Emergency medicine physicians focus on EMS issues and products at annual meeting

Docs challenge ALS vs. BLS outcomes research and learn about prehospital care products at 2015 ACEP Scientific Assembly

By Mark Liao

The 2015 American College of Emergency Physicians (ACEP) Scientific Assembly attracted thousands of emergency medicine physicians and practitioners from around the globe. This year's assembly was held in Boston and as expected, many of the education topics and meetings were focused on EMS-related issues.

Research presentation: BLS vs. ALS
In early November, a paper published in the Annals of Internal Medicine, "Outcomes of Basic Versus Advanced Life Support for Out-of-Hospital Medical Emergencies," by primary author Dr. Prachi Sanghavi generated a lot of buzz in the EMS community. The paper, using Medicare beneficiary data, concluded that ALS transport worsened patient outcomes for studied illnesses including trauma, stroke and respiratory failure when compared to Basic Life Support transport.  

Dr. Sanghavi and her fellow researchers presented their paper at ACEP. Many EMS physicians expressed concerns regarding the study methodology (such as the use of Medicare data to draw conclusions on the effect of Advance Life Support interventions) and generalizability of the data (for example, having an older study population makes it difficult to make conclusions about the effect of ALS care related to younger populations that may sustain very different types of trauma.) The paper is sure to generate a great deal of discussion among physicians for years to come.

Hot topics for EMS physicians and providers
EMS educational sessions included active shooter preparation, mass gathering medical care, cardiac arrest management and even the prehospital management of emerging infectious diseases, such as Ebola and MERS. Many emergency physicians will bring the knowledge that they learned back with them to their home agencies — subsequently changing their local EMS protocols and procedures.

National efforts: Stop the Bleed campaign
The ACEP Emergency Medical Services section and Tactical Medicine section also highlighted the new national effort supported by the Department of Homeland Security, the "Stop the Bleed" campaign. This outreach program encourages citizens to take action in medical emergencies — specifically in situations where a person may be injured in an active shooter incident — by aggressively performing hemorrhage control using dressings, direct pressure and tourniquets. This initiative could easily be taught by EMS agencies as part of their outreach programs to their communities.

Interesting products for EMS
With so many emergency physicians present, product exhibitors and vendors were eager to present the latest devices, gadgets and tools. Some particularly interesting products that pertain to EMS included:

  • The RevMedX X-Stat, a device containing multiple expandable sponges containing chitosan, which is used to stop severe bleeding in areas that are difficult to compress or apply a tourniquet to (such as the axilla or groin).
  • OnStar’s crash telemetry program launched an Injury Severity Prediction service that, in the future, will send data to EMS agencies responding to automobile accidents to help providers recognize when serious injuries may be present before even arriving on scene.
  • The recently FDA-approved Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) device from Pryor Medical, which will be used by physicians to control catastrophic lower body bleeding before a patient is transferred to the operating room or trauma center.
  • The Surgical Cut Suit by Strategic Operations, which allows a live actor to wear a body suit that can have emergency surgical procedures performed on it, including chest tube placement and cricothyrotomy. 
  • ZOLL’s ResQCPR System, which combines an Active Compression-Decompression hand pump with an Impedance Threshold Device to improve CPR hemodynamics.
  • CPR feedback devices from Physio-Control, Laerdal and ZOLL which have gained increased attention in the latest 2015 AHA CPR guidelines.
  • Handheld ultrasounds that fit in the palm of the user's hand, including those from GE and Signostics.
  • Telemedicine products such as those from Max Life, which would help bring video from the eyes of the paramedics to screens in the emergency department.

Political updates: Field EMS bill
Physicians were updated on the status of the proposed Field EMS Modernization and Innovation Act (HR 2366). Unfortunately, at this time, the bill appears unlikely to progress forward, primarily due to concerns expressed from national organizations including the International Association of Fire Fighters, International Association of Fire Chiefs and NFPA. While understandably disappointing for HR 2366 advocates, ACEP remains committed to introducing legislation that improves EMS delivery throughout the country.

Notable awards for ACEP members
Several giants in the EMS/prehospital, disaster and tactical medicine community were recognized during this year’s Scientific Assembly. Dr. Carl Schultz from the University of California, Irvine was awarded the Disaster Medical Sciences Award for his longstanding contribution the field of disaster preparedness, disaster medicine and response. Dr. James Dunford Jr., the EMS medical director for the city of San Diego who established the city’s EMS regional systems of care was recognized with the ACEP Outstanding Contribution in EMS Award. Dr. Daniel Spaite, a respected researcher from the University of Arizona who has focused heavily on EMS, was awarded with an Outstanding Contribution in Research Award. Dr. Richard Camona, a former U.S. surgeon general, was recognized with the Tactical Emergency Medicine Visionary Award for his contributions to the development of this emerging field.

ACEP Scientific Assembly 2016
EMS remains a major focus for emergency physicians, as evidenced by the variety of education content and offerings at ACEP 2015. Keep an eye out for exciting changes and developments in future EMS delivery and protocols. Learn more about ACEP and consider attending the 2016 ACEP Scientific Assembly. 

About the author
Mark Liao, M.D., NRP is an emergency medicine resident physician at the Indiana University School of Medicine located in Indianapolis. His interests include prehospital care, disaster preparedness/medicine, resuscitation science and EMS education. He has no financial interests in any of the companies noted in the article published. 

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