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Which is better: letting pain and muscle spasm immobilize an injured spine or doing it with the same tools we’ve used for decades?  Should hypothermia begin DURING the arrest?  Do response times make any difference whatsoever in patient outcomes?  The answers to these and other hot EMS topics were intensely debated in Dallas last week at the 14th annual Gathering of Eagles, EMS State of the Science Conference.

The U.S. Metropolitan Municipalities EMS Medical Directors Consortium, aka Eagles Coalition, is comprised of EMS Medical Directors from a couple dozen of the largest US cities 911 systems as well a handful of federal agencies.  They meet in Dallas each February to share cutting edge research, lessons learned, and generally advance prehospital care.  The conference is open to physicians, nurses, EMS providers, fire officers, researchers, and virtually anyone else with an interest in the science of EMS.  Their website is http://gatheringofeagles.us.

Trends in EMS are interesting, and the cutting edge was revealed in Dallas last week.  It may well be preferable, and better for patients, to immobilize only people unable to physiologically splint themselves (unconscious, altered, or with neuro deficits).  There are trends suggesting that the earlier hypothermia is initiated, the better outcomes following cardiac arrest.  Traditional measurements of response times (i.e., arrive in 8:59 at least 90% of the time) seem unrelated to outcomes and need close scrutiny to determine when, if ever, time responding truly affects patient outcomes.  Drug shortages are affecting EMS in a big way across the U.S.  Action is needed to assure medications necessary for prehospital care don’t dry up. Interestingly, as reported on the FireEMS page of Fire Engineering, this problem affects only the United States.  Medics and EMTs elsewhere have all the meds their patients need.

The jury is in on tourniquets: when used properly, they are safe and effective for civilian EMS use.  As health care financing evolves, EMS providers need to evolve their interactions with “frequent fliers” to decrease transports, working with hospitals and insurers to be reimbursed for novel home visits that lessen hospital readmissions.  Terminating field resuscitation is an essential skill that needs work.  Hauling unsalvageable patients in to the ED only to rack up massive health care bills is wasteful and inefficient: times are changing.

Hop on the Eagles web site for their soon to be posted copies of presentations from the 2012 conference.  Keep an eye out for Eagles 2013.  This is where EMS and Science all come together.

Mike McEvoy

EMS Editor - Fire Engineering

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