What do you do when when a child can't breath? Pediatric respiratory emergencies can be especially stressful for prehospital providers. This interactive, case based lecture will give ALS and BLS providers the tools they need to recognize different etiologies of pediatric respiratory emergencies and will review the different treatments needed.

• Review the physical exam findings and prehospital treatment for asthma
• Learn the physical exam findings and prehospital treatment for croup
• Discuss the physical exam findings and prehospital treatment for bronchiolitis

Patients experiencing congestive heart failure (CHF) exacerbation with acute pulmonary edema (APE) require rapid preload and afterload reduction. Traditionally, prehospital treatment has been limited to sublingual nitroglycerin at doses that are not able to affect afterload. However, in the hospital setting high dose, bolus intravenous (IV) nitroglycerin has improved patient morbidity and mortality. In this session, Dr. Casey Patrick and Micheal Perlmutter will discuss how Montgomery County Hospital District EMS and North Memorial EMS both implemented a novel prehospital protocol to use bolus dose IV nitroglycerin for patients with APE. The safety, efficacy and impact of this prehospital approach to patients with APE will be discussed.

Research continues to stress the importance of remaining on scene for up to 30 minutes in an effort to improve the outcomes and survivability of cardiac arrest patients. But what happens when even the most successful efforts result in futility and a patient must be pronounced ? Historically, institutions have failed to prepare first responders for this outcome, and "training" for these situations is experiential, at best. As a result, crews continue to default into a “transport for the family," "PR CPR,” or “just for show” mentality that further contributes to the cultural resistance we currently face. We have failed to recognize our unique role in the grieving (healing) process, which begins for the survivors at the moment we determine time of death of the patient. In this class you will learn how to communicate with bystanders effectively and how to identify the process of grief, as well as understand the positive impact first responders can have on survivors when we remain on scene.

One of the most difficult situations in prehospital care is the high-risk patient refusal of EMS transport. This topic is far from straightforward for both learners and teachers alike. This session begins with a discussion of capacity vs. competence, then introduces a brand-new mnemonic, FEARS—for 1) full exam, 2) explain the real risks, 3) ask for assistance, 4) record accurately, and 5) supportive attitude—that can help the next time you care for a complex patient who decides hospital transport just isn’t in the cards.

Skill instructors are the backbone of EMS education and serving as one is a great opportunity for experienced EMS providers to share their talents. Whether you are just getting into education or have been teaching skill labs for years, applying the science of psychomotor knowledge acquisition will lead to increased student success. This session will discuss the principles of skill education and how to leave a legacy with your students.

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Learning Objectives

• Define psychomotor scaffolding.
• List the five levels of psychomotor skills development.
• Distinguish the importance of goal setting in the skills lab.
• Identify the value of real-time skills tracking.

One of the most difficult situations in prehospital care is the high-risk patient refusal of EMS transport. This topic is far from straightforward for both learners and teachers alike. This session begins with a discussion of capacity vs. competence, then introduces a brand-new mnemonic, FEARS—for 1) full exam, 2) explain the real risks, 3) ask for assistance, 4) record accurately, and 5) supportive attitude—that can help the next time you care for a complex patient who decides hospital transport just isn’t in the cards. 

Objectives

• Explain the difference between capacity and competence.
• Understand how to properly document evidence of patient capacity.
• Know how to use the FEARS mnemonic to have a more organized approach to high-risk EMS transport refusals.

EMS is uniquely situated to gain a perspective on patients' determinants of health in a way that cannot be achieved in clinics and hospitals, but core training of EMTs and paramedics is heavily focused on providing acute care. As we move into the mobile integrated healthcare space, is it better to train paramedics to work in the disease-management arena, or is it better to train advanced-practice providers (APP) to work in the field environment? Both groups come with advantages and disadvantages, and selecting one over another depends heavily on the mission you hope to achieve.

Objectives

• Demonstrate understanding of the scope of practice and curriculum limitations of community paramedicine programs.
• List advantages and disadvantages of utilizing a community paramedic vs. an advanced-practice provider in an MIH program.
• Demonstrate understanding of the qualifications of APPs to work in the field environment. 
• Describe innovative and cost-effective ways of incorporating APPs into MIH workflows. 

MIH cases can vary in complexity and workload.  One community paramedic (CP) can be overwhelmed with four patients while another CP is breezing through ten cases.  Is there a way to score the complexity of a patient's case to help determine the workload their lead CP will face?  The presenters of this course have attempted to address this question by developing a MIH Complexity Scale.  This assessment may also help management monitor and delegate workload.  After discussing the development and research of the complexity scale, the presentation will conclude by discussing the vision for future uses of this scale

Once an airway is placed, our job of airway management is far from over. Prehospital providers still need to continuously reassess the airway as well as provide proper breathing management. This presentation introduces best practices for continued airway protection and evaluation, improved breathing and ventilation care, utilization of end-tidal carbon dioxide, and how to plan for the lost airway. Come join in a discussion of how to anticipate and manage what might come up the airway, maximize oxygen administration and carbon dioxide elimination, effectively use a bag-valve mask to prevent increased intrathoracic pressure, and position a patient to make your job easier. 

This session is included in the virtual live stream.

This presentation will take a deep dive into why a divide persists between fire and EMS-based cultures while providing tangible skills and real-world examples to break down such barriers in your own organization.

As EMS moves further into alternative delivery and economic models, many EMS agencies struggle with determining the actual cost and value of their service delivery, especially models that have multirole functions, such as EMS-based fire agencies. This session will walk agency leaders through several ways to determine service delivery costs and the development of alternative payment models (APMs) for the services they could provide (community paramedicine, ambulance transport alternatives, etc.).

Objectives:

• List the five "serial killers" for chest pain and shortness of breath.
• Describe classic ECG findings in a patient with pericardial effusion.
• Understand the common clinical presentations associated with thoracic aortic dissection.
• Know risk factors for pulmonary embolus and deep venous thrombosis.

Poor preoxygenation, incorrect medication selection and dosing, incorrect timing of laryngoscopy, bypassing the vocal cords, inadequate minute ventilation—the list of potential rookie mistakes goes on and on. Whether you've intubated one patient or 1,000, you should know these common pitfalls that can have deadly repercussions and how to avoid them.

Brain science shows that most students' learning strategies are highly inefficient, ineffective or just plain wrong; and that while all learning requires effort, better learning does not require more effort, but rather effectively aligning how the brain naturally learns with the demands of intellectual work. This presentation will offer straightforward strategies for helping students prepare to learn, engage with course material, and set about improving recall of newly learned material at will.

Learners will discover the definition of imposter syndrome: persistent feelings of inadequacy despite evidence of success.   They will explore the five personalities of emergency providers that are at risk for imposter syndrome: the perfectionist, the superman/superwoman, the rugged individualist, the natural genius, and the expert.   Coping mechanisms to deal with it and the special implications for industry leaders will be discussed.

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This segment will deal specifically with placing an endotracheal tube in the patient that is

“hard to tube.” While we understand other devices are an option, and often a good

 choice, this lecture is designed to review understanding anatomy, positioning as well as

 various techniques and devices to be successful at INTUBATION. Through the 

use of photos, videos, and review of adjunctive intubation devices this program

 will present many variations of the standard technique to obtain success.

This session is included in the virtual live stream.

This lecture will review the evidence that debunks the use of spinal immobilization in trauma patients. After this lecture attendees will understand why the best place for spinal immobilization is in the trash.

This session is included in the virtual live stream.

We often start with a diagnosis and teach from there, but getting to the final diagnosis is often a process emergency providers struggle with. To filter from undifferentiated abdominal pain with unstable vitals to an organized differential is often quite challenging.  We’re not going to spend time with nonemergent/chronic diagnoses, just the ones that are deadly when missed—that’s where we as emergency providers must begin. This session focuses on the can’t-miss/"killer" diagnoses associated with four of the most common EMS chief complaints: chest pain, abdominal pain, shortness of breath, and altered mental status.

Objectives:

• List the five "serial killers" for chest pain and shortness of breath.
• Describe classic ECG findings in a patient with pericardial effusion.
• Understand the common clinical presentations associated with thoracic aortic dissection.
• Know risk factors for pulmonary embolus and deep venous thrombosis.

San Antonio is home to Texas' largest homeless shelter, which may have more than 2,000 inhabitants on any given night. The shelter is the largest generator of 9-1-1 calls in the city of San Antonio. The UT Health San Antonio Office of the Medical Director and San Antonio Fire Department developed a clinic-style concept staffed by paramedics inside the homeless shelter. This decreases 9-1-1 calls to the campus location and transports to hospitals. While this population suffers from severe health disparities and is at risk for an emergency, they often have needs that could be better addressed by a dedicated overnight clinic. Dr. Miramontes and Dr. C.J. Winckler developed and  taught the paramedics how to perform this unique alternative care through an intensive training program. Quality assurance has proven the program to be successful, and the investment has paid for itself with a reduction in 9-1-1 calls and increased workforce satisfaction.

Despite our best efforts, many cardiac arrests end in patient death. Field termination is increasingly common, and the EMS practitioner's death notification skill can improve the experience for survivors and prevent pathologic grief. Breaking bad news involves specific communication skills that must be learned and practiced like any other EMS skill. This presentation will discuss various ways in which survivors exhibit grief, examine the aspects of pathologic grief, and describe an approach to breaking bad news during field termination of care. Dr. Kupas will focus on specific actions EMS practitioners should take and avoid and provide operational guidelines for treating our secondary patients: the patient's family members.

Objectives:

• Understand how various people react to grief.
• Describe the predispositions and actions that can lead to pathologic grief in survivors.
• Demonstrate examples of specific phrases to use and to avoid when breaking bad news.
• Discuss EMS agency operational guidelines that facilitate field termination of resuscitation.

Simply stated, no other part of the healthcare system handles prescription pharmaceuticals the way many EMS provider agencies do.  As recent times have demonstrated, pharmaceutical supply chains are vulnerable to drug shortages.  In addition, the requirements around ordering, securing, storing, and documenting controlled drugs can be extremely cumbersome.  In 2017, the Los Angeles County Fire Department launched the first Fire Department-based, federally and state licensed pharmacy.  The department has since realized the benefits of improved supply chains for weathering shortages, pharmacist consultation on medication administration procedures, more efficient distribution processes that have dramatically lowered costs, an automated drug dispensing system for controlled drugs, better compliance with legal requirements for controlled drugs, and reverse distribution contracts that have generated tens of thousands of dollars in refunds.  Best of all, this model is scalable to EMS provider agencies of all sizes.