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 2


Continuing from Part 1, where 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. Here are the rest of the issues –

Need for exchange of data between hospital and EMS systems;[1]


I can find out what happened to my patients much more easily than most people, because I know the unofficial ways to get the information.

That should not be necessary and HIPAA does allow sharing of this information.

Active Shooter management, policies and integration issues, particularly in their Police & EMS integration;[1]


It isn’t about who is in charge.

It is about having everyone recognize the same person as being in charge and having that person know how to handle the scene. The person should probably be a specialist, rather than cross-trained to do everything with just the appearance of minimum competence.

Images credit from Life in the Fast Lane.

STEMI transfers – Hospital are demanding valuable ALS resouces to transfer STEMI and stroke patients when, in some cases, BLS units could handle the task;[1]


Why were these patients taken to hospitals that need to transfer the STEMI and stroke patients?

If they were transported by paramedics initially, what good is that kind of paramedic during any transport.

I can’t recognize a stroke or a STEMI, but I am here because you think I am someone who understands strokes and STEMIs.

If the problem is that the protocols require transport to the wrong hospitals, change the protocol.


Intranasal Narcan delivery by police and firefighters (There is a national push for this by responders who arrive on scene before EMS);[1]


It is popular?

So was blood-letting.

Being popular does not mean that it is safe, effective, or a good idea.

What about the well documented opioid overdose mimics that paramedics have trouble with – stroke, hypoglycemia, seizures, et cetera?

What are the outcomes for these patients in systems that make naloxone a BLS treatment, or even just an advanced first aid treatment?

Consistency in approach to patient refusals;[1]


The patient has the capacity to make informed decisions.

EMS is able to provide adequate information for a person to make an informed decision.

EMS is not coercing refusals.

EMS is competently assessing patients and communicating with patients.

Use of video laryngoscopes and capturing the data from them for QA review and documentation;[1]


Maybe we should find out if video laryngoscopy is the right tool before we make it the standard of care.

EMS loves standards of care. We don’t care how dangerous they are.

Limited funds to bring people in for continuing education;[1]


More than continuing – expanding education.

Keeping up with original paramedic education is not enough.

What we need to know changes. We need to keep up, with the changes, not with the past.

Airway management and monitoring (particularly failure by crews to use waveform capnography) continues to be an issue;[1]


The medic did not include waveform capnography tracings with the chart?

There is less than 100% QA/QI/CYA of intubations?

The medical director does not understand waveform capnography, airway management, and/or oversight?

Not using waveform capnography is due to a critical failure of management that has been adopted by paramedics who have a ceremonial understanding of EMS – enough to pass a test to get a patch, but not enough to provide competent care.


[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