NAEMSP 2015 in New Orleans: Drs. Nick Reinhart, Matt Smetana, Brandon Bleess, Kurt Bloomstrand, Matt Jackson and Ashley Huff (photo courtesy of Dr. Nick Reinhart).

Topic: Ballistics and Field Amputation
Location: Dr. Wipfler's house

Residents from the UICOMP Emergency Medicine EMS Track participated in a ballistics and field amputation training conducted by Dr. Wipfler.  An understanding of ballistics is important in the Emergency Department as we see these injuries frequently.  The ability to perform a field amputation is important for any physician engaging in EMS Medical Direction or participating with a disaster Emergency Response Team.  Residents used a deer carcass donated for the training to learn how different caliber rifles and handguns cause injuries.  They then learned how to conduct a field amputation including preparing a scene, applying tourniquets, using sedation and performing the amputation.  The residents compared the use of reciprocating saw, Gigli saw and .22 rifle for their efficiency and quickness in an amputation.  The Gigli saw was determined to be both the quickest and cleanest tool to use for this procedure.

• EMCrit: Prehospital Amputation
  
• Bruner D, Gustafson CG, Visintainer C. Ballistic injuries in the emergency department. Emergency Medicine Practice. 2011; Dec.
  

Ashley Huff, PGY-3

Topic: Prehospital Advanced Airway Placement and Cardiac Arrest: Media Management
Location: Dr. Jackson's house


Residents discussed the pros and cons to prehospital advanced airway placement in the literature and determined that with appropriate training, it can be beneficial, but if BLS skills are sacrificed for airway placement, it can be detrimental.  PAEMS is currently working with local agencies to increase training opportunities for intubation to improve success rates for intubation in appropriate situations.  Dr. Jackson then gave a lecture on skills for interacting with media as an EMS Medical Director.

• Airway management in cardiac arrest: on size fits all?  Matthew Prekker, University of Washington
  
• EMCrit Podcast 125 - The new intra-arrest form SMACCgold
  
• Hanif MA, Kaji AH, Niemann JT. Advanced airway management does not improve outcome of out-of-hospital cardiac arrest. Acad Em Med. 2010; 17(9):926-31.
  
• Hasegawa K, Hiraide A, Chang Y, Brown DF. Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. JAMA. 2013; 309(3):257.
  
• Wang HE, Balasubramani GK, Cook LJ, Lave JR, Yealy DM. Out-of-hospital endotracheal intubation experience and patient outcomes. Annals of Em Med. 2010; 55(6):527-37.
  

On Sunday, September 28th, UICOMP emergency medicine residents and medical students attended an active shooter mass casualty simulation at Northwoods Mall.  Peoria Special Response Team, Central Illinois Emergency Response Team, Peoria Police Department, Peoria Fire Department and AMT took part.

Residents observed the simulation with leaders from Peoria Fire, AMT, and Peoria SRT.  Kyle Brown, PGY-2, then participated as the hostage taken during the second part of the simulation.  An abandoned house near the mall was used for the hostage negotiation.  Kyle found the experience to be very eye-opening.  He was impressed by how well the negotiator and Peoria Special Response Team controlled the situation and rescued him.

Following the Aurora, Colorado movie theater shooting and Sandy Hook Elementary School shooting, it became clear that we needed a new way to respond to active shooter mass casualty incidents.  Representatives from law enforcement, fire, prehospital care, trauma care, and the military convened in Hartford, Connecticut in April 2013 to hammer out the details.  What they came up with was a multi-tiered approach to managing these situations: http://www.acep.org/disaster/.

Ashley Huff, PGY-3

Residents discussed the use of prehospital spinal immobilization and how it has changed over time.  Using a literature review, the residents determined that backboards are useful in vehicle and terrain extractions but show minimal benefit for long transports.  They also determined that cervical collars are useful in unconscious or altered patients, or those with neurologic deficits, but are not as useful in neuro-intact patients who were ambulatory on-scene.

EMS World: The Evidence Against Backboards by Dr. Bledsoe

NEXUS, the study:
Hoffman, JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. NEJM. 2000; 343(2):94-99.

NAEMSP Position Statement on Spinal Immobilization

Wash U-STL Pilot Study 2009 on Prehospital Spinal Immobilization
Engsberg JR, Standeven JW, Shurtleff TL, Eggars JL, Shafer JS, Naunheim RS. Cervical spine motion during extrication. Journal of Emerg Med. 2013; 44(1):122-127.

Irish biomechanics analysis of prehospital spinal immobilization that got a standing ovation at NAEMSP in 2013:
Dixon M, O'Halloran J, Cummins N. Biomechanical analysis of spinal immobilization during prehospital extrication: a proof of concept study. Emerg Med Journal. 2013.

Ashley Huff, PGY-3