Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Issues and Challenges Discussed by Medical Directors at Eagles Conference – Part 1


A.J. Heightman writes that there are several issues that are important to the medical directors attending the Gathering of Eagles. The conference is over, but here are some of the issues –

More attention to crew “time on chest” during resuscitations and avoiding interruptions;[1]


Other than defibrillation, chest compressions are the only treatment that has been shown to improve the one outcome that matters – survival with a working brain.

Why is this so hard for people to understand?

Don’t stop until the patient is no longer in need of compressions. OK, pause for a couple of seconds to analyze the rhythm and deliver a shock from the defibrillator that was charged before the pause. More than that is bad patient care.

Shortage of paramedics and new EMS leaders – Referenced by several systems;[1]


Is this a real shortage?

Or are they trying to have all responders be paramedics?

The expense of placing the same monitor/defibrillators on ALS engines is now becoming an issue. Some systems are exploring use of AEDs with screens on first response units because the number of times the “full system” is needed is not high;[1]


When the paramedic on the engine is there just to stop a clock, the position is purely ceremonial and there is no reason to give the ceremonial paramedic real paramedic equipment. We really do not want these inexperienced ceremonial paramedics treating patients, because almost everything a paramedic carries can kill the patient.

There is a shortage of EMS leaders who lead in a way that is good for our patients.

Budget cuts and shortages are limiting what can be done in EMS systems, particularly in training, equipment replacement/updating and quality assurance;[1]


We need to spend more on fewer paramedics, so that they are better able to provide appropriately aggressive care to the few patients who will really benefit from paramedic care.

We do not need a bunch of IV technicians to save the nurse from having to start an IV.

We need medics capable of appropriately assessing patients. We have more than enough protocol monkeys.

The ability to do effective QA with limited staff, funding and data resources was pointed out as a key need. The need for the seemless and timely integration of data was referenced by multiple medical directors;[1]


Do the metrics matter, or are they just making sure that the protocol monkeys are doing the Macarena the way the medical director wants it done.

Need for better education and treatment of pediatric patients;[1]


Even pediatric hospitals have trouble with this, so there is no easy solution and it is a real problem.

Instilling pride back in EMS providers, particularly in systems that do not fully appreciate EMS;[1]


Imagine a system that does just EMS and does EMS very well.

We have too many all hazard systems that try to do everything just well enough to avoid getting in the way with whatever they consider their primary job.

Incompetence is common – just don’t point it out. the patients don’t need to know.

Use of technology and negative news to help EMS systems solve system woes. Bad publicity can force politicians to correct (and fund) system issue;[1]


Rather than punish those pointing out problems, we should be asking them to help fix the problems before they become embarrassing stories on the news.

Embarrassing generally means somebody died and it was our fault and we have to find a way to make people forget that it was our fault.

Need to return to basics and not just rely on devices and technology to “assess” the patient;[1]


And not rely on a bunch of impressive patches on inexperienced people doing ceremonial paramedic work.

To be continued in Part 2.


[1] Issues and Challenges Discussed by Medical Directors at Eagles Conference – Editor-in-Chief A.J. Heightman reports from the 2014 Eagle Creek Retreat in Dallas
A.J. Heightman, MPA, EMT-P
Wednesday, February 26, 2014



  1. Response to post “BLS naloxone (Narcan)?-Drugs Falling into the wrong Hands-or Not?” by Jeffrey M. Goodloe MD.
    Teaching the general public to save those suffering a respiratory emergency is a wonderful idea. 50,000 poisonings a year in Ontario Canada, mostly children. What we have unfortunately is the medical profession teaching a contraindicated resuscitation skill to over 1,000 of the general public, to date. Training 30 minutes long one on one, administer naloxone, chest compressions, more naloxone, more chest compressions?? A live human study that is well known to increase morbidity & mortality CJPH 2013;104(3)e200-4. The human volunteers is anyone, walking down the streets. Don’t suffer a respiratory emergency in the province of Ontario. No medical authority says a thing about this practice, ETHICS anyone?
    Toronto Public Health is hoping to reinvent the Glasgow Coma Scale? Patient should become HYPER AWARE. CHEST COMPRESSIONS
    Pulse oximetry off the scale patient is in danger of becoming explosive (pure O2). Extinguish all sources of spark. CHEST COMPRESSIONS NONSENSE
    See video hyperlinked under my name. Patient in video is a layperson. Responders a paramedic & an RN. I know all three personally

  2. You write “Imagine a system that does just EMS and does EMS very well.” Now there’s a novel concept that actually begs for further expounding.

    Do you mean just 911? Do you mean the inter-facility transports that consist of holding Mrs. Smith’s hand and attempting to slip the bill past CMS’s ever “watchful” eyes? A combination of those and more?

    I’d like to think that someday you can have EMS that does EMS and isn’t dependent on the IFT calls paying your bottom line. Don’t lump me in with the socialists or anything; but isn’t someone that is responsible for getting the sick to the hospital, alive, and when possible in better condition worth enough? Enough that we don’t have to saddle them with all hazards.

    Even if is just in the realm of the American ambulance world?