*subject to change

0830- 0930h

201. Are You Making Your Patients Sick?
Karen Swecker, RN, CIC, MedFlight of Ohio

Simple, easy to apply, no cost tactics for the prevention of CAUTI, CLABSI, and ventilator related pneumonia.

202. Got VAN? Dramatically Improving Time to Treatment in Rural Ischemic Stroke
Kevin Kraal, MD, Air St. Luke’s/Magic Valley Paramedics; Brian Hite, BS, RN, CCRN, CFRN, Air St. Luke’s; Stephanie Shawver, BSN, RN, SCRN, St. Luke’s Health System

Management of Large Vessel Occlusion (LVO) stroke in rural environments presents challenges not present in urban areas.  In this presentation you will see how pre-hospital (RW and Ground ALS) identification of LVO using the VAN tool, upstream notification of air transport, and Interventional Neuroradiologists has resulted in dramatic reduction of open artery times.  In addition, the incorporation of prehospital lab draws has further reduced door to lytic and door to transfer times.

203. Stop Drowning the Burns: A Review of Current American Burn Association Resuscitation Guidelines
Christopher Stevenson, AGACNP-BC, RN, MSN, EMT-B, VCU Health/Virginia State Police Med-Flight

Critical care transport requires specialized knowledge and skills related to hemodynamic monitoring. Use of these technologies allows for assessment of cardiopulmonary status and responses to therapy. Clinicians must be familiar with hemodynamic monitoring technologies and have the knowledge and skill to provide safe and effective care during transport. The focus of the presentation is to provide the clinician with a brief overview of pressure monitoring and some of the most commonly used invasive hemodynamic technologies in the transport setting. This will include a discussion of arterial lines, central venous catheters and pulmonary artery catheters. Key safety factors and the unique consideration related to transport of patients with invasive hemodynamic monitoring will be emphasized during this presentation.

204. SHARE THE AIR: Partnering WITH Unmanned Aircraft System Pilots For Safer Airspace.
Amanda Ball, AEMT, CFC, OCS, MedFlight of Ohio

“It’s just a matter of time before there’s an accident.”  “They’re not REAL pilots.”  How often have you said this to yourself after reading an online article regarding a near-miss between a drone and an aircraft?  Drones are easy to buy, fairly easy to operate, and provide a great hobby or cashflow for many operators.  While evolving governmental regulations are in the works, the Unmanned Aircraft System (UAS) world can feel like the wild, wild west… Especially to air medical organizations.   Instead of solely focusing on potential dangers, perhaps another approach may work:  Sharing the Air.  The key to any disaster prevention is proactive relationship building, multi-disciplinary training, and just good old fashion conversation.  Attendees will be supplied with tools & suggestions from a busy air medical organization who chose to proactively work with local UAS enthusiasts by means of local workshops and networking events.

205. The Business of Peer Support
Sherri Dean, BSN, MHA, RN, PHI Air Medical

The conversation surrounding the value and development of a Peer Support team has typically focused on the emotional experiences of individuals.  This session will address the value from a corporate perspective for our organization.  The development, evolution, data, culture, lessons learned and ROI will be discussed in the presentation.

206. I’m Tired… The struggle is real
April Larsen-Oaks, RN, CMTE, Classic Air Medical

As leaders in the Air medical and critical care ground transport field we are constantly monitoring for fatigue and burn out with those we lead. As a leader, we are diligent to spot the signs, counsel our crew members, and form an action plan to assist crew members suffering burnout and fatigue.  Have you ever stopped to think about your own burn out and fatigue as a leader.  Are you able to recognize the signs of professional exhaustion?   A recent poll was conduct on burnout in healthcare management, a staggering ¾ of all managers polled feel burned out. We will take an honest and entertaining deep dive into identifying burnout in leadership, how to recognize burnout in yourself, and how to reclaim our passion for leadership once we become burned out.

207. From the Ground Up: The Journey of Building a New Rotor Wing Base for Success
Keilah Shope, RN, BSN, CFRN; Marla Werner, FP-C, NRP, MedFlight of Ohio

Review the Life Cycle of an organization and how it directly reflects our personal experiences in building a base from the ground up.  The challenges experienced that were expected and those that were not.  From basic needs for the clinical crews and aviation partner, to staffing and the geographic challenges for supplies, deliveries.  Understanding why there are setbacks and milestones and the flexibility to adapt to both and which paths to take to continue grow and to create a positive, productive culture.  Review the staffing challenges from the clinical partners, to leadership and balancing all the new personalities and not having the opportunity to feed the needs slowing but to fast forward almost every aspect of the development and the importance of utilizing seasoned partners from other bases to nurture the growth and progress. We will review this journey, sharing the good, the challenges, and will review tools to use to evaluate were you are in your organizations life cycle, how to get were you want or need to be so you can focus on what is lines up with your Mission, vision and values.

208. Stories from the Street: Keeping our Patients Safe
Lee Varner, MSEMS, CPPS, EMT-P, Center for Patient Safety

In the past few years great strides have been made in EMS with innovative delivery systems, new treatment modalities and a focus on data.  But at the same time clinical mistakes continue to reach patients either directly or indirectly from the care that’s being provided.  The Center for Patient Safety is non profit organization and a federally listed Patient Safety Organization which collects data around adverse events, near misses and unsafe conditions.  This session will present 4 EMS cases where harm reached a patient and will ask the following questions: What happened? Why did it happen? What can we do to prevent it in the future? Each case will be a retrospective review with key findings from the root cause analysis with an additional goal of understanding if the event outcome was a process failure or behavioral choice of the provider.  Resources and basic strategies to prevent future events will be shared during the presentation.

0830- 1045h

208a. MCI Table Top Training
Gustav Clark, NREMT-P, FP-C, Guardian Air Transport

The focus of this training is to facilitate improved patient outcomes during mass casualty incidents. This will be accomplished by improving response, patient treatment and stabilization and expediting transport to appropriate definitive care facilities. This is all accomplished by first responders establishing Incident Command and being practiced and skilled in the Unified Command communication processes required to effectively and efficiently mitigate an MCI.

0945- 1045h

209. Distracting Diagnosis: A Critical Care Transport Professionals Guide to the Autism Spectrum
Amanda Via, MSIHCM, BSN, RN, NRP, CEN, CareFlight Air and Mobile Services

Transportation of an individual on the Autism Spectrum will most likely occur at some point during your career.  Are you prepared?  This session is geared towards helping transport professionals increase their knowledge about  the Autism Spectrum in alignment with the critical care transport of this patient population.   Tips for the provider to to potentially identify an individual on the spectrum with interventions discussed to mitigate challenges that may arise during transport.  If the provider is uneducated about the Autism Spectrum, it may possibly present as distracting diagnosis which could ultimately result in poor patient outcomes.

210. Death by Ventilator: Managing Peri-intubation Problems
Chuck Sheppard, MD, FACEP, FAAEM, Mercy Health System

The peri-intubation period is a high risk time in the emergency intubation.  There is more and more evidence that the importance of “resuscitation before intubation” is becoming more and more important. This talk will address the importance of preventing peri intubation hypoxia and hypotension.  Discussion of the risk factors for peri-intubation arrest. In addition, the importance of preventing ventilator associated complications will be reviewed.  There will be discussion of how to minimize the risks of “downstream complications” from being intubated including pain management, types of sedation, and level of sedation.

211. Not Your Every Day Trauma: Call Me Special Specialty Trauma Populations
Teri Campbell, RN, BSN, CEN, CFRN, PHRN, University of Chicago

This is NOT your everyday adult trauma.  These are a SPECIAL trauma… the ones that make you pucker, the ones you don’t feel confident with, the ones that require your “A” game.  Come to this fascinating case-study based trauma lecture that discusses the specialty trauma consideration for geriatrics, pediatrics, and obstetrics.  This interactive and unfolding lecture will have you at the edge of your trauma-junky seat!

212. Turning Tragedy into Positive Action
Karen Mahaney, CRNA, BSN; David Repsher, BSN, NRP

This session will chronicle and display, in great detail, the HEMS crash of July 3, 2015 in Frisco, CO, which out of two separate, but very desperate survival stories has led to a renewed focus on helicopter safety improvements.  Discussions will center around previously enacted, but never fully implemented legislation, and current pending legislation that, if approved, could enhance future survivalbility and occupant outcomes.  Additional discussion will highlight the persuasive lack of awareness of available safety features, or lack thereof, that is known throughout the ranks of the entire helicopter industry.  It is our hope that by sharing our deeply personal and painful stories, the attendees will feel empowered to bring safety to the forefront in their respective organizations.

213. So Now You Are Responsible To Review Contracts – What Do All Those Words Mean?
Linda Hines, BSN, JD, MedFlight of Ohio

Understanding contractual basics and process are important for business professionals.  Organizations come in all sizes-some have an in-house legal counsel, others use their offsite corporate legal counsel and some are smaller and engage outside counsel. This program offers a foundation and then applies the content providing examples, tools, resources and real life examples.  Focus will include standard contract types, clauses and include discussion of insurance clauses.

214. Fly the Reds, Ground the Greens: A MCI Review
Lamar Green, NRP, FP-C; Tara McIntire, MSN, RN, CFRN, NREMT, Med-Trans Corporation

Medstar Air Care 1, a Med-Trans helicopter was able to service the Alabama/Florida community in responding to the I-10 bus accident involving high school students returning to Texas from Florida. Medstar is a unique helicopter crew in that the paramedics who fly also have ground EMS and/or Fire roles including in their leadership.  At approximately 0530 AM on March 13, 2018, two charter buses with band students were returning to Channelview, Texas from Orlando, Florida.  The driver of one bus witnessed the other bus leave the interstate, drive a significant distance in the opposite lanes of traffic, and drop into a deep ravine, approximately 60 feet.  It was reported that the bus was carrying approximately 50 passengers, mostly teenage students.

215. Precepting: Is It a Privilege or a Right?
Dana Clarke, RN, BSN, EMT-P, Houston Physician’s Hospital

This is an old, but needs to be continually re-visited, topic. As times are changing, technology is advancing , more helicopters services are “popping up,” and we are getting younger, less experienced crews, how do we develop a successful training program with limited budgets resources and even more limited experience? Is the senior employee (you know- the one who hates everyone and everything and is just biding his time to get vested or retire) the best one to train the newbie? Or, do you take the chance on the NEW guy training the NEWER guy? Turnover is, unfortunately, commonplace in this industry. We will discuss some best practices and concepts to consider to develop a successful preceptor program and to engage the new employee to put him on the road to success.

216. An Industrial Auger, Traumatic Amputations, Tourniquets and Chaos – A Patient’s Perspective When the Unthinkable Happens
Janie Kofford-Ford, RN, CFRN, MS, MSN, AGACNP-CB; Randy Scott, BS, FP-C, University of Utah AirMed

The notion that we had “been there, done that and seen it all”  was challenged when we responded to the scene of a meat rendering plant where a 32 year old patient slipped and fell into an auger literally ripping both his legs off above his knees.  After miraculously overcoming the sucking force of the industrial auger, he lifted his upper body out and miraculously had the  strength to straddle supporting beams preventing his entire body from being pulled into the auger.  This was just the beginning of his struggle to survive.  With unbelievable presence of mind, he  placed his belt above one of the stumps and maneuvered over a large pipe.  His continual cries for help were eventually heard by a  co-worker who placed a second belt over the other stump.  This complex call will be reviewed including the integral role that dispatch, rural EMS, the flight crew and receiving hospital all played in these life saving efforts. Options for pain management in the hypotensive trauma patient as well as the latest literature on tourniquets and pre-hospital care of traumatic amputations will be reviewed.  Both the immediate and long term effects of traumatic amputation will be discussed from the patient’s perspective as well as supporting evidence of the long term sequela on victims.  Participants will benefit from lessons learned by listening to the patient’s candid and raw description and the impact of these life altering events on him and his family.  What you hear and see will prove both thought provoking and  inspirational.

216a. Stick a Hose in Your Nose!
Abigail Polzin, MD, FACEP, CMTE, Sanford AirMed

A case description of a unique injury mechanism – insufflation! A 3 year old Hutterite male suffered an insufflation injury when his 5 year old brother placed an air compressor hose in his nose and 120 PSI force of air resulted in nasal and facial fractures along with impressive subcutaneous emphysema. He required a flight to a tertiary care center and numerous specialty consultations.

216b. Introduction to Security Awareness
Bailey Wong, BS, NATA Compliance Services

Would you intentionally leave your wallet out in the open, unprotected? Of course not! So why would people leave their access badges hanging in plain sight or write passwords on post-its? Exercising awareness of potential security threats, how to respond and enforce are important skills to protect yourself, your assets and others. Whether at work or at home, there are practices to incorporate into your routine right away that can be regularly improved and will mitigate security risks.

1330- 1430h

218. Single Dose Killers: Pediatric Toxicology
Michael Gooch, DNP, APRN, CFRN, EMT-P, Vanderbilt LifeFlight

Toxicological emergencies are commonly encountered in transport medicine. Some are more serious than others. In pediatric patients, there are a few single dose killers that are a major concern. This presentation will review these agents, discuss their clinical manifestations, and management priorities for the transport provider.

219. I’m not dead, yet!: The Mobile ECMO Project and How the Helicopter Program Relates To It
Ralph Frascone, MD; Kolby Kolbet, RN, MSN, CFRN, CMTE, Life Link III

This session will discuss ECMO, extracorporeal cardiac life support (ECLS), the mobile ECLS project, and the data that supports it. It will also discuss how the helicopter program staffs and manages the project, and the challenges that it presents.

220. A STAT Page For Whom?  Emergencies In Usually Non-Emergent Specialties
Michael Frakes, MSN, NEA-BC, CMTE, FACHE, Boston MedFlight

Acute neurologic emergencies are a common reason for critical care transport. This presentation will review flight team management of common neuro-critical care complaints, with a focus on acute intracranial hemorrhage.

221. Preparing Your Program For a Storm’s Disaster: Preparing for the Hurricane Florence Landfall
Kevin Collopy, BA, FP-C, CCEMT-P, NRP, CMTE, NHRMC AirLink/VitaLink Critical Care Transport

Hurricane Florence set a direct course over Wilmington, NC in September 2018 and was forecasted to strike the coast as a catastrophic category 4 hurricane with hurricane force winds stretching hundreds of miles from its center. As a coastal program, AirLink/VitaLink has long had a disaster plan, a plan that had been executed in the past decade for two winter storms and two hurricanes and had been tested during many hurricane forecast models Florence however was destined to strike. This presentation will take you step by step through annual pre-season disaster planning, and our organizations preparations, response, and recovery from disaster. Come hear how our organization prepared our program and team for an anticipated disaster, how we planned vehicle positioning, and how we improvised in the days after the hurricane passed. Enjoy our pearls and best practice tips, and opportunity for improvement so that you can prepare your program for disasters that may strike your own region.

222. Champagne Simulations on a Beer Budget: How to Get the Most from Your Simulations
William Rowland, BS, NRP, FP-C, Vanderbilt LifeFlight; Lee McMurray, MSN, RN, CEN, CFRN, NRP, CMTE, Air Methods Corporation

Simulations have become a staples of high-quality medical education. Hospitals and schools create multi-million dollar simulation labs with top of the line equipment, but how can a department with limited resources tap into the power of high fidelity simulation? How do we tap into this to make our 10 minute round robin scenarios more engaging and effective. Simulations live on a spectrum, at one end of the spectrum is a full motion, immersive simulator with high quality telemetry and debriefing tools. At the other end, you have your stereotypical EMT class where a student is asked to lay on a floor and act out a scenario from a one page piece of paper and the proctor filling the gaps with a box of expired supplies, oxygen adjuncts and c-collars. Almost every EMT student has been instructed to lie on a floor and act out an injury or illness for their fellow classmates. Small budgets and limited resources necessitate the need for creative solutions like rehabbing manikins from Ebay and turning a 30 year old antique ambulance into High quality mobile simulator.  A cost effective option that will rival some of the most high end simulation labs available for a fraction of the cost. This process open your eyes to the possibilities, as well as the limitations of rehabbing old equipment, while finding creative solutions to solve problems.

223. Critical Incident Stress Management (CISM): Because Our “Normal” Isn’t Normal…
Lt. Brett Key, Oklahoma Highway Patrol/Warrior’s Rest Foundation; Kyle Kennedy, DO, FACOEP, Midwest Aerocare/Med-Trans Corporation

Air medical providers face unique challenges on a day to day basis. These challenges are clinical, physical and also often emotional. Understanding the common stressors that can occur and becoming proactive in our approach to managing these stressors, helps to ensure that our crews and our organizations remain healthy. Session will cover common critical incidents encountered by air medical providers as well as describing how these incidents can affect the individual both immediately after the event as well as cumulatively over time. Also discussed will be the role of a Critical Incident Stress Management Team, key components of a successful team and need for structured training for the individuals on that team. As an industry, EMS has a suicide rate approaching 10 times that of the general population. While many stressors are unavoidable, being prepared for these stressors and proactive in our approach to caring for ourselves and our peers is as much our responsibility as the care we deliver to our patients.

224. Playdate in the Sandbox: Regional Programs Working Together in a Competitive Industry
Cory Oaks, MPA, FP-C, CCP-C, Classic Air Medical; Nathan Morreale, MBA, FP-C, NR-P, University of Utah AirMed; Brent Palmer, BSN, CCRN, Intermountain Life Flight

We all know the medical transport industry is an extremely competitive environment and the state of Utah is no different. After many years of flying over the top of each other we have come together and formed the Utah Chapter of the Association of Air Medical Services. What started as a means to increase communication has evolved into a safety committee, education committee, and best practice committee that has worked to improve patient care throughout the intermountain west. The presenters, all three board members from the local AAMS Chapter, and all three from different agencies, will discuss the evolution to what is now an organization comprised of all agencies within the state as well as those from neighboring states. Join us to learn how these collaborative efforts have made patient care safer, better, and allowed the different programs to “play nice in the sandbox”.

225a. Legal Spring Cleaning: A Checklist for Finding and Fixing Liability Issues Your Program is Ignoring
Gregory Cassis, JD, FP-C, University of Virginia Pegasus

Often we spend large amounts of time on small language changes in a policy or with far fetched hypotheticals. At the same time we ignore areas of more obvious concern in “plain sight.” This session will discuss how to spot these issues and provide solutions. Issues discussed will include protocol deviations that have become normalized, inequality in expertise that affects care, improper equipment for the patient populations served and quality assurance programs that aren’t confidential. Participants will learn how to identify when these issues have become risks and will learn how to approach finding solutions for the problems without massive expenditures or program overhauls.

225b. Does Your Performance Equal Your Perception?
Scott McClain, NRP, Nightingale Regional Air Ambulance

This session will touch on how most flight teams think they are the best! However have you personally spent any time at all the other flight programs? Most of us have not. That is why I am developing a “ride and share program” this unique program gives flight team members throughout the United States the ability to go and spend time with other flight programs, to ride with them, to talk about each others safety practices, to observe other teams training events, or Management team with only one goal in mind.to ensure your team’s perception of themselves truly equals their performance. The best part is. you don’t have to spend a dime! This program will be 100% funded by a private funding account. I believe that this program alone could change the lives of flight crew members and only improve the quality of care they provide while building a network of domination, not competition.

1445- 1545h

226. Child Abuse: How the EMS Report and Documentation Can Help Ensure an Abuser Is Convicted
Derrick Jacobus, MA, FP-C, NRP, MidAtlantic Medevac and Monroe Township Police Department

Did you ever respond to a pediatric emergency where the story just did not seem right, the pieces were not coming together, or there was an unexplained gap in the timeline? Trust your instincts. If you suspect something, even when there is not compelling supportive evidence, share and report your suspicions following your organization or state’s policy. Intuition is a valuable instinct; when the details do not add up, follow procedures to report suspicions of child abuse or neglect. When in doubt, report your concerns. Use common sense and good professional judgment. Most often, law enforcement investigators rely on the initial reporting for child abuse cases from medical responders in order to walk an investigation from beginning to end. EMS are the “eyes and ears” and see the environment the child is in, which makes them the ideal reporter. A “hunch,” to the call to the abuse hotline, to the vital, comprehensive documentation are all pieces which will lead to a conviction of the abuser. If one of these pieces are missing, it lessens the case against the abuser and makes the job for detectives more difficult. This lecture by a Federal Bureau of Investigations Child Exploitation Task Force Officer will discuss the details in these cases and why EMS plays a vital role in the investigation of child abuse.

227. You Want Me to Take a Reciprocating Saw and Do WHAT?
Christopher Galton, MD, NRP, FP-C; Jeremy Cushman, MD, MS, EMT-P, FACEP, FAEMS, Mercy Flight Central

This session will start with a description of crush physiology and the current best practices.  We will then highlight some of the analgesic and regional anesthetic techniques for these specific patients.  The session will round out with a discussion about field amputation and a description of our crush and impingement response program.  We will be using audience participation software with integrated case management questions throughout.

228. Trauma Care: More Than Just a Band-Aid
Rudy Cabrera, RN, CFRN, MSN, EMT-P; Joshua Cools, BS, FP-C, Memorial Hermann Life Flight

As trauma continues to be one of the leading causes of death, Memorial Hermann Life Flight would like to review the most comprehensive prehospital patient care for the injured victim. In addition to tourniquets and wound packing, the Life Flight team will review pelvic binders, JETT devices, REBOA and direct access to the operating room. Additionally, appropriate medication selection and ventilation techniques will also be discussed for hemodynamics and cerebral perfusion.

229. Shop Til You Drop: Why NOT to Helicopter Shop
Jason Haynes, RN, CFRN, NR-P, CMTE, MedCenter Air; Abby Walden-Peterson, MHA, CMTE, Atrium Health – Mobile Medicine

How stubborn is your local EMS agency in not doing what’s right for the patient? Encountering aviation dangers associated with helicopter shopping also resulting in delay in treatment during the ‘Golden Hour’ and family members being split up and transported to various tertiary care centers? Is it time to break up? Learn from three different scene calls, one county, and two flight programs.

230. Implementing a Shared Governance Model in an Emergency Transport Program
Scott James, MBA, RN, CFRN, NEA-BC, The George Washington University Hospital, Center for Trauma and Critical Care

Shared Governance is a model of nursing practice that is designed to integrate core values and professional practice to create quality care, nurse empowerment, and employee satisfaction and retention.  This session will discuss the implementation of shared governance in a transport business setting as it applies not only to nurses, but to all disciplines working in an emergency transport program.  Key topics will include: surveying the program for shared governance readiness, education of staff members, establishing a shared governance structure and setting ground rules, developing outcome-based expectations for staff, and using the governance structure for empowerment and staff retention activities.

231. Take a PAWS: Helping Each Other Heal: Peer Animal Assisted Wellness Support & CISD for Our Own PAWS = Peer Assisted Wellness Support
Debi Hastilow, RN, EMT-P, BSN, CEN, CMTE; Todd Bailey, BA, MBA, CMTE, MedFlight of Ohio 

Has your give a **** meter been pegged? We take care of others 24/7/365 days a year, but who takes care of us? A critical incident is any event experienced on or off duty that is outside normal experiences that produces stress.  These events can interfere with a crew member’s coping mechanism’s and therefore impact performance and sometimes safety.  This program utilizes best practices to assist in maintaining performance, special support and healing.  Come see how we developed a peer initiated wellness support team for our crews and actually had to utilize it months after it was implemented upon the death of a friend and fellow crew member. A therapy dog and a group of volunteer crew members bolstered spirits and encouraged comrades when and where needs arose, when the going got tough. The speaker will be accompanied by Ollie – therapy dog – to assist with presentation techniques and discussion. Peer Animal Assisted Wellness Support (PAWS) is a new canine support program that aids partners or those in need during and after traumatic incidents, promoting holistic healing and comfort. PAWS includes crew visits to relieve the daily stress’ of air and ground medical transport or dispatch, visits for partners and family members after traumatic events like injury, death, and provides grief counseling. MedFlight is also engaging a newly formed Critical Incident Stress Management Team (CISM) made up select partners who will participate in formal management to assist external flight teams, medical, fire, and law enforcement personnel during times of major incidents, disasters and loss of co-workers when requested. A critical incident is any event experienced on or off duty that is outside the realm of normal experiences that produces significant stress. These events can interfere with a person’s coping mechanisms. The new CISM team will respond to a critical incident, assist the person in maintaining performance in their duties, and when applicable, aid in facilitating contact with special support services.

232. How to Develop a Training Blueprint for Success
Jeremy Norman, BAS, FP-C, NRP; Allen Wolfe Jr., MSN, APRN, CFRM, CMTE, Air Methods Corporation

Training and Education are the cornerstones to maintain quality assurance across any type of work. At many medical transport programs the rational for training is best describe as “we have always done it that way” or “I don’t know why we are doing this”. A sound training blueprint sets the stage for success and guides the team to specific quality or operational goals. A training blueprint is a CAMTS best practice.

233. Hurricane Michael: Remote Coordination of a Disaster Response
Michael Wargo, RN, BSN, MBA, PHRN, CMTE, HCA Mission Health; Joseph Hill, RN, BSN, CFRN, CMTE; Marty Delaney, EMT-P, MBA; Brandon Thomas, EMT-P, CPA, Air Methods Corporation

Hurricane Michael was the third most intense Atlantic hurricane to make landfall in the United States.  It arrived at Mexico Beach, Florida as a Category 4 on October 10th and continued a destructive path while enroute to the coast of Georgia.  Gulf Coast Regional Medical Center was near the direct impact zone of the hurricane and required both pre-emptive and post land fall evacuation of patients from the facility as well as ongoing planning to address the health needs of the area.

233a. BPAP, Taking It To The Next Level
Joshua Piotrowski, NRP, CC-EMTP, FP-C, Erlanger LIFE FORCE

You transport bi-level patients daily, and you feel pretty comfortable with it. Do you feel comfortable changing making changes in their settings and are you confident what needs to be changed? Has your patient ever transitioned to being intubated because they “couldn’t tolerate it”? Was that transition because of their pending clinical pathway or was the ventilator not optimized for their success? Walk away from this lecture with the answer to these questions and understand the rarely utilized back menus to become a clinical expert with bi-level ventilation.

233b. How To Be A Patient Advocate Without Burning Bridges
Rachel Hollinger-Janzen, RN, BSN, CFRN, CCRN, CEN, Promedica Air and Mobile

Being a flight nurse or medic is a hard job. You need to be a jack of all trades and provide critical care thousands of feet in the air. In addition to all this you have to play nice; with doctors, nurses, fire departments you name it. How do we do what’s best for the patient when dealing with resistance to our plan of care from another medical professional? Is it possible to be diplomatic and courteous while still getting your point across? Can we be a patient advocate, do what’s best for the patient, and still build relationships with the sending medical professionals rather than burn bridges? This session addresses all of these topics and provides tools and scenarios to deal with some of these difficult situations.

1600- 1700h

234. Heavy Lifting: Size Doesn’t Really Matter: Safe And Efficient Bariatric Transport In The Air And On The Ground
Bryan Peterson, RN, BSN, CCRN, CFRN, CMTE, STAT MedEvac

Bariatric patients create unique challenges for transport teams. Many customers are left struggling to care for these patients when the transport services refuse to move them or are not capable of safely transporting bariatric patients to definitive care. Maintaining the commitment to our customers by assuring we will safely transport any patient they ask us to the bariatric population has increasingly challenged us to find more efficient ways to provide safe and rapid transport services. By changing the approach to every aspect of the way we triage, plan and move bariatric patients we have created a process that treats these as the specialty transports they truly are. The implementation of bariatric transport kits at our helicopter bases has standardized the process and reduced the workload and risk of injury to the transport crews. We will discuss the systematic approach taken to mitigate the risk and assure the safety of the patient and crews by changing the process and by implementing the use of air assisted transfer devices.

235. Managing Severe Obstructive Respiratory Failure
Matthew Roginski, MD, Dartmouth Hitchcock Advanced Rescue Team

We will discuss the pathology and physiology behind severe obstructive respiratory failure to understand principles behind ventilator management. Starting with the pathology of asthma and COPD we will transition to the physiology of airflow obstruction including discussion of resistance and compliance, expiratory flow limitation, dynamic hyperinflation, and effect on respiratory rate on lung zones with different time constants. Finally, we will discuss strategies of ventilator management and commonly encounter problems including progressive hypercapnia, high airway pressures, inspiratory flow patters and improving alveolar minute ventilation.

236. Sick, Not Sick, BS, OS!!!  Cognitive Biases as Applied to Patient Assessment
Dana McDonald, NRP, CCPM, FP-C, I/C, Air Evac Lifeteam

This topic explores the process by which we make decisions and inadvertently allow our brains and patterns of thinking to get in the way of making patient care decisions.   Case studies and an interactive presentation will be utilized to demonstrate how each of the biases affect patient assessment, treatment, and outcomes.

237. OSI-HEMS: It’s Not How Safe You Fly, It’s How you Fly Safe
Ira Blumen, MD, FACEP, University of Chicaog Medicine

Vision Zero must be our ultimate objective, but it is more than not having an accident. It’s not how safe you fly, but it’s how you fly safe. While it may never be possible to prevent all helicopter EMS (HEMS) accidents, we may, however, be putting our crews and patients at unnecessary risk if we miss opportunities that could reduce the number of accidents and save lives. Since 1972, there have been over 340 HEMS accidents in the U.S. – over 220 since 1998. Over one-third of the accidents resulted in one or more fatalities. Over a 20 year period, these accidents have killed more than 160 of our colleagues and 21 patients whose lives were entrusted to us. This presentation will review the findings of the most extensive HEMS safety research to date. During this multi-year study, more than 40 air medical and aviation professionals spent more than 13,000 cumulative hours to analyze 144 HEMS accidents. The team reviewed nearly 3,000 electronic NTSB documents containing more than 12,500 pages and pictures. Following this extensive root cause analysis, the research group identified interventions and mitigating factors that may have prevented these accidents. Finally, objective recommendations will be made to provide decision-makers with an opportunity to determine how and where to make safety-related improvements that may prevent future accidents and save lives.

238. A Quarter Century of the AMTC:  Quotes and Learnings from 25 years of Educational Sessions
Andrew Hawk, MD, CareFlight Air & Mobile Services

Beginning in 1994, I have annually attended the AMTC and the respective educational sessions.  Over the years, the educational sessions have provided learning opportunities that I have compiled via speaker quotes.  In addition, speaker quotes from the annual AMPA pre-conference have been included.  These quotes have been applied as learning points and often expanded to learning topics for our program’s educational system. Taken in total, they have changed the day to day clinical care that our critical care crew members provide.

239. The Night I Almost Jumped: EMS Culture and EMS Suicide
Matthew Giacopelli, BS, NR-P, Paramedic, York Regional EMS

A look at the reasons why an EMS provider may contemplate and attempt suicide. Case studies of EMS providers who have completed suicide will be presented. The extent of the problem in EMS, and the stigma of mental health that goes along with it will be discussed. The audience will then learn about coping mechanisms and steps to take toward resiliency.

240. Surviving an Incident II: Tactics to Orchestrate the Rescue
Michael Shaffer, BSN, RN, PHRN, NRP, CFRN, CMTE, STAT MedEvac

In the first session, Surviving an Incident – Tactics and Strategies in the Wild (2018), I discussed tactics for survival. In this session, I will build upon the survival component by discussing how to develop a special operations team.  In today’s world, the team needs to be trained in search and rescue, wilderness medicine and tactical medicine.  The team can be faced with many tasks; including searching for a missing air medical crew, treating survivors of a wilderness mishap and participating in a tactical situation.    The goal is to provide insight on the preparation phase. I will discuss the different missions the team may be faced with and offer examples of training modules that will encompass all components of your organization.  We will explore various training options, to include classroom, small group practical sessions, and wilderness sessions, as well as to be compliant with the 10th edition CAMTS standards.

241. When the Patient Took too Many “Blue” Pills: Toxicology Emergencies
Christian Grant, BS, NRP, C-NPT; Jennifer Vieira, CEN, CCRN, CFRN, CNRN, EMT-B, Boston MedFlight

This lecture is to discuss four different toxicology emergencies in a case study format.  Speakers will present four cases and review immediate interventions required as well as assessment skills to rapidly move forward with being able to reverse or eliminate agent in order to stabilize.  Speakers will review imaging, lab values, interventions to eliminate the suspected toxin, airway management, medication administration, as well as EKG and hemodynamic stabilization.  Speakers will also discuss use of consults such as toxicology, cardiology, and the use Poison Control Center. Speakers will discuss briefly on each topic as follows Serotonin Syndrome, OD using Beta-Blockers/Calcium Channel Blockers, Anticholinergic Syndrome, ASA, amphetamines, TCDs, and cocaine. The talk is given with the intent to give listeners better skills and awareness in recognizing a possible OD to prescription and non-prescription medications.