Time and Distance: A Dinosaur`s View of EMS World Expo 2015

Ed's Note: Mark Your Calendars! EMS World Expo 2016 is scheduled for October 3–7 in New Orleans, LA. Visit EMSWorldExpo.com for more information.

As I was walking around the exhibit hall of EMS World Expo 2015 in Las Vegas, I saw something that warmed my heart: A booth for the National EMS Museum was selling a patch with the star of life. It was not an ordinary star of life, this one had a dinosaur wrapped around the star instead of a snake. I immediately bought one.

I proudly proclaim I am an EMS dinosaur. My EMT class was in 1977, and I became a paramedic in 1980. I sometimes wonder if the length of my career should be some sort of common core math problem.

I am currently an EMS instructor and preface many of my lectures with the statement that my paramedic textbook had a section on veterinary medicine, so I could care for the horses that pulled my ambulance. 

As you can probably imagine, I am as resistant to change and set in my ways as a mule who wants to avoid a field of cacti unless you can prove to me why I should change.

That is where a convention like EMS World Expo 2015 plays such an important role. With speakers from all over the United States and several other countries, new studies, procedures, assessment methods and tools can be explored by attendees.

An excellent lecture on strokes talked about a team approach to treating large vessel occlusions that involves paramedics directly contacting a neurologist from the scene. Using a new assessment tool called R.A.C.E., patients at high risk for a LVO stroke are transported to the cath lab for possible removal of the clot using a stent-like device. Initial results are looking very good.

Another presentation on measuring lactate levels in the field was interesting. Increased lactate levels are an early sign of shock. It is being used for septic shock patients now, but can have much broader use for detecting early shock in trauma and burn patients.  

The last lecture on the last day was really interesting. It looked at studies being done in New Jersey by MONOC, which is a paramedic provider. One is the use of two defibrillators to give a simultaneous double shock to a patient. Early indications are encouraging, but they emphasized more outcome data was needed. Another study looks at the use of lidocaine in pediatric cardiac arrest instead of amiodorone. 

This lecture also discussed the use of prehospital ultrasound for a number of situations, such as cardiac arrest, shock, trauma, strokes, diagnosing CHF vs. COPD and several other possibilities. Ultrasound can be done in the field and transmitted to the receiving facility. It is being used on the International Space Station for diagnosing medical problems via telemedicine.

One thing I liked about this lecture was the speaker continually stated the need for more studies and outcome data. They accepted there is still a lot that is not known about what they are trying to do. But, they are still trying.

Then there was the massive toy store, the exhibit hall. All the major manufacturers and suppliers and some new startup companies were there. There were a lot of technology-based devices. What caught my eye were some of the more basic items that would make providers’ jobs easier and safer.

The one that really stood out was a product from MeDirect, a new company created by a paramedic. Dosing medications for pediatric patients has always been problematic. Trying to do math in a stressful situation is prone to error.

This company has created a series of syringes for different medications with the kilogram doses etched on the barrels. The name of the drug and its concentration are also etched on the plunger. All you do is draw up the amount of drug to the indicated weight on the barrel. No math. The syringes themselves do not contain any medication. So, they will have a very long shelf life as opposed to pre-filled syringes.

A supraglottic airway also caught my eye. It is called the "i-gel" made by Intersurgical. It looks like an LMA but has no inflatable cuff. Instead, it has a soft, gel-like cuff that will conform to the patient's airway to make a seal. It also has a port to deliver oxygen for passive ventilation during CPR. Several EMS systems are using it, and it has even been approved for EMT use in some areas.

On the more high-tech side, Frazer, an ambulance manufacturer, displayed one of its ambulances with a CT scanner mounted inside. It is part of a study being done in Texas to see if bringing the scanner to the patient along with tPA can reduce stroke treatment time. Apparently, there are about five vehicles like this in the U.S.

It is so easy to get lost in our day-to-day life as prehospital providers. That is why I think it is important to go to a large conference like EMS World Expo 2015. You get to see what other systems are doing, what new research is being done and find people who face the same challenges and frustrations. Plus, there is something energizing about being in the same place with 5,000 other providers from all over the U.S. and the world—48 different countries were represented last year.

On a final note, I came across a class of high school EMT students. I was able to talk to them for a few minutes and realized there are still some young people who care about doing something worthwhile for other people as opposed to for themselves. They expressed the same kind of aspirations and apprehensions as I did when I was their age. It brought home to me that with all the technology and other advancements, it still comes down to people willing to take up the challenge of prehospital care. 

Barry D. Smith is an instructor in the Education Department at the Regional Emergency Medical Services Authority (REMSA) in Reno, NV. Contact him at bsmith@remsa-cf.com.