Insights from EMS Expo 2023: International Science Symposium

Fireground rehab, administration of blood in the field, treatment disparities, and the impact of motorcycle helmet laws were just some of the topics being talked about at the International Science Symposium, a part of EMS World Expo 2023 in New Orleans.

Eight presenters shared their original research during the symposium’s oral abstract sessions, which are organized by the Prehospital Care Research Forum at UCLA.

Kevin Crocker, with Montgomery County Hospital District EMS outside of Houston, Texas, presented research looking at his agency’s use of ketamine for agitated pediatric patients. Their retrospective study included 60 patients, ages 9 through 17, and was focused on whether they experienced any adverse events after a “dissociative dose” of ketamine was administered.

What they found, according to Crocker, was that ketamine in these patients seems rather safe. While a quarter of them experienced at least a moment of hypoxia (defined as SpO2 below 90%), only 5% required ventilatory support, and only two of the patients were intubated. That said, MCHD has implemented a clinical safety bundle for all patients who receive sedation to ensure they are monitoring closely for possible adverse events and can intervene immediately.

Crocker’s presentation was awarded the Best Oral Presentation award, as decided on by attendees of the sessions.

Demonstrating the wide range of research using the data collected every day by EMS clinicians, Morgan Anderson of ImageTrend presented her study examining the impact of Missouri’s new motorcycle helmet law. The law, enacted in 2020, reduced requirements for motorcyclists to wear helmets–now, only riders under the age of 26 or those without any health insurance must wear a helmet.

So Anderson, an epidemiologist, and her co-authors took a look at EMS reports for patients involved in motorcycle crashes before and after the law went into effect to see if there were differences. And they found some.

First, they reported a 53% decrease in helmet use among those involved in a crash. They also saw a 50% increase in signs of head injury, an even larger increase in critical acuity, and a 20% increase in trauma team activations. Perhaps surprisingly, they also found a large decrease in whether helmet use or lack of use was documented at all, an unfortunate finding given that their results overall suggest EMS data can be extremely valuable not just in evaluating EMS care, but also in studying the outcomes of legislation or other public health actions.

Sara Houston, a paramedic in Durham, North Carolina, presented the results of her team’s use of national data from ESO to examine whether a patient’s weight had any impact on the success of endotracheal intubation attempts or blind insertion airway device attempts.

Among the more than 40,000 patients in their dataset who met the criteria for the study, they reported that overall intubation success rates were 79.5% and blind insertion airway device success rates were 92.8%. When looking specifically at the association with patient weight, they found that intubations were 36% less likely to be successful in heavier patients, while blind-insertion device attempts were more likely to succeed in less heavy patients.

Another innovative study looked at the rehab of firefighters–but rather than examine the impact of heat exhaustion, or how to cool their body temperatures, Caitlin Delaney presented her research on rewarming firefighters who operate in cold weather. It’s a project that makes sense for the EMT who is currently a student in Buffalo, New York, where firefighters frequently battle blazes in subfreezing temperatures. 

Delaney and her colleagues recruited 17 firefighters to walk in a treadmill in what was essentially a giant refrigerator, while wearing their turnout gear and breathing apparatus, to simulate the exertion of firefighting on a cold day. They used heart rate and surface temperature monitors and even CorTemp sensors–a pill the study participants swallowed to measure internal temperatures–and also surveyed the firefighters afterward.

What they concluded was that simply removing the participants from the cold environment was enough to prevent further discomfort or any adverse impacts of the cold. The heat they generate during physical activity, trapped by their gear, kept them mostly warm enough, making “active rewarming” unnecessary.