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

- Rogue Medic

Gathering of Eagles 2014


 

Here is a look at some of the presentations (and brief comments on what to expect) that are scheduled for this weekend’s Gathering of Eagles.[1]

Friday –
 

Indoctrination?
 

11:00 am-11:10am
Indoctrinating the Docs:
Training All First Year Medical Students to be NREMTs
– Thomas H. Blackwell, MD (Greenville)

 

That should be a negative presentation, since indoctrination is a means of changing minds when reason does not work. I am a fan of reason.
 

Ketamine (Ketalar)?
 

1:15pm-1:25pm
Another Way to Break the Ache:
Using Low Dose Ketamine for Pain Control
– Melissa W. Costello, MD (ACEP)

 

There seem to be a few reasons medical directors are hesitant to adopt ketamine (laryngospasm, which is manageable; vomiting, which is manageable; unfamiliarity, which is manageable; diversion, which is manageable), even though it is probably the most versatile EMS drug available.
 


EMCrit – Practical Evidence 014 – ACEP Procedural Sedation Update for 2013[2]
 

We endanger our patients with our contortions of extrication, when we could improve conditions for EMS and for the patients by decreasing the amount of screaming and thrashing about.

How does it help to protect the patient’s potentially injured spinal cord if we are providing intermittent stimuli of extreme pain and the patient is reacting by moving – including movement to the neck and back, far more than any capability of a collar and board might restrict movement.

We use backboards, which do not appear to be beneficial, while we avoid ketamine, which is beneficial.
 

Intranasal?
 

1:45pm-1:55pm
Care Ease Through the Nares
Nasal Fentanyl for Kids
– Peter P. Taillac, MD (NASEMSO)

 

IV (IntraVenous) is not the only route available for administration of medications, so why do we artificially limit EMS at the expense of our patients?
 

Too many medics?
 

3:00pm-3:10 pm
Are More Paramedics Elemental or Detrimental?
Lessons Learned from an ALS Expansion Program
– Andrew J. Harrell, MD (Albuquerque)

 

Because dilution of experience improves quality? 😳
 

EMS Palliative care?
 

4:30pm-4:40pm
Raising Questions about a Pain-Full Subject:
Survey Results Regarding Palliative Care Processes
–Arthur H. Yancey II, MD (Atlanta)

 

The patient is dying this year, so I have an excuse to ignore the patient’s pain.

No ethics for us, we’re EMS.
 

Saturday –
 

Airways in Cardiac Arrest?
 

8:30am-8:40am
Tracheal Deviants:
The Effect of Airway on Cardiac Arrest Outcomes
– Jason T. McMullan, MD (Cincinnati)

 

Using airways to treat cardiac arrest is not supported by any evidence, but maybe there is something that has been found to support our favorite mythology – or is it our second favorite mythology, after backboards?
 

EMS ECMO?
 

9:15am-9:25am
A Change in Scene-ery:
Re-Thinking On-Site Management of Cardiac Arrest
– Paul R. Hinchey, MD, MBA (Austin)

 

The idea of transporting dead people may have justification as a bridge to ECMO (ExtraCorporeal Membrane Oxygenation), but do we have any evidence that this improves outcomes?
 

Ketamine and ketamine analogues not perfect together?
 

10:15am-10:25am
Epidemic Proportions:
Dosing Ketamine in the Era of Mamba Dramas
– Christopher B. Colwell, MD (Denver

 

Methoxetamine (Mexxy), O-desmethyltramadol (an ingredient in Krypton), and synthetic cannabinoids (ingredients in Black Mamba and Annihilation and others may produce excited delirium and may not be best treated with ketamine, due to possible combined toxicity. Ketamine and methoxetamine suggest similarities and if it is a genuine chemical dosage problem, and the dose does make the poison, could we be contributing to the problem?

How might we ruin Reese’s Pieces?
 

Two opioids in one?
 

10:30am-10:40am
Double-Duty Dopers:
Managing Fentanyl-Laced Heroin Abuse
– C. Crawford Mechem, MD (Philadelphia)

 

Is it any surprise that the ingredients of street drugs are a surprise?
 

BLS naloxone (Narcan)?
 

10:45am-10:55am
Drugs Falling into the Wrong Hands – or Not ?
Naloxone Use by Non-EMS Personnel
– Jeffrey M. Goodloe, MD (Tulsa and OKC)

 

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?
 

Repeated EMS-worthy inebriation?
 

1:30pm-1:40pm
Re-thinking the EMS ”Response” to Serial Inebriates:
Sobering Reflections from an EMS Medical Director
– S. Marshal Isaacs, MD (Dallas)

 

What do we do with the people who go out and have such an intoxicatingly good times, that they end up with us?
 

IO BP? IO PaO2?
 

2:00pm-2:10pm
New Skills From Drills:
Using Intraosseous Systems for Hemodynamic Monitoring
– R.J. Frascone, MD (St. Paul)

 

Interesting, but does it just make us more likely to treat surrogate endpoints and harm our patients?
 

Respect the Mythology?
 

3:15pm-3:25pm
It May Send Shivers Up Your Spine:
Taking Aim at Removing the Backboard Altogether
– W. Scott Gilmore, MD (St. Louis)

 

Pulling the board out from beneath the feet of the EMS myth makers.

Superstition vs. Reality?
 

3:30pm-4:00pm
The Great Debate
The Long and Short of It Being: To Spine Board or Not
The Bony Debaters Will Each Be Asked to Bring a Disc and then Back up Their
Statements with Pithy Remarks and Avoid Assertions that May Lead to Re-Tractions
of some Radicular Idea. They Must Follow Every Facet of the Debate Process
Carefully and take Precautions to Stay Neck and Neck with Their Opponents and
avoid Distracting Activities

– Raymond L. (“Sugar Ray”) Fowler, MD — the PRO (& ex-Con)
VS.
Terence D. (“The Terminator”) Valenzuela, MD, MPH — the CON (& ex-Pro)

 

Let’s hope they pay more attention to the absence of evidence – there is no evidence that justifies using Spine Boards to transport patients – than the abundance of puns they are so fond of.[3]

Footnotes:

[1] Gathering of Eagles – The EMS State of the Sciences Conference
Friday, February 28 and Saturday March 1, 2014
Dallas, TX
Agenda in PDF Download format.

[2] Practical Evidence 014 – ACEP Procedural Sedation Update for 2013
EMCrit
Dr. Scott Weingart
Written analysis of position statement and podcast.

[3] EMS Spinal Precautions and the Use of the Long Backboard – Resource Document to the Position Statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma.
White Iv CC, Domeier RM, Millin MG; and the Standards and Clinical Practice Committee, National Association of EMS Physicians.
Prehosp Emerg Care. 2014 Feb 21. [Epub ahead of print]
PMID: 24559236 [PubMed – as supplied by publisher]
 

The backboard has been a component of field spinal immobilization despite lack of efficacy evidence.

 

Just like blood-letting and every other superstition-based treatment.
 

The ambulance stretcher is in effect a padded backboard and, in combination with a cervical collar and straps to secure the patient in a supine position, provides appropriate spinal protection for patients with spinal injury.

 

Why not just leave out the harmful device that cannot be demonstrated to improve outcomes or even to be safe?

.

Comments

  1. I look forward to this event and seeing the presentations, some are good, but many are a crapshoot… Really it seems like one big circle jerk. They actually gave Crawford Mechem an award, which is down right laughable if one has any experience the EMS system he oversees. So many of these docs are in bed with the IAFF that they will not say anything to offend them. Andrew Harrell has given the presentation on ALS expansion at an IAFF conference (http://www.doctorfowler.com/www/lectures/iaff/ALSexpansiondenverIAFF.pdf). His ppt. didn’t seem to note ANY lessons learned, so it will be interesting to see if he makes any changes for the “eagles”.

  2. RE: BLS Naloxone (Narcan) Drugs Falling into the Wrong Hands – or Not ?
    Naloxone Use by Non-EMS Personnel
    – Jeffrey M. Goodloe, MD (Tulsa and OKC)

    New CPR Guidelines Oct 15, 2015 ILCOR Part 3 ‘Adult Basic Life Support and Automated External Defibrillation’
    See page 5 ‘Opioid Overdose Response Education’ Read my comments hyperlink BLS 891
    http://circ.ahajournals.org/content/132/16_suppl_1/S51.full.pdf+html

    Hyperlink BLS 891 read all comments https://volunteer.heart.org/apps/pico/Pages/PublicComment.aspx?q=891

    Soon to happen all over Ontario?? My deputation Toronto Board of Health https://youtu.be/QhsDjmI9H9c Read comments

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