Advanced hemodynamic monitoring is widely used in critical care—but its impact across emergency care can be profound. Advanced hemodynamic monitoring (i.e., assessment of preload, afterload, cardiac output, and global systemic perfusion) could help establish goals of resuscitation and oxygenation, which vary depending on diagnosis and disease stage. This session will evaluate each component to assist you in understanding the effects of what we do at bedside.

Objectives:

• Describe the pathway of basic hemodynamic flow of the cardiac cycle.
• List the most common advanced hemodynamic values and how they affect decision-making in the management in the different types of shock.
• Analyze covert and overt data in recognition of specific clinical pathologies.
• State the three components of oxygen delivery. 

The human body is an interwoven system of systems. For it to work efficiently, all these systems have to be functioning normally. When a system does not function normally, EMS is often called. As an EMT, you have heard that the patient has DKA, but do you really understand what that means? During this session, physiology and pathophysiology will be presented through a series of cases that demonstrates how subtle alterations in these systems can cause major issues. The focus of this presentation won’t be on the specific treatment of the diseases presented; instead it will allow the attendee to understand why or how the disease can be treated.

Objectives:

• Describe the physiology and pathophysiology of glucose metabolism.
• Describe the physiology and pathophysiology of ventilation.
• Describe the physiology and pathophysiology of cardiac muscle respiration.

Over the last decade, the rise of community paramedicine and mobile integrated healthcare programs has reinvigorated efforts to involve EMS in injury prevention programs. Along with a growing recognition that preventing injury and illness reduces costs and improves health, the EMS profession has adopted a more proactive stance toward caring for communities.  But injury prevention is not solely the domain of community paramedics or large EMS systems—and to achieve the people-centered vision described by EMS Agenda 2050, it is time for all EMS organizations to focus on keeping patients safe and healthy before the emergency, not just after.  Two decades ago, the drowning of a toddler inspired paramedics to create EPIC Medics and assume community leadership in injury prevention. In addition, they have presented the Nicholas Rosecrans Award annually to an EMS agency that demonstrates a commitment to population wellness and injury prevention. In this session, you’ll hear from the winners of this year’s award, including how they implemented their program and the lessons learned along the way. You’ll also hear updates about previous years’ winners and engage in a discussion on the integration of EMS and public health in the community.

Everything you do as an educator either contributes to excellence among your students or tears it down.  Do you wish students wanted to work harder?  Wanted to be the best?  You can make them want it!  This session will make sense of the science behind human motivation and show you how that research can be applied to our classrooms.  Many of the techniques behind peak performance are very easy to implement.  Why not give your students a fighting chance at greatness?  After all, each one of them is a reflection of you!

Objectives:

• Identify classroom behaviors and attitudes that demoralize and detract from success.
• List at least three activities that promote a student’s drive for excellence in EMS.
• Appreciate that classroom and school ground attitudes, language, and behavior do directly impact the ability of any student to exceed expectations.

How can we best care for our oldest and most fragile patients? We put a lot of work into education and practice in the management of cardiac arrest, but what if we focused more on the identification and correction of the factors that may lead to cardiac arrest? When we do this for geriatric patients it can lead to significantly improved outcomes. This program focuses on pre-hospital management of geriatric peri-arrest factors with the goal of avoiding cardiac arrest and, if the worst happens, optimizing BLS and ALS resuscitation care.

Description: This session will include presentations from an EMS Fire Chief, an EMS Medical Director, an Emergency Physician/CPR researcher, and a Cardiologist/CPR researcher. All have been involved in the development and deployment of Head Up CPR. The talks will include the underlying science of Head Up CPR, how to implement Head Up CPR, and the latest preclinical and clinical outcomes of this breakthrough in resuscitation science.

Objectives:

• understand the shortcomings of conventional CPR in the flat position
• understand the key physiological effects of Head Up CPR
• understand how to easily implement Head Up CPR into a BLS protocol

There was no greater leader and strategist than Chinese military general Sun Tzu. His seminal text The Art of War is considered a masterpiece of strategy that presents a philosophy for managing conflicts and winning battles. His book, which details a complete philosophy on how to decisively defeat one’s opponent, was based on a holistic approach to strategy. This approach is especially relevant to today’s marketplace, where EMS is “under attack,” and we need to develop strategy for survival like Sun-Tzu did. The lessons of Sun Tzu have stood the test of time and have taught generations of leaders the fundamentals of being an effective leader in areas such as conflict management, developing organizational strategy and the importance of interpersonal relationships. This session will review these, and other, lessons and assist you in defining expectations of leadership as well as living up to your own personal leadership potential.

• Describe the threats to your EMS agency, knowing how to reframe your agency and the services it delivers, as well as lead your agency into the future.
  
• List the do’s and don’ts of setting organizational goals and objectives.
  
• Understand personal power (beyond your positional authority) and how to effectively use it in your leadership role.
  

A dirty needle stick or blood splashed in the eye can be a terrifying event to a clinician. In one national study of paramedics, 22 percent of respondents reported at least one blood exposure during the previous year.  Is your agency truly prepared to address the clinical and regulatory challenges of infection control?  Nick, the designated infection control officer for one of the largest county-based ALS first-response agencies in Georgia, and Samantha, an attorney for one of the largest hospital-based EMS systems in the Southeast, translate the legal requirements of infection control for EMS agencies, discuss simple changes to work practices that can greatly reduce the chance of exposure, and explain best practices for handling exposures.

• Analyze the key components of the Ryan White Act as it relates to infection control practices and notification to emergency response employees who may have been exposed to infectious diseases.
  
• Describe the role of the designated infection control officer and describe characteristics of successful programs.
  
• Illustrate best practices for setting up infection control oversight at the agency level to enhance provider safety and avoid legal liability.
  

Learn tips and tricks for keeping your pediatric patients and their families calm and improve communication during prehospital encounters.

• Review tips on how to examine and treat pediatric patients while keeping them calm.
  
• Discuss the importance of body language and tone of voice in communicating with pediatric patients and their families.
  
• De-escalate to keep parents and kids calm when the parents are unhappy.
  

Some students do not know how to learn.  While most have been learning all their life, many students do not know the mechanism by which they acquire and retain information.  Many do not know under what circumstances they learn the best or the most.  You can help!  Current research, theories and trends in educational methods and psychology will be explored.  Strategies will be presented for teaching the same material to different learners.  The emphasis is on saving time and enhancing performance in our EMS classrooms.  Educators will learn how to set students up for academic success.

For every second a stroke goes untreated, 30,000 brain cells die.  The most important part of getting timely treatment for a stroke is to know and understand the warning signs described by the FAST acronym. Our team collaborated to create the world's first stroke recognition tool targeting the Hispanic community, which faces elevated stroke risk. This presentation will demonstrate how this simple tool has been used in Polk County, Fla., and integrated with EMS stroke protocols to attack this problem.

Objectives:

• Name at least 3 stroke symptoms.
• Recognize diversity in stroke outcomes.
• Recognize stroke mortality and morbidity in the Hispanic community.
• Recognize stroke symptoms related to the Spanish language.

The best doctors are paramedics, in our opinion. Have you thought about going back to school? Join this panel of paramedics turned physicians to learn about the pathway to becoming your own medical director. We will share the pearls and pitfalls of making the plunge and applying to medical school, as well as what to expect after you get in. We need more EMS physicians in this world—come learn how you could be the next one!

• Understand the opportunities that exist for additional education beyond EMS.
  
• Understand how to apply to additional educational opportunities and what the requirements are.
  
• Describe the difference and comparative benefits of the many different career choices available with additional education.
  
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Historically black colleges and universities (HBCUs) are more successful in getting students admitted to medical schools than the Ivy League. What do those schools know that the others do not?  They use learning and motivation science to address what is an opportunity gap, not an achievement gap, and surround learners with the support needed for success while using the teaching strategies proven to make a difference in underrepresented students. Come learn what they are doing—it's good education for all your students!

This will be a panel discussion surrounding a Statewide system of care approach. Discussions will surround what led the state to implement a process and system, the need to gather and evaluate data in an effort  to help identify gaps in definitive care throughout the state.  For Example, knowing we have a gap in a rural area of the state for for definitive care and services with Trauma, Cardiac Cath Labs or Stroke Teams. The system would then help to identify needs and work with the hospitals to train and stand up services to fill gaps throughout the state. Additional discussion surrounds EMS transport decisions and support through a destination call center. This helps ease the process for medics in the field, hospital statuses are monitored by the call center. We will discuss how some urban areas may not use this system on a daily basis but have incorporated the system during disasters and mass casualty events to help distribute patients throughout the region or state. The final topic will be incorporating a specialty such as Burn Care into an already established system and the challenges associated with such an implementation.

• Upon completion of this discussion, participants will have a better understanding of a how a state-wide system of care for traumatic injuries and acute illness can improve response to disasters.
• Upon completion of the discussion, participants will understand the challenges associated with implementing such a system.
• Upon completion of this discussion, participants will have a strong understanding of the LERN systems usage in the state of Louisiana and how it has impacted patient care.

Grossness and kidding aside, understanding the normal and abnormal fluids that the human body produces can provide valuable clues to underlying conditions.  You’ll never believe how informative the gunk in that tissue can be.

We’ve all spent a lot of time learning about (and administering) drugs in cardiac arrest. Does any of it really matter? Epinephrine—Are we saving the heart at the expense of the brain? Amiodarone? Lidocaine? Are they doing anything other than numbing the skin? Does it matter if we give it quickly? How about IV vs. IO? Dr. Jarvis will review the literature on epinephrine and anti-dysrhythmics in cardiac arrest as well as recent work looking at the impact of route of administration. He’ll keep you awake as you learn the latest information that should be shaping your clinical practice.

• Understand how literature should provide the foundation for clinical practice.
  
• Describe the importance of timing with epinephrine use.
  
• Describe the impact of epinephrine on outcomes in cardiac arrest.
  
• Discuss the difference in outcome between amiodarone, lidocaine, and placebo in cardiac arrest.
  

Advanced airway management, especially the use of rapid sequence intubation (RSI), has been commonly held as a procedure that only Advanced Life Support clinicians need to understand and perform. RSI can have significant effects on the patients who are determined to need airway management, both positive and negative. It can be a high-stress, high-acuity, procedure with a narrow therapeutic window.  Frequently ignored in RSI education has been the BLS clinician, who is present for each RSI. The goal of the program is to educate the EMT in the process of advanced airway management, especially RSI, and how they can contribute to the overall success of a procedure that has a significant effect on patient outcomes. We strongly believe it is the EMT that is the "X factor" in successful and consistent RSI outcomes.

Objective

• Understand the terminology of advanced airway management/RSI, goals of therapy, misconceptions of RSI, its importance in prehospital patient care. State of New Jersey RSI program will be referenced.
• Describe the procedure of RSI, patient selection, determining difficulty, preparation, medication, securing the airway, and confirmation. EMTs will identify key areas where BLS knowledge and skills are important steps.
• Identify pitfalls in procedure, such as preoxygentation, suction, and communication; and how the BLS clinician can contribute within their scope of practice to minimize the effects of these problems.
• Communication between ALS/BLS and human factors will be identified. The BLS clinician will learn to identify areas where they can improve in communication and avoid common errors.

Paralytics are an extremely important, yet potentially dangerous tool in the pre-hospital setting. It is important that pre-hospital providers be up-to-date and aware of the most current literature surrounding these agents to successfully facilitate a safe and effective intubation. Is there a "one-size fits all" when talking about the use of paralytics for rapid sequence intubation (RSI) ? Is there a "preferred" paralytic in specific patient populations? What are the most important side effects and clinical pearls that pre-hospital providers should be aware of? All of the aforementioned questions and more are addressed with the most current evidentiary support.

• Describe the purpose and utility of paralytics in the pre-hospital setting
• Describe the specific patient populations for which each paralytic would have the greatest clinical efficacy
• List the most common side effects associated with both depolarizing and non-depolarizing neuromuscular blockers
• Understand the pharmacodynamics and pharmacokinetics of neuromuscular blocking agents

We all want to know what push dose pressors we should use for patients, and if we should even implement them. When we look at the data, we find 3 things use in the OR, use in the OB units and sometimes in the ED and we heard it on a podcast. This presentation will go over the identification of when we should consider push dose pressors, what medications should we look at and if there any medications that we can also use outside of the push dose pressor world. VIPER looks at the use of Phenylephrine and Vasopressin as the main arms of medication for the push dose pressor and evaluates the pros and cons to these and other medications for the peri-intubation arrest. By the end of the lecture, the learner will be able to understand the use, and implementation of Push Dose Pressors in the prehospital, peri-intubation arrest setting.

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U.S.-based healthcare professionals take the advanced life support guidelines at face value and often simply “follow the recommendations” verbatim. If you did this in 2015 you may find yourself reversing course on certain recommendations just five years later. Taking a look under the hood each time the guidelines are updated is a critical exercise for everyone in healthcare, and this year is certainly no different. Join Drs. Peter Antevy and Mark Piehl as they examine the most concerning PALS 2020 recommendations and the evidence base that helped derive them. You may leave this talk with some difficult choices to make.

• Evaluate the evidence for changes in the recommend ventilation rate during CPR
  
• Understand the benefits of push-dose epinephrine for symptomatic bradycardia
  
• Recognize the benefits of adequate fluid resuscitation in septic shock
  
• Understand the recommendations for blood transfusion in pediatric trauma