EMS State of the Sciences Conference: Report from the Gathering of Eagles Part 1

The 17th annual EMS State of the Sciences Conference—more commonly referred to as the Gathering of Eagles—convened in Dallas, TX, on February 20 and 21, 2015, hosted by Paul Pepe, MD, MPH.

This event is famous for its 10-minute bullet plenary presentations, lightning rounds and other innovative educational advances, delivering 60+ presentations over two days, which, according to conference evaluations, change nationwide medical practices almost overnight.Comprised of the jurisdictional EMS medical directors from the nation’s largest municipalities and their counterparts in pivotal federal agencies, the faculty is responsible for the care of nearly 100 million citizens and is influential in shaping future EMS practice trends worldwide.

Over the next few months, we will share highlights from the  conference, which presents cutting-edge information and advances in EMS patient care, clinical research and systems management.

This month we write about the research and programs featured in presentations by Peter P. Taillac, MD,  FACEP, and Peter Antevy, MD.

Researchers Developing Tools To Help EMS Providers ‘COPE’ with Pediatric Deaths

Presentation: Termination of Resuscitation Efforts for Children: How Do You COPE? Presented by Peter P. Taillac, MD, FACEP, Utah State EMS Medical Director, Chair, Medical Directors Council, National Association of State EMS Officials (NASEMSO)

EMS providers may have the necessary clinical tools to provide prehospital care for patients who have severe injuries and critical health issues, but they often lack the tools that help them cope in the aftermath of declaring the death of a child.

A team of researchers in Kentucky is working to change that with its project Compassionate Options for Pediatric EMS (COPE). The goal is to create a downloadable “toolbox” app for EMS providers that will give them resources to deal with the aftermath of a child’s death. The program also will include tools for the EMS providers to share with the parents and other family members as they start their grieving process.

The nine-member team received a grant for the project in September 2013 from the Health Resources and Services Administration (HRSA) and is in the second year of the three-year grant. The project is the brainchild of Project Director/Principal Investigator Mary E. Fallat, MD, professor of surgery at the University of Louisville and division director of pediatric surgery at Kosair Children’s Hospital.

“The project idea was really something that I’ve thought about throughout my career, not only as a pediatric surgeon, but also as the program director for the EMS for Children program in Kentucky,” says Fallat. “I’ve been interested in helping EMS providers and doctors cope with the death of  children for a long time. Part of it stems from the fact that I think people are afraid to declare death in a child. They are empowered from a medical standpoint, but they have a hard time making that step. I think all types of providers, from EMS to physicians, have a more difficult time pronouncing a child than an adult. I think it compels them to work longer, even when they know their efforts can’t save the child.”

With that mind-set as the framework, Fallat said the focus of the COPE project is about the next steps. The team conducted two pilot studies before receiving the grant, first surveying first responders in the field and then, surveying EMS directors in each state that has one.

“It really is about what happens after the child dies and how the EMS providers come to grips with it,” Fallat says. “Often the child dies at the home. Then the EMS providers are in the position of trying to make the family members feel comfortable and begin the grieving process. But they’re also dealing with their own grief.”

Beth McClure, BS, CCRC, clinical research nurse/coordinator for pediatric surgery at the University of Louisville, said first responders can have a difficult time relating to the parents of the deceased child because of that.

“EMS providers often are the first to encounter a parent whose child dies outside of the hospital setting,” McClure says. “EMS providers have to do CPR at the scene or en route to the hospital and sometimes, despite that effort, the child dies. The EMS providers can feel overwhelmed about that and then even more overwhelmed having to be the person to tell the parents.”

The research to develop a toolbox has a twofold focus of assisting the providers with their own emotions and then assisting the providers with helping the family.

“This is about coping after the fact and being comfortable moving forward,” Fallat says. “It’s about taking the next steps. And it’s about recognizing that the EMS providers are the second victim in these situations. It’s very difficult to have to tell a parent their child is dead. It’s difficult after such an incident being told that you have to be back for another shift at 7 a.m. when you’re going through post-traumatic stress. We want to provide some coping skills for the providers to get through the rest of their job and life in the aftermath, but we also want to provide tools that they can give to the parents and families to help them.”

Fallat said education in prehospital care lacks such assistance.

“Pediatric calls make up just 10% of most EMS runs so I guess that’s why there isn’t more of an emphasis,” Fallat says. “But that’s why it is so important to have it: because of the infrequency of taking care of children. For EMS, there’s very little education about pediatrics. We want to change that.”

During the first year of the grant, the team delved into and analyzed the literary research. The team also developed a focus and direction for what they wanted to accomplish. Now, the focus is on developing a downloadable app and potentially a website to provide guidance and information to first responders. The app will include, among other things, videos with real-life teachable moments.

Fallat said the team hopes to have the app available by the end of the year, with plans to field-test it before being fully implemented. An educational presentation will also be given at the EMS World Expo 2015, September 15–19 in Las Vegas, NV.

The COPE project is supported by the Health Resources and Services Administration (HRSA) and Maternal and Child Health Bureau (MCHB), Emergency Medical Services for Children (EMSC) Targeted Issues grant program, Grant No. H34MC26204 for $849,246. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

Public Access Bleeding Kits Can Help Save Lives

Presentation: Public Access to Hemorrhage Control. Presented by Peter Antevy, MD, President, Greater Broward EMS Medical Directors Association.

Most people have a first aid kit in their medicine cabinet, glove box or even desk drawer. Someday, a “severe bleeding kit” might become a permanent fixture as well.

The town of Davie, in South Florida, recently implemented a program to place severe bleeding kits in all of the town-owned buildings and train everyone to use the tourniquets in the kits. Often, during mass casualty incidents, first responders cannot get to everyone immediately. The citizens become the first responders. With proper training and equipment, the citizens can help improve patient outcomes.

The program is the brainchild of Peter Antevy, MD, a physician at Joe DiMaggio Children’s Hospital and medical director for several fire departments, including the Davie Fire Rescue Department. Antevy, the inventor of the Handtevy Pediatric Box, also serves on the EMS World editorial advisory board.

“We are in an urban environment with a number of potential active shooters,” Antevy says. “Many times, people bleed out before they can get professional help. We realized that the majority of deaths were treatable.”
Most violent or mass casualty incidents require police officers to secure the scene first.

“In many situations, firefighters and medics have to stay outside until the scene is secure,” Antevy says. “We recommended that a couple of paramedics could go in with the first police officers, but we had a lot of resistance about that in South Florida. So we asked the police to carry a tourniquet kit. They said ‘no,’ even when we suggested it might help save one of their own lives.”

Antevy tried a different approach.

“I went to our EMS chief (Julie Downey) and talked to her about adding kits with tourniquets,” Antevy said. “She thought it was a great idea but we would have to train people to use them first.”

That is exactly what the Davie Fire Rescue Department did.

“We had some resistance at first but then the people who learned discovered that it’s relatively easy,” Antevy says. “We have given the training to people with no medical background and it’s basically a one-minute instruction on how to use it. I think there is value in it and value in teaching it through the fire department’s CPR classes and public expos. More and more, people are finding themselves in situations with active shooters and we are actively teaching people how to escape and hide. But instead of just hiding, this helps them possibly save a life. Ironically, once the police force heard about how easy it was, they started educating themselves.”

The severe bleeding kits, which Antevy and Downey created, each are contained in basic pencil boxes and include:

• 2 Combat Application Tourniquets (CATs)
• QuikClot gauze
• 2 5x9 simple gauze pads
• 2 rolls of regular gauze
• 1 set of gloves.

“We assembled the kits ourselves,” says Downey, who is the assistant chief, Division of EMS, for the Davie Fire Rescue Department. “It was easy to do. I would encourage anybody to do something like this. It cost Davie just $2,500 to create these for the entire town.”

The severe bleeding kits were added to the 60 AEDs that Davie previously mandated for inclusion in all town-owned facilities. Since the program began six months ago, more than 600 Davie employees and 200 people from the general public have received training.

“We put the equipment in our high-profile areas, outside at the police shooting range, in the fire stations, in the town hall, at the pool, in our parks and in the garage that has a lot of heavy equipment,” Downey says. “It’s really easy to learn how to use each item in the kit. It can be used for any type of mass casualty incident–an airplane crash, a car accident. We provide CPR training to lots of businesses, the Girl Scouts, the Boy Scouts and other groups. Within that, we have severe bleeding training and we are talking to them about how to make makeshift tourniquets or their own kits. We’re hoping nobody ever has to use one, but if they do, the more people who are trained and have access to them, the more chance someone’s life can be saved.”

Ultimately, Antevy envisions widespread deployment of severe bleeding kits.

“In five years, I think it’s realistic to have severe bleeding kits in every glove box, every teacher’s drawer and every emergency room,” Antevy says. “Every teacher should have and know how to use one. We’ve heard in tragedies such as the Sandy Hook shooting, the man who was shot recently at the Los Angeles airport, even as far back as Columbine, how people bled out because medics and first responders couldn’t get to them in time. But if people on the inside know how to do it, it could save lives. I think the concept will catch on everywhere.”

Davie Police Officers Carry Individual Tourniquet Kits

After training to use the severe bleeding kits, the Davie Police Department also decided they wanted their own kits that each officer could carry at all times. Antevy and Downey agreed to create portable versions for each police officer.

The “Individual Police Officer Kits,” or IPOKs, are similar to the severe bleeding kits that the public now has access to in Davie, with two alterations. The IPOKs have a different kind of tourniquet, a SWAT-T tourniquet.

“The police officers wanted something smaller, something more compact,” Antevy says. “The SWAT-T looks like the inner tube of a bicycle, only it’s flat.”

Additionally, the police officer kit includes a HyFin Chest Seal.

“If someone has an open chest wound, the chest seal can be placed over it,” Antevy says. “It’s like a big square sticker that can cover the hole. The public kit doesn’t have this because if it’s not used correctly, it can cause some problems for the patient. It requires a little bit of professional knowledge because sometimes it requires a ‘burp,’ like burping a baby. You have to lift it up and reapply it to remove the air. The police officers are trained how to do this.”

The IPOKs go under each police officer’s vest.

“The police officers decided they wanted the kit on them at all times,” Downey says. “Their vests are bulky and they have their guns, Tasers and handcuffs, so they wanted something easy to carry. The severe bleeding kits fit right inside their ballistic vests. We also have them in supervisors’ vests for the fire department. The kit is very small and compact, only about a quarter of an inch thick. Every officer has one and it is intended to be used either for that individual officer or a buddy who needs it. But it also can be used for the public if needed.”

An added benefit is that the fire department and police department collaborated on the training and creation of the kits.

“It really brought the police department and fire department together,” Antevy says.

Susan E. Sagarra is a writer, editor and book author based in St. Louis, Mo.