Monday, November 24, 2008

Texas EMS Conference - Day 1

The EMS Conference kicked off this morning with the keynote address by Dr. John Griswell who spoke on medical ethics. That's a tough sell first thing in the morning, and it's tough to make it interesting, but he did a pretty good job and he brought up some good points:
  • Doctors and EMS are in the medical practice together and neither can function alone.
  • Ethics is not legality. Legal standards are minimum standards. Ethical standards should go above legality.
  • One common denominator in unethical behavior us a sense of entitlement or superiority. "We're better than they are so we can use them," or "They were going to die anyway" statements can be used to rationalize ethical lapses such as in Nazi Germany or in many ethical lapses in the US.
The second session I attended was entitled "America's School Shootings" by Ken Bouvier. His was a very informative and entertaining presentation. Don't get me wrong, the subject was totally serious and Ken was serious. But, he did throw in a joke or two at tasteful and appropriate times. Some of the main points of his presentation were:
  • School shootings have been going on for a long time and will happen again. It's up to the police, fire and EMS communities to have a plan in place in case it happens in their area.
  • The scenes are usually chaotic and inherently unsafe. Sometimes EMS crews will have to jump in before the "all clear" is given. It could take up to an hour for things to settle down enough to where things are truly "safe."
  • The kids who perpetrate school shootings fit a certain profile:
    • History of clinical depression or signs of clinical depression which were not noted until after the fact
    • History of suicidal thoughts or actions
    • Had low self-esteem
    • Tended towards satanic and/or Nazi ideals
    • Were taking Ritalin and sometimes another anti-depressant
    • Many were late bed-wetters
    • Most were members of broken homes
    • Almost all were victims of some kind of abuse
It is mostly incumbent on the parents to lock up their guns securely and to only allow kids to use them under proper supervision - especially if they have some of the profile signs listed above.

The last session of the morning was entitled "The ABCs of Cardiac Arrest: Is the 'B' Necessary?" given by Ken Navarro. Ken made some very interesting observations about assisting cardiac arrest victims with compression-only CPR (or CCR - Cardio-Cerebral Resuscitation):
  • Despite changes in ALS techniques, there has been no statistical increase in survivals of cardiac arrest victims.
  • Studies have show there is no real statistical increase in out of hospital cardiac arrest patients, and good-quality CPR is most effective.
  • CPR techniques need to be taught properly and graded objectively. Most people cannot tell if they are compressing deep enough, fast enough and allowing the proper time between compressions.
  • Starting in the 16th century and continuing until the 19th, a fireplace bellows was commonly used to resuscitate those in respiratory arrest. (Trivial fact which was interesting to me)
  • Compressing the heart alone isn't responsible for moving blood around the body during compressions. It's also the effect of pressure change in the chest which helps move things along. Compressions must be deep enough to change the pressure in the chest to sufficiently help the heart move blood.
  • Often times, while using a BVM, too much pressure is built up in the chest so blood movement is either slowed or stopped because the blood can't get into the heart to get pumped.
  • Studies show that bystander no-compression CPR is no less effective than more traditional methods.
  • A Wisconsin study showed (again) that good quality compressions make the most difference when determining what will lead to greater survivability.
It was a very interesting session.

The afternoon kicked off with a presentation by Kirk Mittleman entitled "Critical Calls Take Critical Thinking." 

He started off the session by showing two video clips showing the importance of seat belt usage and how wearing them can increase the survivability of people in motor vehicle collisions. The first was by the Montana Department of Transportation called "Room To Live" which stressed the fact that there is room to live inside a vehicle during a collision and that being ejected raises the chances of being killed. It is quite a moving story. The second was of a related topic showing how one person not wearing a seat belt can cause injury or death to the other passengers even if they are belted. Here's where you can catch it on YouTube

The rest of the presentation was quite good, but I really think these two videos should be the highlights of it. I plan to show these to my kids (one drives, another is about to, and the youngest needs to make sure to wear his belts).

Dr. Ed Racht and Dr. Paul Pepe gave a great talk entitled "In-Hospital Care Driven by EMS" which pointed out examples of equipment and techniques which started in EMS and made their was into hospitals instead of the other way around. Those in EMS have always had to be more "creative" and find ways to get things done for their patients outside the "nice" confines of a hospital. EMS is also aided by hospitals which now specialize in types of care (i.e. trauma, stroke, sepsis, pediatrics, etc.). 

Dr. Racht talked about a web site which rates hospitals by certain criteria based on surveys taken by patients of those hospitals: I just checked out some of the hospitals in my area and it was a bit of an eye-opener. I recommend you check it out.

The last session of the day I attended was called "Port-Partum Pre-Eclampsia" given by John Rinard. Not knowing much about pre-eclampsia I found it quite informative. It's especially telling that pre-eclampsia and eclampsia can occur up to 4 weeks post-partum. I had no idea that was the case.

We're staying at the Hilton. It's a nice place with a bit of history. This is the former "Hotel Texas" which is where John F. Kennedy stayed the night before he was shot in Dallas. There are pictures hung all around the building showing President Kennedy at various times around the hotel that fateful morning.

I have a complaint about the accomodations. In the bathroom are the "obligatory" signs inviting guests to help save the Earth by reusing their towels. It's a nice idea, which I often do. But, I think it's rather hypocritical to ask us to save the Earth by reusing our towels when I have to run the water for 10 minutes before it gets hot enough to shave with. That's very wasteful. I know it might be petty, but I've shaved with cold water enough times that I know I don't like it. Although there is not sticker on the back of the door indicating how much the room is worth per night, I'm sure we're paying enough for there to be hot water without waiting that long.
** Follow up on the hot water situation **

There is also a low-flow shower head in the tub. Hotel owners and managers: please hear this - "low-flow" and "water-saving" does not have to mean low water pressure. You can have both water savings and high pressure.

Now, that's not to say I'm totally dissatisfied with the hotel. It's good, but I expect a bit more from the Hilton name.

Dinner this evening was at The Reata. Very good chicken-fried steak and excellet desserts. If you're in Downtown Fort Worth it's definitely worth stopping by.


  1. Tina Lugibihl11/25/2008 6:19 PM

    I was forwarded your conference schedule by the producer of the "Room to Live" video. You see I am the mother of the man killed in the accident. I am very honored that you were interested in our video. It helps to know that we are touching people and hopefully saving lives. Jeremy dieing is the most horrific thing we have ever gone through but knowing that he didn't die without a purpose helps ease the pain somewhat. Again thank you so much for using the video. God Bless Tina Lugibihl

  2. First off, please accept my deepest sympathies for the loss of your son. No parent should have to endure what you have. The courage it took you, your husband, Jeremy's wife and his friend to relive that event and tell the story in this film was tremendous.

    I, too, hope this film helps remind people how important it is to take that little bit of effort to belt up while in the car. It's the least we can do for those we care about since they will suffer most if we are killed.

    Two friends of mine lost sons to traffic accidents within 9 months. Each time I grabbed my then 16-year-old son by the shoulders and looked him straight in the eye and told him that he needed to pay close attention while driving and not to drive with someone who's drunk or high because if he were killed the ones he left behind would be the ones to suffer his loss. I've started telling my #2 son the same thing as he gets into more social situations where he or his friends will be driving.

    I fully plan to show "Room to Live" and the commercial I mentioned in this blog post to all my sons. I hope the stark reality of your story will stick with them and help them remember to make better decisions.