The Gathering of Eagles: Why It Matters

The 24th annual EMS State of the Science Conference, better known as the Gathering of Eagles, began bright and early Thursday, June 16, 2022, at the Seminole Hard Rock Hotel and Casino in Hollywood, Florida. As usual the scene was jam-packed with topics, faculty, and attendees ready to dive into and learn about the “state of the science” in EMS.

The conference started with an overview and summary of philosophy presented by Raymond L. Fowler, MD, officially dubbed the “first Eagle,” and course coordinator Paul E. Pepe, MD, MPH. Learning sessions began with a customary review of the 5 most important EMS research publications of the last year as assessed by one of the most popular Eagles and conference presenters, Corey M. Slovis, MD, medical director for Nashville EMS, the city’s fire department and airport, and a professor of emergency medicine at Vanderbilt University.

Conference History and Philosophy

The Gathering of Eagles has become one of the most progressive and important EMS conferences worldwide.

The faculty, derived from the US Metropolitan Municipalities EMS Medical Directors Consortium (the “Eagles Coalition”) consists of most of the jurisdictional EMS medical directors from the country’s largest emergency response systems, as well as the chief medical officers for pivotal federal agencies such as the FBI, Secret Service, and White House medical unit, and also global municipalities such as Berlin, Paris, and London and nations like Scotland, Italy, Ireland, New Zealand, Canada, and Australia.

This cohesive cadre of leading EMS specialists not only oversees the medical aspects of day-to-day 9-1-1-type emergency responses and early resuscitative interventions for trauma, stroke, cardiac care, and other critical emergencies in the nation’s (and some of the world’s) most populous cities, but most of them are also responsible for many of the medical aspects of homeland security and disaster management in these high-risk venues (in which nearly 100 million persons dwell and make their livelihoods).

Their ability to deal with these significant responsibilities is facilitated in many ways by the close cooperation of this unique convocation of physicians, who also generally serve as the main interface between local government and the medical community in their municipalities.

The purpose of the highly popular annual Eagles conference is to share with participants and faculty alike the most cutting-edge information and advances in EMS patient care, research, and management, as well as trending challenges (and lessons learned from them), while also introducing novel patient care strategies and techniques.

Beyond the faculty this unique conference is also famous for having pioneered the 5-minute bullet plenary presentation, “lightning rounds,” and other innovative educational advances that have not only provided attendees with dozens of presentations over 2 days but, according to conference evaluations, have also changed nationwide medical practices almost overnight.

The Eagles Consortium has become an extraordinary influence in shaping future EMS practice trends and the medical aspects of disasters and homeland security, not to mention day-to-day 9-1-1 responses and resuscitations worldwide. The group has advanced (by years) equipment and treatment practices such as:

• Adult IO use;
• Reduced call-to-cath-lab times and improved STEMI/blockage removal results;
• The expanded use of mechanical compression devices, particularly the Physio-Control LUCAS device;
• Effective use of the impedance threshold device;
• Implementation of the now-proven “pit crew” approach to resuscitations;
• Use of the mucosal atomization device (MAD);
• BLS and police administration of naloxone for narcotic overdose reversal;
• ALS (and now BLS) use of CPAP to improve care and reduce intubations and associated (often fatal) complications such as ventilator-associated pneumonia;
• Initiation of head-up neuroprotective CPR.

Conference Origins

In February 1998 the elected leadership of the paramedic association of Pittsburgh called on Pepe, the soon-to-be-named commonwealth medical director for Pennsylvania. They asked if he could put on an educational offering that was “state of the art” or even beyond.

Over the previous 2 decades, Pepe had frequently presented challenges to the status quo of EMS care at national and scientific meetings, often based on his own groundbreaking research in Seattle and Houston. In many cases his recommendations became the standard of care worldwide, usually years later. The paramedics were anxious to have their own glimpse into the future.

Coincidentally, Pepe had just heard from a pair of old friends: Fowler, the first president of the National Association of EMS Physicians (NAEMSP) and original national program director for Basic Trauma Life Support, and Jeff Clawson, MD, the national guru of emergency medical dispatch. Both were planning to visit Pittsburgh at around the same time. The doctors planned to get together and talk about their latest projects.

This provided Pepe the beginnings of a faculty for an impromptu 2-day course for the paramedics. Within the next week he had put together the first “EMS State of the Science: Evolution and Revolution” meeting. Inspired the coincidence of Fowler’s and Clawson’s arrivals, he made a spur-of-the-moment decision to call on several other old friends. He recruited innovative EMS medical directors from several major US cities, including Marshal Isaacs from San Francisco, Jim Dunford from San Diego, Dave Persse from Houston, Brian Zachariah from Dallas, and several others.

Despite the last-minute request, these friends all agreed to drop their previous plans and contribute. The idea was to exchange ideas among each other and let EMS personnel, managers, and medical directors (and anyone else interested) eavesdrop.

Rave Reviews

Even with the short notice and limited marketing (mostly word of mouth), the auditorium at Allegheny General Hospital in Pittsburgh was packed with EMS personnel when the day came. The audience included everyone from frontline EMTs and paramedics to regional leaders, including Pennsylvania’s state EMS director.

The course was not only cited for its aggressive content (with sessions like “EMS Response: Do You Always Have to Send an Ambulance?” and “Mouth-to-Mouth Ventilation: Is it Really Necessary?”) but also for its hard-hitting, “to-the-point” 15-minute bullet presentations. These didactics were amplified by faculty panels that exuded enthusiasm and camaraderie. Dozens of the evaluations repeated the same phrase: best conference I’ve ever attended.

Even the faculty raved. Clawson said, “I’ve never taken so many notes since medical school—I was spellbound by each and every talk.” Fowler said, “I’ll promise you this: If we do this again, it will be the one meeting I definitely won’t miss.” Added Isaacs, “Let’s absolutely make it annual event. I’ll be there every year.”

And they all did return the next year—and with some new friends. By 1999 the original “Evolution and Revolution” group included the likes of Drs. Ed Racht from Austin and Frank Pratt from Los Angeles County.

By 2002 the cadre had expanded to include Drs. Michael Copass and Leonard Cobb from Seattle, Marc Eckstein from LA, Joe Ornato from Richmond, Virginia, Paula Willoughby from Chicago, Crawford Mechem from Philadelphia, and several others.

Hearing about the roster, one EMS-oriented member of the media remarked in a report, “This is a gathering of Eagles”…and the name stuck.

AJ Heightman, MPA, EMT-P, is senior advisor and chief development officer for Cambridge Consulting Group. He is best known as editor emeritus of JEMS (the Journal of Emergency Medical Services), where he spent 27 years developing editorial content. He is also an adjunct instructor of clinical research and leadership at George Washington University School of Medicine and Health Sciences and serves as an academic advisor for the San Diego Fire Rescue paramedic program. Contact him at ajheightman@gmail.com.