTENDEE
ATTENTION
ACCOMPLISH YOUR GOALS WITH CUSTOMIZED

SPONSORSHIPS WITH PACKAGES STARTING AT $1,000!

EXHIBITOR LIST AS OF AUGUST 24, 2015
EXHIBITING AS BOOTH # EXHIBITING AS BOOTH # EXHIBITING AS BOOTH #

AIRON CORP . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3525 FISDAP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3522 NATIONAL VOLUNTEER FIRE COUNCIL . . . . . . . . 3830
AKRIMAX PHARMACEUTICALS. . . . . . . . . . . . . . 2621 GAUMARD SCIENTIFIC . . . . . . . . . . . . . . . . . . . . 2315 NCE/NATIONAL CREATIVE ENTERPRISES . . . . . . 2820
AMBU SMARTMAN . . . . . . . . . . . . . . . . . . . . . . . 3229 GENERAL DEVICES . . . . . . . . . . . . . . . . . . . . . . . 2823 NORTH AMERICAN RESCUE, LLC . . . . . . . . . . . . 3533
AMERICAN COLLEGE OF EMERGENCY GERBER OUTERWEAR . . . . . . . . . . . . . . . . . . . . . 3836 NUMASK INC. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3122
PHYSICIANS, ACEP . . . . . . . . . . . . . . . . . . . . . 2925 H&H MEDICAL CORPORATION . . . . . . . . . . . . . . 3024 NUSET LOCK . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3121
AMERICAN EMERGENCY VEHICLES . . . . . . . . . . 3211 HAIX NORTH AMERICA INC . . . . . . . . . . . . . . . . 3128 ONSPOT AUTOMATIC TIRE CHAINS . . . . . . . . . . . 3423
AMERICAN HEART ASSN - EMERGENCY HALYARD HEALTH . . . . . . . . . . . . . . . . . . . . . . . . 3434 OPERATIVE IQ . . . . . . . . . . . . . . . . . . . . . . . . . . . 4021
CARDIOVASCULAR CARE . . . . . . . . . . . . . . . . 2911 HARTWELL MEDICAL LLC . . . . . . . . . . . . . . . . . . 2915 OSAGE AMBULANCE . . . . . . . . . . . . . . . . . . . . . . 2211
AMERICAN HEART ASSN - MISSION:LIFELINE . . 2910 HEALTH & SAFETY INSTITUTE, ASHI OSI INTERNATIONAL LLC . . . . . . . . . . . . . . . . . . 2530
AMERICAN MILITARY UNIVERSITY . . . . . . . . . . . 3527 & 24-7 EMS . . . . . . . . . . . . . . . . . . . . . . . . . . 3416 OXYGEN GENERATING SYSTEMS INTL . . . . . . . . 4045
ANGELTRAX. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2002 HEALTH CARE LOGISTICS . . . . . . . . . . . . . . . . . . 2015 P H & S PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . 3134
ARMSTRONG MEDICAL INDUSTRIES INC . . . . . . 2819 HORIZON MEDICAL PRODUCTS . . . . . . . . . . . . . 3834 PANASONIC SYSTEM COMMUNICATIONS
ATHENA GTX . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2319 HORTON EMERGENCY VEHICLES . . . . . . . . . . . . 2207 COMPANY . . . . . . . . . . . . . . . . . . . . . . . . . . . 3327
ATLANTIC EMERGENCY SOLUTIONS HOVERTECH INTERNATIONAL . . . . . . . . . . . . . . . 3442 PCG HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2821
& SKEETER BRUSH TRUCKS . . . . . . . . . . . . . . 2615 IAMRESPONDING.COM. . . . . . . . . . . . . . . . . . . . 3825 PEDIATRIC EMERGENCY STANDARDS, INC. . . . . 3125
B BRAUN MEDICAL INC . . . . . . . . . . . . . . . . . . . 3427 IMAGETREND, INC. . . . . . . . . . . . . . . . . . . . . . . . 3819 PELVIC BINDER . . . . . . . . . . . . . . . . . . . . . . . . . . 3842
BEYOND LUCID TECHNOLOGIES . . . . . . . . . . . . . 3542 INNOVATIVE HEALTHCARE CORPORATION . . . . 3123 PERSYS MEDICAL . . . . . . . . . . . . . . . . . . . . . . . . 2619
BINDER LIFT LLC . . . . . . . . . . . . . . . . . . . . . . . . . 3526 INNOVATIVE TRAUMA CARE . . . . . . . . . . . . . . . . 3019 PHILIPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2807
BOUND TREE MEDICAL . . . . . . . . . . . . . . . . . . . . 2803 INTERMEDIX . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3324 PHYSIO-CONTROL . . . . . . . . . . . . . . . . . . . . . . . . 3206
BRADY PUBLISHING . . . . . . . . . . . . . . . . . . . . . . 3519 INTERNATIONAL ASSN OF FLIGHT & CRITICAL PL CUSTOM EMERGENCY VEHICLES . . . . . . . . . . 2611
BRAUN INDUSTRIES, INC. . . . . . . . . . . . . . . . . . . 2402 CARE PARAMEDICS . . . . . . . . . . . . . . . . . . . . 2923 PLANO MOLDING COMPANY . . . . . . . . . . . . . . . 2119
CAMBRIDGE SENSORS USA, LLC . . . . . . . . . . . . 2730 INTERNATIONAL POLICE MOUNTAINBIKE ASSN . 2521 PLATINUM EDUCATION GROUP . . . . . . . . . . . . . 3922
CENTER FOR DOMESTIC PREPAREDNESS . . . . . . 2722 INTUBRITE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3333 POWERFLARE SAFETY BEACONS . . . . . . . . . . . . 3023
CHARLESTON COUNTY EMS . . . . . . . . . . . . . . . . 3521 ISIMULATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3224 PULMODYNE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2721
CHESAPEAKE FIRE DEPARTMENT . . . . . . . . . . . . 3640 IWOMEN / INT’L ASSN OF WOMEN IN FIRE PYNG MEDICAL CORP. . . . . . . . . . . . . . . . . . . . . 2927
CLORDISYS SOLUTIONS, INC. . . . . . . . . . . . . . . . 3336 AND EMERGENCY SERVICES . . . . . . . . . . . . . 2724 QUANTUM EMS. . . . . . . . . . . . . . . . . . . . . . . . . . 2817
CODE KIT PRO . . . . . . . . . . . . . . . . . . . . . . . . . . . 3331 JONES & BARTLETT LEARNING . . . . . . . . . . . . . . 2812 QUICK MED CLAIMS . . . . . . . . . . . . . . . . . . . . . . 3747
COLUMBIA SOUTHERN UNIVERSITY. . . . . . . . . . 3124 KARL STORZ ENDOSCOPY AMERICA . . . . . . . . . 3523 RAE SYSTEMS BY HONEYWELL . . . . . . . . . . . . . . 3436
COMPX SECURITY PRODUCTS . . . . . . . . . . . . . . 3028 KELDERMAN MFG . . . . . . . . . . . . . . . . . . . . . . . . 2121 RESCUE CHIC. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1914
DATATECH911 . . . . . . . . . . . . . . . . . . . . . . . . . . . 3340 KEMP USA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3236 RESCUE ESSENTIALS . . . . . . . . . . . . . . . . . . . . . . 3636
DECON 7 SYSTEMS, LLC . . . . . . . . . . . . . . . . . . . 2731 KNOX COMPANY. . . . . . . . . . . . . . . . . . . . . . . . . 3230 RES-Q-JACK INC . . . . . . . . . . . . . . . . . . . . . . . . . 3925
DEFENSE LOGISTICS AGENCY . . . . . . . . . . . . . . . 3330 KUSSMAUL ELECTRONICS. . . . . . . . . . . . . . . . . . 2219 ROSCO VISION SYSTEMS . . . . . . . . . . . . . . . . . . . 3528
DEMERS AMBULANCE . . . . . . . . . . . . . . . . . . . . 2507 LAERDAL MEDICAL CORP . . . . . . . . . . . . . . . . . . 3006 RX FABRICATION . . . . . . . . . . . . . . . . . . . . . . . . . 1911
DIGITAL-ALLY INC . . . . . . . . . . . . . . . . . . . . . . . . 3426 LIQUID SPRING LLC . . . . . . . . . . . . . . . . . . . . . . . 2921 S&S MEDICAL PRODUCTS . . . . . . . . . . . . . . . . . . 3846
DIGITECH COMPUTER . . . . . . . . . . . . . . . . . . . . . 3725 M2 INC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2421 SAM MEDICAL PRODUCTS . . . . . . . . . . . . . . . . . 2419
DISTANCE CME . . . . . . . . . . . . . . . . . . . . . . . . . . 2628 MARYLAND FLIGHT PARAMEDICS SOUTHEASTERN EMERGENCY EQUIPMENT . . . . 3810
DOD, DOMESTIC PREPAREDNESS SUPPORT ASSOCIATION . . . . . . . . . . . . . . . . . . . . . . . . . 1913
SSCOR INCORPORATED . . . . . . . . . . . . . . . . . . . 3425
INITIATIVE HOMELAND DEFENSE AND MASIMO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2912
EXHIBITING
STRYKER EMS . . . . . . . . . . . . . . . . . . . . . . . . . . . 3010
AMERICAS’ SECURITY AFFAIRS . . . . . . . . . . . 3329 MCKESSON BUSINESS PERFORMANCE
TAC-MED LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . 3622
ECORE SOFTWARE INC . . . . . . . . . . . . . . . . . . . . 2728 SERVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3540
TARGETSOLUTIONS . . . . . . . . . . . . . . . . . . . . . . . 2922
EKG CONCEPTS . . . . . . . . . . . . . . . . . . . . . . . . . . 3822 MDSP AVIATION COMMAND . . . . . . . . . . . . . . . 1802
TCF EQUIPMENT FINANCE . . . . . . . . . . . . . . . . . 3126
EMERGENCY MEDICAL PRODUCTS, INC. . . . . . . 2519 MEDAPOINT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3021
TELEFLEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3014
EMERGENT BIOSOLUTIONS, INC. . . . . . . . . . . . . 4020 MEDICED.COM . . . . . . . . . . . . . . . . . . . . . . . . . . 2929
THE BRATTLEBORO RETREAT UNIFORMED
EMS SAFETY FOUNDATION . . . . . . . . . . . . . . . . . 1919 MEDIX SPECIALTY VEHICLES . . . . . . . . . . . . . . . . 3815
SERVICE PROGRAM . . . . . . . . . . . . . . . . . . . . 3136
EMS WORLD . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4029 MEDLOGIC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3025
THE TOOLKIT GROUP. . . . . . . . . . . . . . . . . . . . . . 3733
INFORMATION
EMSAR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3131 MEDSOURCE INTERNATIONAL CO., LTD . . . . . . . 3233

THE WISE CO INC . . . . . . . . . . . . . . . . . . . . . . . . 2719
EMSCHARTS, INC . . . . . . . . . . . . . . . . . . . . . . . . . 3516 MEDTRONIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2011
THEEMSSTORE.COM . . . . . . . . . . . . . . . . . . . . . . 3645
ENOVATIVE TECHNOLOGIES . . . . . . . . . . . . . . . . 2321 MERCURY MEDICAL . . . . . . . . . . . . . . . . . . . . . . 2810
TRANSLITE LLC . . . . . . . . . . . . . . . . . . . . . . . . . . 3422
ESI RAPID RESPONSE . . . . . . . . . . . . . . . . . . . . . 3617 MERET PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . 3547
TURNKEY SURVEYS . . . . . . . . . . . . . . . . . . . . . . . 2732
ESO SOLUTIONS . . . . . . . . . . . . . . . . . . . . . . . . . 3216 MICROFLEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3419
UNIVERSITY OF FLORIDA . . . . . . . . . . . . . . . . . . 2830
EXCELLANCE INC . . . . . . . . . . . . . . . . . . . . . . . . 3614 MID-ATLANTIC EMERGENCY VEHICLES/LIFE
UNIVERSITY OF PITTSBURGH . . . . . . . . . . . . . . . 3536
FAAC INCORPORATED. . . . . . . . . . . . . . . . . . . . . 2220 LINE EMERGENCY VEHICLES . . . . . . . . . . . . . 2429
VE RALPH & SON INC . . . . . . . . . . . . . . . . . . . . . 3625
FAIRFAX COUNTY FIRE & RESCUE . . . . . . . . . . . 3936 MILLER COACH CO. INC. . . . . . . . . . . . . . . . . . . . 3220
VFIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2827
FEDERAL SIGNAL. . . . . . . . . . . . . . . . . . . . . . . . . 3031 MMS-A MEDICAL SUPPLY COMPANY. . . . . . . . . 3919
VYGON USA . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3421
FERNO-WASHINGTON INC . . . . . . . . . . . . . . . . . 3606 MOORE MEDICAL CORP . . . . . . . . . . . . . . . . . . . 3611
WELDON A DIVISION OF AKRON BRASS. . . . . . . 2816
FIRE NEWS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3628 MORTAN, INC. THE MORGAN LENS . . . . . . . . . . 3634
WHELEN ENGINEERING CO., INC. . . . . . . . . . . . . 2919
FIRE SOAPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3627 NASCO/SIMULAIDS INC. . . . . . . . . . . . . . . . . . . . 2411
ZIAMATIC CORPORATION . . . . . . . . . . . . . . . . . . 3227
FIREHOUSE SOFTWARE . . . . . . . . . . . . . . . . . . . . 3642 NATIONAL EMS MUSEUM. . . . . . . . . . . . . . . . . . 1807
ZOLL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3905
FIRST LINE TECHNOLOGY LLC . . . . . . . . . . . . . . . 3119 NATIONAL FIRE PROTECTION ASSOCIATION . . . 3127
FIRST PRIORITY EMERGENCY VEHICLE . . . . . . . . 2007 NATIONAL LIBRARY OF MEDICINE . . . . . . . . . . . 3530
FIRSTWATCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4019 NATIONAL REGISTRY OF EMT’S . . . . . . . . . . . . . 3440

EXHIBIT FLOOR PLAN AS OF AUGUST 26, 2015
The exhibit hall is displayed horizontally for easier viewing. Please note that the floor is actually vertical.
ENTRANCE

See website for live floorplan
BOOK YOUR EXHIBIT SPACE

BEFORE THE FLOOR SELLS OUT!
Join these influential companies as an
EMS Today exhibitor and gain access
to more than 4,500+ attendees.
EXHIBITING
INFORMATION

GAIN APPROVAL TO ATTEND
YOUR ATTENDANCE AT EMS TODAY IS WORTH THE INVESTMENT
GAIN APPROVAL TO
ATTEND IN 4 STEPS 150 conference
sessions & workshops
1. GAIN BUY-IN
Identify conference track subjects that satisfy your CEH
needs/professional goals and visit www.emstoday.com
to locate exhibitors that address specific needs within
your organization. Prepare a list of benefits that you
32 CEH offered
can achieve by attending EMS Today.
2. DEVELOP A PROPOSAL
Use our JUSTIFICATION LETTER that is provided at www. 4,500+
emstoday.com and fill in the blanks with the specific
sessions you would like to attend and exhibitors you
attendees
would like to meet. Be sure to include information on
the Early Bird deadline, discounted hotel rates and local
discounts at restaurants/attractions while you are in
Baltimore.
250+
3. SHOW HOW EVERYONE BENEFITS
exhibitors
Share your event goals with your department at work
and demonstrate how your participation will help
your team achieve their goals. BONUS: with your paid
registration you receive a 12-month subscription to
the digital edition of JEMS (you can print articles,
SAVE WITH
download them, share them ... all year long!) THE EARLY
4. GET STARTED BIRD RATES!
REGISTER BY
Use the above advice and visit www.emstoday.com to
download and customize the JUSTIFICATION LETTER to
JAN. 15, 2016!

get started. Look in the dropdown under “Attend” on
the main navigation; “Get Approval To Attend.”
SAVE $100!

SCHOLARSHIP INFORMATION
ATTEND EMS TODAY ON A SCHOLARSHIP
READY FOR YOUR FIRST EXPERIENCE AT

EMS TODAY? APPLY FOR A SCHOLARSHIP!
The purpose of the EMS Today Conference and Expo Scholarship program is to provide financial assistance to those EMS
professionals who are interested in advancing their career by taking part in the EMS Today Conference program but may not
have the financial means available to them.
HOW IT WORKS:
Exhibitors receive Gold Full Conference registrations with the purchase of their booth space. They are often not able to utilize
all the passes they are allocated, therefore, exhibitors can donate their unused Full Conference registrations and then they are
awarded to deserving applicants.
SCHOLARSHIP RECIPIENT TESTIMONIALS

I am a Paramedic student from VA and I wanted to attend The company I work for will not pay for me to attend. I have
EMS Today for the past 3 years but could not afford to do so never attended any type of EMS event to this scale due to
due to student loans, no funding from my agency, and just availability of funds. I support a large family on one income
like most of the students out there…BROKE!!! I can truly say and need assistance. I have recently been tasked with the role
this was one of the best experiences of my life. Thank you of Clinical Base Educator and believe this conference would
to all the staff at EMS Today who put together the exhibitor greatly benefit my patient care and educating the flight
pass donation program that made this possible for me! You crews.
guys ROCK!! - Name Withheld
- J. Diesel / NREMT-I
EXHIBITORS - INTERESTED IN DONATING

A CONFERENCE REGISTRATION?
If you are interested in donating your extra conference
registrations for EMS Today 2016, please contact
Rod Washington at RodW@Pennwell.com

HOTEL INFORMATION
Book your Hotel NOW! Discounted rates only available through

Preferred Convention Services (PCS) and cannot be guaranteed
after January 28, 2016 or until the room blocks are filled.
Visit www.EMSToday.com/travel-info/hotel-information.html to book your hotel room.
BALTIMORE HARBOR HOTEL LORD BALTIMORE RENAISSANCE BALTIMORE

101 W Fayette St, Baltimore, MD 21201 20 W Baltimore St, Baltimore, MD 21201 HARBORPLACE HOTEL
202 E Pratt St, Baltimore, MD 21202
BALTIMORE MARRIOTT INNER

HARBOR AT CAMDEN YARDS HILTON BALTIMORE ROYAL SONESTA HARBOR COURT
110 S Eutaw St, Baltimore, MD 21201 401 W Pratt St, Baltimore, MD 21201 550 Light St, Baltimore, MD 21202
DAYS INN INNER HARBOR HOTEL HOLIDAY INN INNER HARBOR SHERATON INNER HARBOR HOTEL
100 Hopkins Pl, Baltimore, MD 21201 301 W Lombard St, Baltimore, MD 21201 300 S Charles St, Baltimore, MD 21201
HAMPTON INN BALTIMORE-

PCS is the only official housing company associated with EMS Today 2016.
DOWNTOWN/CONVENTION CENTER HYATT REGENCY BALTIMORE
While other hotel resellers may contact you offering housing for your trip,
550 Washington Blvd, Baltimore, MD 21230 300 Light St, Baltimore, MD 21202 they are not endorsed by or affiliated with the show and entering into
financial agreements with such companies can have costly consequences.
After the deadline of February 11, 2015, the EMS Today housing block is
closed and you are responsible for securing your own accommodations.
Reservation Guarantee: Credit Card Guarantee: A credit card valid through
the last day of the meeting is required to process and guarantee each
reservation. Confirmations: A reservation confirmation will be e-mailed to
you from the PCS once your reservation has been confirmed. You will not
receive a confirmation from your hotel. If you do not receive a confirmation
within 3 business days, please call 1-888-763-7236. Make sure to check
your spam email box. Changes and Cancellations: All changes and
cancellations must be made with PCS on or before 5:00PM on February
11th, 2015. The credit card provided will be charged one (1) night’s room
and tax by the hotel if the reservation is cancelled 7 days or less from the
arrival date. Early departures are subject to penalty fee set by hotel.

BALTIMORE HIGHLIGHTS AND HOW TO SAVE MONEY
TRANSPORTATION SHOW YOUR BADGE PROGRAM:
Not sure how you will get around the city of Baltimore? Worried about ex- Get the most out of your trip by participating in Baltimore’s Show Your Badge
pensive cab rides? Well, worry no more. Check out the Charm City Circulator Program! Visit the EMS Today website to view which Baltimore restaurants and
for FREE transportation around the city! With a fleet of 21 shuttles that attractions you can use your badge to receive promotions or discounts. The provided
travel three routes in Baltimore City, and operating 7 days a week, every list includes all participating establishments and their offers, as well as the require-
10 minutes, you can see the city FREE! AMTRAK is also offering a 10% ments of use. Take advantage of all that Baltimore has to offer by checking out these
discount off the best available rail fare to Baltimore, MD between February promotions now!
22, 2015 – March 03, 2015. To book your reservation call Amtrak at 1 (800)
872-7245 or contact your local travel agent and mention the Fare Code
Number: X68T-910.
CONVENTION CONCIERGE
PLACES TO EAT
Need to set up a group dinner while you are in Baltimore?
Get the best burgers & fries around at Five Guys, located at the Inner Harbor
Want to take a tour of the city? The city of Baltimore offers a Convention Concierge
Shopping Center, 201 E. Pratt Street. Head upstairs to Philips Seafood and en-
to the attendees of EMS Today. So don’t be shy – give them a call and let them set
joy the local specialty: crab cakes, steamed crabs or crab macaroni & cheese.
up some fun for you while you are visiting Baltimore. Call the Convention Concierge
Want some entertainment with your dinner? Visit the Hard Rock Café for
Express Service Line: 877-BALTIMORE.
classic rock n roll memorabilia, located at 601 E. Pratt Street. Across the street
is P.F. Chang’s offering yummy Chinese cuisine and a tasty happy hour.
LEGEND & HOTEL DISCOUNTS

1. Baltimore Marriott Inner Harbor: 6. Hyatt Regency Baltimore:
• 20% off Dinner-discount (excludes alcohol) • Happy Hour Specials Over 3 Peak Nights • 25% F&B Discount • Parking Discount of $14 for 1 car per guestroom
2. Days Inn Inner Harbor Hotel: 7. Lord Baltimore
• 25% F&B Discount • Unidentified Parking Discount • Comp Continental Breakfast 8. Renaissance Baltimore Harborplace Hotel:
3. Hampton Inn Baltimore-Downtown/Convention Center: • 20% F&B Discount • Happy Hour Specials Over 3 Peak Nights
• Comp Hot Breakfast 9. Royal Sonesta Harbor Court:
4. Hilton Baltimore: • 10% F&B Discount (excludes alcohol) • 10% Discount on Parking
• Happy Hour Specials Over 3 Peak Nights 10. Baltimore Harbor Hotel:
5. Holiday Inn Inner Harbor: • 20% at Balto Tavern & Tap • Happy Hour Specials Over 3 Peak Nights
• 20% F&B Discount • Discounted Valet Parking at $20 per Vehicle
11. Sheraton Inner Harbor Hotel:
• 15% F&B Discount • Happy Hour Special In Orioles Bar
PLACES TO GO AND
THINGS TO SEE
The Inner Harbor area is within walking distance

of the convention center but you can also use
the light rail to navigate around town. The Babe
Ruth Birthplace and Museum is just three blocks
west of Camden Yards, at 216 Emory Street. Just
follow the 60 baseballs painted on the sidewalk
from the stadium to the Museum and check out
Babe’s house, tons of memorabilia and learn
more about his career. Want more sports? Head

to the Sports Legends Museum at Camden Yards,
located at 301 W. Camden Street. With a focus
on Baltimore area teams, Johnny Unitas, college
game day and the Negro baseball league, you’ll
explore hundreds of artifacts and interactive ex-
hibits. Then go upstairs to Geppi’s Entertainment
Museum with nearly 6,000 pop culture exhibits
featuring cartoons, super heroes, games, comic
books, TV shows and much more.

REGISTRATION INFORMATION
Registering for EMS Today is easy! Consult the table

REGISTRATION: NOW OPEN! below to decide which registration option is right for you
– the full conference option offers the best value.
SAVE WITH THE EARLY BIRD RATES!

REGISTER BY JANUARY 15, 2016 AND SAVE $100!
4 WAYS TO 1. ONLINE: @ 2. EMAIL: 3. MAIL: 4. FAX:
REGISTER www.emstoday.com registration@pennwell.com EMS Today Direct +1-918-831-9161
Registration Department
PO Box 973059
Dallas, TX 75397-3059
BEST VALUE Silver Single Exhibitor

WHAT REGISTRATION TYPE - Gold Passport Day - Full Full Exhibitor
IS RIGHT FOR YOU? Passport (2-Day) Conference Conference Vistor Only
(3-Day) Delegate Delegate
Early Bird Registration Pricing - registration on or before 1/15/16 $440 $320 $205 $175 $30
Registration price on or after 1/16/16 $540 $420 $305 $175 $40
Keynote Session
Exhibit Hall Entrance
BLS Clinical Track
ALS Clinical Track
EMS Leadership Track
Special Topics Track
Networking Reception Thursday
Networking Breakfast Saturday
Networking Party (Offsite)
JEMS Games
Exhibit Hall Learning Center
ADD A PRE-CONFERENCE WORKSHOP TO YOUR REGISTRATION

Pre-conference workshops offer intensive opportunities for attendees to gain skills and knowledge in specific industry fields.
These courses will be held on Wednesday, February 24, 2016. Both half day and full day courses will be available. Check the
EMS Today website for a full listing of course offerings.
Half day workshops......$125 early/$150 reg Full day workshops.......$215 early/$240 reg

Stay Connected with EMS Today
But why wait until you are onsite to connect with others in
the EMS community? Connect with us on social media today!
#EMSTODAY2016
2015 EMS Today Social Media Stats
777
#EMSTODAY TOTAL IMPACT
9,177,685
(the potential times someone saw the hashtag on social media)
INDIVIDUALS AND
#EMSTODAY TOTAL AUDIENCE REACH COMPANIES THAT USED
1,197,752 #EMSTODAY
EMS TODAY
PHOTOBOOTH
720,984
TOTAL PAGE
IMPRESSIONS
266,050
TOTAL PAGE REACH
START CONNECTING NOW

USING #EMSTODAY2016

DON’T WAIT!
REGISTER BY JANUARY 15TH & SAVE!
ALL IT TAKES IS A LITTLE PLANNING TO SAVE MONEY….
• Register by January 15, 2016 and save $100
• Register with a group – the more you bring, the more you save
• Scholarship Opportunity – for first time attendees, apply online
• Restaurant Discounts in Baltimore – just show your badge and save
• Book your hotel early through PCS to save
• Follow us on social media for contests and special discounts!
FEBRUARY 25-27, 2016 | Baltimore Convention Center | Baltimore, MD | www.emstoday.com
OWNED & OFFICIAL PUBLICATION PRESENTED IN PARTNERSHIP WITH

PRODUCED BY OF EMS TODAY
#EMSToday2016

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FOOTBALL PLAYER C-Spine p. 36 ALBUQUERQUE Community EMS p. 54 The BVM Effect p.

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Enhance decision support

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OCTOBER 2015 VOL. 40 NO. 10

Contents 36 HEAD & SHOULDERS

50 REPORTED SEXUAL ASSAULT

DEPARTMENTS & COLUMNS

2 JEMS | OCTOBER 2015 www.jEms.COm

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The Countdown to the 2015 Guidelines Has Begun.

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1510jems_3 3 9/25/15 10:58 AM

EDITOR-IN-CHIEF – A.J. Heightman, MPA, EMT-P – aheightman@pennwell.com

MEDICAL EDITOR – Edward T. Dickinson, MD, NREMT-P, FACEP

ART DIRECTOR – Kermit Mulkins – kermitm@pennwell.com

DIRECTOR OF ePRODUCTS – Tim Francis – timf@pennwell.com

SENIOR ACCOUNT MANAGER – Cindi Richardson – 661-297-4027 – c.richardson@jems.com

AUDIENCE DEVELOPMENT MANAGER – Linda Thomas – lindat@pennwell.com

CHAIRMAN – Frank T. Lauinger

FOUNDING EDITOR – Keith Griffiths

FOUNDING PUBLISHER – James O. Page (1936–2004)

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iN∫X™ INTEGRATED PATIENT TRANSPORT & LOADING SYSTEM™

*READ THE WHITEPAPER AT

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DUMP TRUCK DIVE

8 JEMS | OCTOBER 2015 www.jEms.COm

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THE ALL-NEW F-650/F-750

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EMS TODAY 2016

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