Docs vs. Terrorists: The Gathering of Eagles Kicks Off

The 20th EMS State of the Science Conference, better known as the Gathering of Eagles, kicked off Friday in Dallas with several dozen rapid-fire presentations from EMS medical directors from America’s largest (and a handful of major European) cities. 

The densely concentrated 5- to 10-minute presentations were grouped around themes of pressing importance to EMS in 2018, including terrorism, MCIs, drug abuse/addiction, stroke, injury management, and the evolving healthcare system and future of EMS. 

The morning’s first package dealt with terrorism. Program coordinator Paul Pepe noted that a predominant but underappreciated emotion for EMS providers in many attacks is guilt—unable to help immediately during protracted incidents like the Pulse shooting and attack at Paris’ Bataclan, responders may be forced into frustrating waits even as unreachable victims bleed and die. During this time they may speculate about the deaths ongoing and come to feel vulnerable, the adrenaline of their response depleted, which may lead in turn to suboptimal performance.

Palm Beach County’s Ken Scheppke discussed the 2017 Ft. Lauderdale airport shooting, noting that while the attack lasted just 85 seconds, chaos and fear persisted long after. Video showed confused travelers worried about further violence; people were found hiding hours later. We need a way to sound the all-clear after such incidents, Scheppke said; other lessons learned included staging responding law enforcement, who in Ft. Lauderdale clogged people’s egress by jamming parking areas. 

The guilt noted by Pepe was also cited by Coral Springs/Parkland, Fla., doc Peter Antevy, president of the Greater Broward EMS Medical Directors Association, who responded to last month’s shooting at Marjorie Stoneman Douglas High School only to be forced to stand by amid reports shooter Nikolas Cruz was still loose. A new fact about Cruz: He ultimately climbed to the school’s third floor, Antevy said, with the intention of opening fire on fire and EMS responders below—but the hurricane glass in the school’s windows wouldn’t break. 

AMR’s Ed Racht spoke on the Las Vegas Route 91 Harvest Festival Massacre of last October. Early in the incident, even as the news reported two fatalities, initial responders were ballparking 50-60 dead (accurately, as it turns out; the final death toll was 58). Trust your early instincts about such severity, he said; Vegas started more resources rolling based on that first impression. 

More unusual Vegas notes: In addition to the penetrating trauma of being shot, some victims incurred blunt trauma from trampling in the ensuing panic. And some had bullet wounds that entered low and exited high—the unanticipated result of ricochets. Ride-sharing services like Uber and Lyft did so well at getting people away and to care as to merit consideration of a more formalized role in the future. Finally, Racht said, it may be time to abandon triage tags in such events. Besides the difficulty of organizing triage in such mayhem, fearful concertgoers realized the tags were a ticket out, and one even presented for transport with a black tag apparently taken from a deceased. 

Pierre Carli from Paris, a first-time speaker at the show, noted that the evolving nature of terror threats now includes worries like pediatric MCIs (e.g., the 2004 Beslan school attack), which may strain limited pediatric resources; “gas chamber” scenarios like Russia’s 2002 Dubrovka Theater attack, where gas used by police to incapacitate hostage-takers instead killed 170 hostages (this requires a plan for mass rescue breathing); and “zombie” attacks where numbers of ambulatory but contaminated victims of toxic exposures rush to responders for help, overwhelming the decontamination process (this has happened in Syria). 

Berlin’s Stefan Poloczek, another newcomer, recounted lessons from his city’s 2016 Christmas market attack. Among those: cleaning is psychosocial hygiene—allow and encourage providers to clean up as soon as feasible after such events; care about your commanders, who may be subject to second-guessing; and have a shopping list ready in case you’re offered a budget boost in the aftermath. 

As the talks drifted into more generic MCIs, New Orleans’ Jeff Elder described being on scene as a drunk driver plowed into a 2017 Mardi Gras parade. There’s a real need for time to mobilize and respond to MCIs, Elder said, and to prepare yourselves mentally for potential mass fatalities. Some New Orleans providers didn’t get that that day, but at least a fortuitously placed garbage truck stopped the driver and prevented a worse toll.

Following the 2013 SFO plane crash, San Francisco’s Clement Yeh reported, with a need to move large numbers of people, his city developed MCI buses—the only ones in California. These can accommodate 26 ambulatory or 15 beds plus 10 seated patients. Potential uses include mass evacuations, fireground rehab, and mass-gathering care. 

Col. John Holcomb, former commander of the U.S. Army’s Institute for Surgical Research, concluded the morning with a look at military advances in lifesaving that can benefit civilian care. As tourniquets have soared in popularity, he predicted, so too will field transfusions of fresh whole blood in coming years. (These are already beginning in a few select jurisdictions, including some in Texas.) The data supporting it, he said, is “overwhelmingly compelling.”