Quick take: Head-up CPR, drones and hypothermic emergencies
Celebrating outstanding achievement by collegiate EMS, innovation at the NCEMS conference
BOSTON — The 30th annual National Collegiate EMS Conference was held February 24-26, 2023, in Boston. The conference included 13 workshop sessions, three plenary sessions, an academic poster session, hands-on skills labs, student lecture competition, BLS and ALS competition, and several social and networking functions for over 1,200 registrants from 112 colleges and universities across the United States and Canada.
Annual awards were presented to recognize outstanding achievement by collegiate EMS organizations and individuals, including:
- The Richard W. Vomacka Student Speaker Competition: Eric Grin and Julia Perugini of Tufts University
- Annual Skills Classic Winner – BLS: Binghamton University
- Annual Skills Classic Winner – ALS: University of Vermont
- Collegiate EMS Week Celebration of the Year: University of Delaware
- Collegiate EMS Video of the Year: The George Washington University
- Collegiate EMS Community Engagement Program of the Year: University of California Riverside
- George J. Koenig, Jr. DO Service Award: Bruce Fairfield
- Collegiate EMS Advisor of the Year: Kevin Crisp of St. Olaf College
- Collegiate EMS Provider of the Year: Joey Alderson of Western Illinois University
- Collegiate EMS Organization of the Year: Embry Riddle Aeronautical University
Following are takeaways from several conference sessions.
What’s up with Heads Up? The Future of CPR
Presented by N. Alex Cutsumbis, BS, NRP, a graduate of the SHRS Emergency Medicine Program, and an instructor for the University of Pittsburgh and Center for Emergency Medicine paramedic education programs
The idea behind heads-up CPR came about after analyses of the impact of CPR when tilting the body. It was found that contrary to expectations, head-down CPR outcomes were poor. It was theorized that tilting the head down would increase blood flow to the heart and brain from the force of gravity. What was found in animal experiments was that tilting the head down increased intracranial pressure and decreased cerebral perfusion pressure. By tilting the head up for CPR, the ICP fell and cerebral perfusion pressure increased by statistically significant levels. Long-term outcomes were improved.
Elevated CPR is performed with an impedance threshold device and using mechanical cardiopulmonary resuscitation with a device to elevate the head and thorax. A few EMS systems have been engaged in studies and Baptist Health became the first U.S. hospital system to adopt heads-up CPR.
Studies have been conducted on animals and in EMS systems, and there are some conflicting results. Results include an increase in cerebral blood flow, lower ICP pressures, and increased cerebral perfusion pressure. Generally, the studies have been finding a higher probability of ROSC and favorable neurological outcomes. More research is needed.
First Due Actions for the Non-Transporting EMT
Presented by J. Dominic Singh, BA, NRP, I/C, staff advisor to UMass Amherst EMS, chief of operations for Spencer EMS, and a career firefighter/paramedic for Amherst Fire
Non-transporting EMS is common among organizations such as fire departments, quick response services and events EMS. Collegiate EMS often provides services to support sports, concerts and other campus activities not requiring transport services. Some of the considerations for non-transporting EMS include the gear needed, scene planning and planning for egress.
Gear considerations consist of managing immediate life threats and stabilization of the patient, (e.g., stop the bleed and airway supplies). Consider lightweight equipment, including handheld suction rather than electric suction pumps. A pulse oximeter with plethysmograph is handy to have. Gear should be portable as a fully stocked ambulance is not necessary for patient stabilization. Scene planning is important and based on the venue. Preplan egress to move a patient with consideration given for narrow stairs, tight hallways and other unique features found in the venue.
Drones in EMS: Current Evidence and Future Directions
Presented by Tom Leith, AB, a fourth-year medical student at the University of Michigan
Drones and unmanned aerial vehicles (UAVs) are becoming more common with both hobbyists and in public safety. In addition to being used for video and surveillance, drones are being used to deliver equipment and supplies to the scene of an incident. As more advanced drones are developed, they may be used to transport patients in the future. Some of the items being delivered by drone include AEDs and medications. Delivery can be made to lay rescuers on the scene of an incident, to rural areas, for disaster medicine, and to remote areas in wilderness EMS and search and rescue. Use of drone delivery is low cost with potentially high reward. Studies suggest that improved delivery times can lead to improved quality of life years. Drone delivery of AEDs can be more flexible than fixed-point public access AEDs.
Responders in remote locations may not be able to carry an exhaustive supply of different medications. With the increase in opioid overdoses, one medication that can be delivered by drone is naloxone. Other medications that can be delivered as needed include benzodiazepines for acute seizures and blood. Rwanda is using drones to deliver blood. In search and rescue, drones can deliver food, water, clothing, shelter and rope rescue gear. Drones are also used for surveillance, including finding people in wildfires, in avalanches, and for maritime rescue using imaging and following radio transceiver signals.
Too Hot, Too Cold, 2 Legit 2 Quit: Hyper and Hypothermic Emergencies
Presented by Benjamin Abo, DO, P, EMTT, FAWM, an emergency physician and toxicologist, and assistant professor for Florida State University School of Medicine
The traditional infographics and posters for heat and cold injuries do not give complete information and can be misleading. For example, heat stroke should not be defined as when a person’s body stops sweating and is red and dry. Heat stroke occurs when there is an altered mental status and high body temperature. Cooling on the scene before transporting the patient is critical to survival. One way this can be performed is through cold water immersion rather than simply placing ice packs in the armpits and on the groin. Use the body bag from the ambulance with bags of ice from a convenience store. Fill the body bag with ice and water from a fire hose. Stop the hyperthermic process and then transport the patient. Hypothermia, likewise, should be treated aggressively. Patients will lose core body heat through convection and to the ground through conduction. They need to be warmed up!
The annual NCEMSF conference is held the last weekend of February and rotates among several cities. Check www.ncemsf.org/conference for announcements for next year’s conference location, information on presenting and registration. Vendors, exhibitors, graduate medical and health school programs, and alumni are always welcome.