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Oct 12, 2019

This episode is a wrap up covering the highlights from the Tactical Trauma international conference on pre-hospital critical care and trauma. This conference emphasizes tactical medicine, with a panel of experts speaking throughout the 2 days.

 

0:10 - Introduction of the conference

0:45 – Introduction of the expert panel

1:25 – Reflecting on the Las Vegas Shooting. Description of the original triage station which was not setup for an MCI with major trauma. Severely injured patients were kept on scene for approximately 45 minutes, due to unknown location of gunshots being fired.

2:45 – A big takeaway from this session is to assign a civilian to each patient, as many are willing to help. This way there is someone watching every patient who could report on their overall status (ie. Doing well vs deteriorating), freeing up medically trained resources for the most critical patients. Included in this talk was a discussion in how to involve and empower bystanders, as the first responders may not be on scene within minutes.

4:30 – The concept of an “immediate threat vacuum” is discussed, and defined as a period of time where victims are not being treated by EMS. Currently, this remains an opportunity for improvement.

5:00 – Military success rests on the fact that everyone is trained on tactical casualty care, thus allowing that vacuum to be filled.

5:45 – Hemorrhage control for the bystander needs to continue to be emphasized. A major campaign in America is Stop the Bleed, which emphasizes basic bleeding control techniques for the general public. This has also raised awareness for bleeding control kits, which are now readily available in certain public locations (ie. Schools, airports) Link: https://www.stopthebleed.org

6:15 – Studies into casualties were not done until quite recently, where experts were able to analyze drills and incidents to create real timelines for casualties. It was found that victims were not surviving with current protocols, indicating a need for change. There is now widespread access to data regarding specific wounds and their prognostic factors.

7:15 – A reflection of the Pulse nightclub shooting shows that there may have been fatalities due to decisions that came under fire, as there was previously not much data available to study and prepare adequately.

8:00 – A quick discussion on how pre-hospital providers must be prepared for anything that can occur out of hospitals. There is a quick reminder that not all hot-zones are created equal, therefore every environment is different and professionals must train and adapt to this.

8:35 – Some internet searches have revealed that terrorists are using response tactics to learn and improve their terror plans.

9:30 – Brief reminder on how expanding on experience can come in the form of extensive training, along with length of service.

10:00 – Summary of Michael Lauria’s presentation on Emergency Action Drills. This is adapting the way we train to optimize response and link that to subsequent patient outcomes. One way is to look at how other fields train for high risk scenarios, such as the military and the aviation industry. This presentation looked at the medical side of training, and the opportunity for improvement in training

11:00 – Discussed here are the steps for developing ERADs. 1. Identifying time sensitive threats that need to be addressed first (ie. Massive exsanguination, difficult airway). 2. Looking to literature, and coming up with solutions to these threats. 3. Engraining those steps in our mind during training. This has worked well for other professions in their high-risk trainings (aviation, military combat). This shows the importance of training like you fight, so you can fight like you trained when it comes time for that initial reaction.

15:30 – Wrap-up of Mark Forrest’s preventable deaths by exsanguination. The presentation revisited the topics that had no research, including Hydrogel technology and others that need further research. The bottom line takeaway is stopping the bleed with basic techniques has been proven to save lives, while other technologies may be in the horizon.

17:12 – iTClamp use in head and neck trauma has been shown to be fairly effective in studies, while it performed poorly compared to CAT Tourniquet in the lower extremities. However, 7.5% of military wounds are above the neck and result in very high mortality. The iTClamp has shown success in these situations. One link to a study on animal models: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3786550/

18:05 – Brief update on Junctional hemorrhages. Multiple devices have been shown to be effective in the lab, however their field application has been limited by weight, time, training. SAM has seemed to be the most popular anecdotally. Wound packing and close monitoring is likely the most effective method at the moment.

18:50 – Dr. Kate Prior’s presentation on leadership in a team-based setting with Inclusive Leadership practice. A deeper anecdotal discussion regarding inherent bias in the team environment is discussed here as well.

21:30 – Discussion on the timing of intubation in hypotensive poly-trauma patient. Two main reasons prevailed, the instability that comes with induction, and the negative effects of ventilation.

22:10 – Discussion on the resuscitation of the bleeding pediatric patient. Using the adult knowledge in the pediatric patient, just changing based on weight has more evidence behind it now.

22:55 – Discussion on Damage Control Resuscitation. This depends highly on the setting, and resources available in that setting. Examples of this include consistent hypotension prior to trauma surgery, the use of whole blood, and following the blood pressures being less ideal than signs of perfusion and blood flow using ultrasound. One key point is that each person has a different shock tolerance, and predicting this is virtually impossible.

25:45 – Conclusion of Day 1 Wrap-up.

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