*subject to change

0945 – 1045h

301. Critical Care for People with Special Needs
Bryon Denton, MSN, RN, CFRN, PHRN, Air Methods Corporation

When patients that have intellectual disabilities or special needs require critical care transport, crew members are often tense attempting to understand the abilities and disabilities of the individual. This session will provide an overview of the most common types of developmental/intellectual disabilities. The session will also cover the different legal issues regarding decision-making and consent for patients with developmental/intellectual disabilities. Basic tips and strategies to help the transport clinician communicate with patients with disabilities and methods to alleviate anxiety in both the patient and caregiver are included as well. This session will also include basic techniques for assessing individuals with special needs and common abnormalities found in specific conditions.

302. Don’t Leave Me Breathless: A Proactive Approach to Pediatric Reactive Airway Disease/Asthma.
Samantha Gee, MD, FAAP; Caleb Carmin, RN, CCRN, CMTE, Nationwide Children’s Hospital

Asthma is one of the most common chief complaints for children presenting to the emergency department, often requiring interfacility transport to the nearest tertiary care center. Transport clinicians have the ability to rapidly improve their patient’s clinical status or let the disease progress. This lecture will demonstrate the effectiveness of prompt, aggressive asthma treatment through protocol implementation and case presentations. The days of “we just gave an aerosol” are history.

303. Mechanical Chest Compressions in Flight: Are We Doing Better?
Dean Hoffman, CEP, FPC, Guardian Air Transport

A follow up to 2018 presentation on chest compressions in flight with a review of Guardian Air Transports implementation of a compression device at two high volume bases with review of cases and first hand experiences.

304. Survival Training – A Different Approach
Chip Henderson, CMTE, MTSP-C, Nationwide Children’s Hospital

Many times, EMS survival training is taught with the focus on how to survive in the wilderness for extended periods. The trainers talk about things like the “Rule of Threes,” finding and purifying water, building shelters and starting fires. While these skills are important and have benefit, in this day and age of satellite and GPS tracking systems, the chances that an EMS flight crew member will find themselves needing to survive in the wild for more than a few hours is slight. When a Communications Center loses contact or tracking of an EMS aircraft, steps are being taken to locate the aircraft and/or the team on board within minutes. This session will focus on steps that should be taken before a crew gets into a survival situation and more importantly avoiding a long-term survival situation by focusing on actions crew members can take to aid in getting rescued as soon as possible.

305. Caring for the Caregiver: Building Resiliency through Yoga, Mindfulness and Meditation
Marie Longo, ACNP-BC, FNP-C, CNP-APRN, Metrohealth Medical Center

Flight crews and first responders are faced with tragedy and death on a daily basis.  This leads to a stress response within the body. Over time these stresses can build up affecting the individual both mentally and physically.   This session will discuss tools to increase resiliency with a focus on Yoga, Mindfulness and Meditation.

306. What Got You Here Won’t Get You There 2
Cody Winniford, BA, LP, CCP-C, FP-C, PHI Air Medical

Merely being “qualified” to be a leader often leaves much to be desired as far as effectiveness as a leader. However, many people are selected for leadership positions because they “meet the qualifications” or check the boxes on a job description. We must stop defining leadership through styles and platitudes and help people to BECOME the leaders they were meant to be by giving them tools to codify beliefs and behaviors into a leadership philosophy that ENABLES them to lead across all professional, cultural, and generational boundaries. This presentation will provide a background in the need for new approaches to leadership development and will provide a 5 step plan and toolkit for developing an empowering personal leadership philosophy.

307. Blood In The Head From The Other Side Of The Bed: A Story About The Worst Headache Of My Life
Zachary Roper, RN, CCRN, NR-P, FP-C, St. Luke’s University Health Network

This session begins with a review of neurological anatomy and physiology, transitions into the pathophysiology of arteriovenous malformations and intracranial hemorrhage, and finishes with a case study about a Flight Paramedic turned Neurological ICU Nurse who became a patient in the ICU that he worked in secondary to an AVM rupture. CT scans, MRI’s, Angiograms , and applicable practice pearls will be included in the session.

307a. Flight Center Jeopardy!
Jared Velez, CFC, EMT-A, University of Utah AirMed

Communications Specialists are tasked with being knowledgeable on several different disciplines. A good Communications Specialist should be well rounded in a hand full of areas that might not be their specialty. The participants will be challenged with this interactive question and answer game centered around their industry knowledge.

307b. Self Destruct Sequence Initiated: Demystifying Sepsis
Joshua Piotrowski, NRP, CC-EMTP, FP-C, Erlanger LIFE FORCE

You’ve treated Sepsis hundreds of times, sometimes with success and sometimes without, but have you ever fully understand the pathology behind it? Our body is complex and continually attempting to repair itself, but sometimes those attempts can be self-destructive. Walk away with a clear understanding of the pathology of sepsis and why it causes the devastation that it does. With this newfound appreciation, you’ll be able to more accurately treat your septic patient thanks to your understanding of the process.

1000 – 1200h

308. It’s So Real it Will Make You Squeal!! Hands on Anatomical Cardiopulmonary Lab
Sharon Purdom, BSN, CFRN, EMT, Med-Trans Corporation

During this ‘hands on’ lab, the participant will gain a better understanding of anatomy and physiology using discarded hog hearts and lungs. Numerous procedures (intubation, ETC, LMA, needle cric, surgical airway, retrograde intubation, intubation aids, needle decompression, coronary artery injection/caths, right vs left MIs and pericardialcentesis) will also be reviewed and performed. It will be limited to the first 30 wanting to participate (pre-registration NOT required)and unlimited to observers. EVERYTHING will be provided for the participants.

1100 – 1200h

309. ECMO, Impella, Balloon Pumps, Let’s Fly! A Nurse Driven Approach to the Mechanical Circulatory Support (MCS) Patient Transport
Kathryn Davis, RN, BSN, CCRN; Kathleen Stoddard, RN, BSN, CCRN, SE-ECMO, University of Utah AirMed

It’s 2:30 in the morning, you’ve been called to transport a 45 year old male from 2 states away that is post cardiac surgery, is in heart failure and is unable to wean off of bypass. The balloon pump they placed isn’t helping and they have now cannulated VA ECMO. The patient is intubated, has 3 chest tubes and is reported to be on 9 drips. The sending facility needs you to transport the patient to the nearest ECMO specialty hospital.  Your team consists of a flight nurse, a flight paramedic, a CVICU specialist RN and a respiratory therapist. Are you prepared for this transport? Is your program ready for these transports? Do you have the skill mix you need?  Do you have all of the equipment you need?  If your answer to any of these questions is no, then come let us show you how our program established an interdisciplinary team for these transports and how you can build your own. This team ranges from mechanics, pilots and transport personnel all the way through a team of cardiothoracic surgeons.  With over 35 specialty MCS RN’s and our transport team, we have successfully completed over 100 MCS specialty transports and are continuing to see positive outcomes in these patients.

310. Aortic Emergencies:  It’s Only the Biggest Vessel in the Body…
Christopher Galton, MD, NRP, FP-C, Mercy Flight Central; David Lyons, MD, University of Rochester School of Medicine and Dentistry

This session will briefly review the anatomy associated with the aorta to set the stage for building an understanding of the hemodynamic implications of the very different physiologic problems with various aortic emergencies.  He will follow this with the highlights of the air medical management principles and current GAMUT data points for these patients.  Dr. Galton will discuss the evidence behind some of the novel medications for blood pressure and heart rate control.  He will finish up with the surgical treatment options for these patients.  There will be audience response software used throughout the presentation that will specific case management options.

311. Cabin Pressure: Agitated Delirium in the Sky
Derrick Jacobus, MA, FP-C, NRP, MidAtlantic Medevac and Monroe Township Police Department

On occasion, Law Enforcement, EMS, and Fire personnel are dispatched to the scene of a medical and/or criminal incident that involves a person who is reportedly out of control. Upon arrival on the scene, the emergency responder may be confronted by a person who is violent, highly agitated, irrational, partially dressed, and resists physical restraint with surprising strength. These subjects could be suffering from a “unique syndrome” commonly referred to as Excited Delirium. A person suffering from Excited Delirium (ExDS) may have taken an illicit drug, suffering from a mental illness, or both. This combination of factors and the persons irrational conduct could lead to a very violent confrontation. Significant injuries and/or death to both the officer and ExDS subject are possible outcomes. When this happens at 1,000′ it creates for a unique problem – both for the patient and the crew. First responders need to recognize the fact that these people are suffering from an acute, potentially life threatening medical condition. In addition to this, remorse, normal fear, understanding of surroundings, and rational thoughts for safety are absent in such subjects. Join us for a real life case study of a patient who placed the crew and himself in immediate danger and how the crew handled the incident… Would you have done the same?

312. How Do You Manage a Fleet of Helipads? From Landing on the South Lawn to landing a Helipad Safety System
Martin Fisher, Atrium Health/MedCenter Air; Michael Middleton, Bayards International

The design and development of a helipad monitoring and safety system. The system helps to monitor multiple locations while maintaining the overall safety of the fleet.

313. 911 Buddy Check: Breaking the Stigma of Mental Health
Daniel Mills, FP-C, NR-P, Air Evac Lifeteam/911 Buddy Check Project

A recent study found that more firefighters and police officers died by suicide in 2017 than all line of duty deaths combined. The USA today reported 103 firefighters and 140 police officers died by suicide in 2017 alone. This is just with a presumed 40% reporting. The 911 Buddy Check Project aims to change the stigma of mental health, while bringing awareness to suicide and the issues plaguing the emergency services field. Are you ok? Simple words that often go unspoken. We are reaching pandemic level of suicide, mental health and substance abuse amongst emergency services workers. The time is now to stand up and make a change. The 911 Buddy Check Project is removing the mask and getting real, raw and relevant about mental health and dismantling the deadly stigma associated with not asking for help.

314. “Team Dynamics”: It’s More Than a 7:48 Video…
Daniel Holmes, AA, NRP, FP-C, EMSI, JeffSTAT

Working in teams is a fact of life. Every day each of us is called upon to work in conjunction with others in both our professional and personal lives. The functionality of these teams impacts corporate culture, patient care, safe operations, base morale, job satisfaction, and overall success of the organization. Additionally, as Millennials and iGen’ers continue to enter our organizations, the expectation of working in teams increases amongst our workforce. We’ll discuss the steps to building a successful team and the stages all teams move through as they grow. Also, we’ll learn how to use “Team Building Exercises” to identify the stage our team is in, and how we can help them progress to the next stage. Conflict within teams is natural and productive, but what do we do when unhealthy conflict arises? Finally, we’ll review some essential skills for leading innovative teams.

315. Stories from Florence: Are You Personally Ready to Work a Major Disaster?
Sara Thomas, CEN, EMT, RN; Bethany Hart, EMT-P, CCEMTP, NHRMC AirLink/VitaLink Critical Care Transport

Hurricane Florence made landfall September 13, 2018 at Wrightsville beach only 8 miles from our major medical center.  Causing over 18 billion dollars of damage to our region and cutting off the greater Wilmington area from the rest of the state for days with flood waters.  How would knowing that you were reporting for a life changing storm affect you as a provider?  Stories from the storm looks from the view point of providers from NHRMC’s AirLink/ VitaLink program as they experienced “The storm of a lifetime.”  Are you prepared to provide care with few resources and intense emotional stress?

315a. A World Upside Down: Transporting Prone
Michael Boone, BSN, RN, CFRN, CCRN; Bryan Boone, BSN, RN, NREMT, CFRN, CEN, IU Health LifeLine/Heavy Lies the Helmet

Prone positioning in the presence of Acute Respiratory Distress Syndrome (ARDS) has been a controversial topic over the years due to variable results. Recent studies, however, have shown a significant decrease in mortality rates. These findings suggest that prone positioning has beneficial effects, and should therefore be performed in most critical care settings. Increased frequency of this therapy has led to providers being called to transport these patients; often times for ECMO support at the receiving facility. But can transport providers safely transport these patients in the prone position? We will review ARDS, the specific benefits of prone positioning, and how we can effectively perform these transfers.

315b. Bridging Communication Gaps in Inter-Facility Transports
Lisa Owen BSN, RN, CRN; Andrew Hynes, MS, BSN, RN, CCRN, CSC, University of Rochester Medical Center

Inter-hospital transports are inherently more complex than they have been in the past. With increasing patient acuity and complexity, there is currently no standardization of handoffs outside the acute care hospital. With a standardized transport team tool kit, patient care is not being compromised and in turn patient care is being optimized. Better communication with the complete interdisciplinary team provides optimal transition in patient care. The ability to have a specialized nursing staff drives a seamless transition of acutely ill patients to a higher level of care.

315c. Pull Ups in the Kitchen: Setting Goals and Realizing Potential in a Stressful Environment
John von Rosenberg, MA, FP-C, Vidant EastCare

The highest mountains in the world are not summited spontaneously, but rather after years of mental and physical preparation. Providing high quality patient care in an aircraft presents the need for similar preparation. This talk will discuss the art and necessity of establishing goals, both short-term and long-term, as a means of accomplishing daily tasks and realizing long-term dreams. The air medical industry is fraught with high stress, time-sensitive situations in which the well-being of others depends upon the ability of the crew to perform in spite of environmental challenges. Small, attainable goals lead to success, which breeds future success. This presentation will cover the neurophysiology of stress, stress preparation, and stress performance as well as methods of managing and harnessing the stress response to improve the quality of patient care. Potential pitfalls in coping mechanisms will be identified along with strategies to prepare for negative effects of constant exposure to stressful situations. Mindfulness, resiliency, and the importance of mentors will be discussed along with methods of creating personal strategies for planning for the future and improving performance on a daily basis. This talk will review evidence-based literature regarding stress, performance, cognition, and goal-setting. Audience members will develop directly applicable skills and mental practices that will positively impact practice for patients and crews.

1330 – 1430h

316. HELLP Me!  Are You Ready for an OB Emergency?
Elizabeth Lohr Scott, BSN, RN, CCRN, CFRN, NRP; Jermaine Clayborne, BSN, RN, CCRN, CFRN, FP-C, C-NPT, University of Virginia

Obstretrical transport is a high stakes, low volume event where you are treating two patients in one.  This session will review common obstetrical emergencies, discuss laboratory values and vital signs, review fetal heart rate and tocometer tracings and introduce evidence based interventions for improving outcomes for mother and baby.

317. Little Hearts. Big Problems: Critical Congenital Heart Disease on Transport
Nathan Lepp, MD, MPH, PHI Air Medical

Infants with critical congenital heart disease (CCHD) are often the most ill infants that neonatal transport teams must care for. Their complex anatomy and physiology pose several challenges. Using a case-based approach and audience response system, attendees will leave the session with a better understanding of critical congenital heart disease, its presentation, its challenges, and the skills to care for them on transport.

318. Trauma, Just Do It: Embracing the Complexity of Simple
Chris Hartman, MD, FACEP, Franciscan St. Francis Hospital

A simple approach to the multisystem trauma patient is not a simplistic approach. A simple approach does, however, free the provider’s mind of unwanted clutter, enabling us to more effectively treat critically injured patients while our adrenaline is surging. With great appreciation for complex pathophysiology, Dr. Hartman’s session will distill a glut of algorithmic art into a simple approach applicable to any trauma patient.

319. The Wizard of Oddz: A Statistical Analysis of HEMS Accidents and Risk
Ira Blumen, MD, FACEP, UCAN, University of Chicago Medicine

Since 1998, the HEMS community has averaged over 11 accidents and 4 fatal accidents every year. In one year alone, our accidents took the lives of 29 people. Despite the opportunity for lessons learned, new policies, practices and recommendations from various sources, we continue to see HEMS accidents and fatalities every year and we continue to have more questions than answers. Is there accurate data on HEMS accidents, accident rates and fatal accident rates? Do you have the answer? Does your program? Your aviation operator? Our community? The FAA or the NTSB? Sadly, one thing is certain there will be more accidents. What are we doing about it and what are you doing not be the next chapter of this tale. What are you doing to avoid being the next accident? This presentation will provide a statistical analysis of HEMS programs, the number of helicopters, total flight hours and annual accidents. Most important, the presentation will provide the most accurate calculation of HEMS accident rates and fatal accident rates available. The presentation will conclude with an overview of numerous risk management strategies that could reduce the number of accidents and improve overall HEMS safety.

320. Your Critical Incident Stress Program: Does It Work?
Phil Ward, NRP, FP-C, Travis County Emergency Services/STAR Flight

With increased attention to mental health issues and PTSD in EMS, Fire and Law Enforcement, many organizations have implemented CISM and CIRT programs into their Employee Assistance Programs.  Does your organization have a program in place?  What does it look like and is it effective?  Do your employees have buy-in?  We will share my story, the CISM strategy offered post-incident with my previous organization, and then share PHI Air Medical’s CIRT model and how the team was able to help me years later.

321. TQM: A View From the Bottom
Leslie Rostedt, BSN, BA, AAS, RN, CEN, EMT-P, NHRMC AirLink/VitaLink Critical Care Transport

Total Quality Management is a theory typically utilized by management and presented from a leadership perspective.  Our system includes general staff members as part of this team and provides a unique perspective to Total Quality Management. This presentation will show how including staff members in the team improves the overall process while avoiding pitfalls that would occur in a management only committee.

322. Air Medical Transport in Recent Natural Disasters
Justin Fairless, DO, NRP, FACEP, University of Texas Southwestern Medical Center

Review of Air Medical Transport (rotor wing and fixed wing) during recent United States Natural Disasters.  Concepts of integration of private air ambulance services, local and state governmental agencies, and federal agencies will be discussed.  Examples of response to recent disasters, including Hurricane Harvey (2017) and Hurricane Michael (2018) as well as the Camp Fire (2018) will be discussed.  Future expansion to include a more organized approach to disaster preparedness and response will be included in the discussion.  National Guard, State Guard, FEMA / DHS, NDMS HHS, as well as Local and State Fire/EMS/Law Enforcement integration with public and private air medical transport agencies will require a coordinated effort to improve patient movement before, during, and after widespread national disasters in the United States.

1445 – 1545h

323. What To Do If Warm and Blue? A Pediatric Case Study On Acquired Methemoglobinemia
Andrew Baxter, EMT-P; Amanda Bash, RN, BSN, CCRN, EMT, Cleveland Metro Life Flight

Why so blue?  What is blue baby syndrome? Explore this with a critical care ground case study of the pediatric patient with acquired methemoglobinemia. We will discuss how to make this diagnosis and what it means.  Review the etiology, assessment, treatment and its implications in critical care transport.

324. Guiding Resuscitation with Point of Care Ultrasound
Benjamin Smith, MD, Carolina Air Care

Ultrasound is already standard practice in most emergency departments and ICUs.  It is also becoming much more widely used in the prehospital and critical care transport environment.  This lecture will explore how point of care ultrasonography can be used to guide resuscitation of critically ill and injured patients.  Using multiple case presentations, the lecture will show how point of care ultrasonography can provide critical diagnostics that affect medical decision making and will cover the current research guiding prehospital and critical care ultrasonography.

325. Complications! Case Presentations of Patient Deterioration
Kevin Collopy, BA, FP-C, CCEMT-P, NRP, CMTE, NHRMC AirLink/VitaLink Critical Care Transport

Sometimes, even when a protocol is followed, patients deteriorate. Every medical procedure comes with risks of complications; when complications do occur, patients suffer. While complications don’t mean someone made a mistake, its easy for a clinician to doubt their own care after the complication occurs. This presentation discusses several common prehospital and critical care transport interventions, the known complications, and their evidence based frequency. After presenting the data behind the complication rates of these common interventions, you’ll hear about three actual cases where things went wrong: hypotension following rapid sequence intubation, intracerebral hemorrhage following fibrinolytics, and respiratory arrest following analgesia and sedation. Hear how clinicians managed their patient’s complications and how structured support was provided following each complication to help support the involved crew members to help improve the care of the crew members and their entire system.

327. When YOU Become the Trauma: Developing Your Own PAIP
Tammy Chatman, BS, CMTE, Flight for Life Transport System

Every hospital, air and ground medical transport programs as well as first responder agencies has or should have a Post Accident/Incident Plan (PAIP) that they follow in the unfortunate event of an incident or accident. What about you? Do you have your own personal PAIP or do you assume that “They will take care of you?” What does that mean? Being “taken care of” means different things to different people. At the end of the day it is you who is ultimately responsible for your safety and well being. Teenagers have an attitude that nothing will ever happen to them; they are invincible. Many EMS providers think this same thing; bad things happen to other people and those are the people I take care of. It is this attitude that causes us to put planning for the unthinkable on the back burner of our lives. We forget about practicing personal responsibility for ourselves and those we love. If you are involved in an incident or accident and suffer injuries that prohibit you from doing the job you love, short or long term, what will you do? Have you done your homework so that you are not forced into financial ruin? Many of our colleagues choose to ignore pre-planning for life’s unexpected challenges like these. The reasons vary but a lack of preparation can be a recipe for long term disaster to you and your family. Whether you are new to air medical transport and EMS or have been in the industry for many years, this presentation has information that will guide you in developing your own personal PAIP.

328. Power and Authority, Leadership Lessons from the Ground Up
Daniel Nayman, MBA, NRP, FP-C, WakeMed Mobile Critical Care; Cory Oaks, MPA, NRP, FP-C, CCP-C, Classic Air Medical

The skill of management and the art of leadership in the science of medicine. Regardless of the title held, supervisor, paramedic, manager, educator, nurse, director, president, orientee, vice-president, EMT, or CEO, our responsibility, our entire job, is to achieve results and reach goals. As our responsibility grows the authority we are granted to help us achieve those results tends to grow as well. The power to achieve results, however, isn’t based on the position you hold or granted with a promotion, it is achieved by the inspiration and trust that you instill in others. In this discussion we will review critical leadership traits and practices, and how to implement those practices to achieve greater organizational and individual success.

329. Impella in Flight: Postpartum Case Study
Cathleen Vandenbraak, BSN, MBA/MHA, CEN, CCRN, CFRN; Alex Shehu,AAS, NRP, CCEMTP, FP-C, JeffSTAT

Impella transports are a recent addition to the critical care transport field in our region. In the last several years JeffSTAT has transported many patients with an Impella device in place. One recent case was a postpartum patient home just a few days with her newborn. This case study will review the initial care at the referring facility and follow through the care in flight. In hospital and transition out of hospital care will conclude the presentation.

1600 – 1700h

330. What to Expect When You’re Not Expecting
Bobbie Carlisle, RN-C, NICU, BSN, RN; Nicole Milne, BSN, CFRN, RN, University of Utah AirMed

Neonatal Resuscitation can be difficult if you are not familiar with the steps. We will break down each step and explain what is occurring in the neonate during each step. We will discuss the new NRP guidelines. We will do a case review of an adult/pediatric RN that had taken NRP 3 weeks prior to responding to a call of a home birth and discuss what steps she felt were most beneficial.

332. Unraveling the Mystery of Sodium Bicarb:  Understanding How It Works and Implications for Clinical Decision Making
Kimberly Smith, RN, MSN, CFRN; Roderick Wold, RN, ND, CNS, CCRN, AirLife Denver 

Sodium Bicarbonate is a staple that all critical care clinical providers have access to through their stocked medications.  Do we really understand how sodium bicarbonate works and when it can be helpful vs. harmful to our patients?  Should we give bicarb for DKA, toxic ingestion, hyperkalemia, or lactic acidosis?  This lecture will take a deep dive into this common medication to help the transport provider make an informed decision regarding the use of sodium bicarbonate. Come get involved in an open discussion of clinical scenarios where sodium bicarbonate may be beneficial as well as situations where the administration of this medication may not be the best choice.

334. When the Help Needs Help
Dana Clarke, RN, BSN, EMT-P, Houston Physician’s Hospital

Hurricane Harvey devastated the city of Dickinson. There were numerous paramedics and firefighters stranded, both at the station AND in their homes, unable to get in or out to help neighbors, their community OR themselves.It was a most HELPLESS feeling. We will discuss those feelings, how to prepare for possible disaster and how to combat those feelings of helplessness in non-controllable situations.

336. Over-Triage of Critical Care Transport Helicopters: A Failure Mode and Effects Analysis
Robert Grabwoski, DNP, APRN-CNP, AGACNP-BC, CPNP-AC, CEN, CFRN, CCRN, CMTE, EMT-P, Metro Life Flight

Over-triage is a problem many critical care transport programs must deal with. This Failure Mode and Effects Analysis, a quality improvement study, investigated the human-systems factors influencing interfacility helicopter over-triage, and their downstream effects. During this session, we will discuss how this QI study was performed, what factors were found to be the leading influencers to over-triage, and what downstream institutional, administrative, and other effects were discovered.