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Clinical Practice Sessions

The Top Ten List: Articles from 2022-2023 That May Influence Your Practice
Russell MacDonald, MD, MPH, FCFP, FRCPC, DRCPSC; University of Toronto

The volume and quality of prehospital and transport medicine research continues to grow, making it difficult for the practitioner to keep up to date.

This presentation provides a synopsis of ten recent journals relevant to prehospital and transport medicine, highlighting their relevance and importance to the physicians, nurses, paramedics and other allied health care professionals providing air or land critical care patient transport.

Water, Water Everywhere: Pulmonary Edema From Crackles To Crashing
Michael Frakes, APRN, CMTE, FCCM, FAEN, FACHE; Boston MedFlight

The volume and quality of prehospital and transport medicine research continues to grow, making it difficult for the practitioner to keep up to date.

This presentation provides a synopsis of ten recent journals relevant to prehospital and transport medicine, highlighting their relevance and importance to the physicians, nurses, paramedics and other allied health care professionals providing air or land critical care patient transport.

Bizarre and Unusual Clinical Case Studies 2023
Allen Wolfe, MSN, CNS, APRN, CFRN, CCRN-K, CTRN, TCRN, CMTE, FAASTN; LifeLink III

Trauma continues to be a leading cause of death across the globe, especially for younger ages. When analyzing trauma-related deaths, acute traumatic hemorrhage is one of the leading causes of death, along with brain injuries of mortality. Major trauma resuscitation has been through a long journey to the current standard of care, which has improved the outcome of the patients. During the last 40 years, there has been a gradual trend to move from a universal and dogmatic approach to a more patient-tailored strategy. In trauma care, anatomy is becoming less important and physiology has progressively taken its place under the spotlight. This lecture will look at some interesting complex bizarre trauma cases involving several mechanisms.

Pediatric Psychiatric and Behavioral Emergencies in Transport
Jennifer Flint, MD; Children's Mercy Hospital

Psychiatric and behavioral emergencies are increasing in children with a significant increase during and following the COVID-19 pandemic. This talk will review the current literature on the management of a pediatric patient with an acute psychiatric or behavioral emergency during interfacility transport. This talk will also review the recent implementation of a clinical practice guideline for a pediatric critical care transport team including a behavioral health observation tool and approach to pharmacological management in the transport environment. This talk will also discuss practical implementation of a multi-disciplinary team and use of a high-risk scoring tool into an approach for transporting a high-risk pediatric patient with a mental health crisis or need.

Babies and Bullets
Teri Campbell, MSN, RN, PHRN, CEN, CFRN; University of Chicago UCAN

Babies and bullets NEVER belong in the same sentence. However, pediatric GSW injuries are skyrocketing in the U.S. Pediatric GSW victims are complicated by physiologic compensatory mechanisms clouding assessment, special equipment needs, and multiple emotional and psychological distractors. Come to this fast-paced, scenario-based lecture to learn how to manage the big problems associated with our littlest GSW patients.

PALS for Non-Pediatricians: At All Times
Andrew Hawk, MD, FACEP; CareFlight Air and Mobile Services / Premier Health

"PALS: At All Times" is an ever-ready PALS-consistent approach to the sickest pediatric patients. It is a concept based on years of PALS updates and clinical experiences - with the simple goal of being primed and ready to initiate and provide ongoing care of the significantly sick or injured pediatric patient. Most critical care transport providers do not take care of compromised pediatric patients every day. It is therefore imperative that bedside care givers have an approach that is structured, accurate, and focused on the basics. "PALS: At All times" topics include vital signs, medical equipment sizes, airway pearls, drug dosages, non-arrest interventions, and arrest sequences - all with the goal of retention and application in the high stress situation of pediatric critical care. And since "PALS: At All Times" is PALS-consistent, it can be used in conjunction with the Broselow tape, the Handtevy system, and Pedi-Ed-Trics.

TMI about Pediatric TBI
Maria Mandt, MD; Children's Hospital Colorado

Despite medical advances, traumatic brain injury (TBI) continues to be the leading cause of death and disability in children. The nearly 3,000 deaths per year in children due to TBI, account for more pediatric deaths than nearly all other causes combined. While in many ways, kids ARE little adults, the management of pediatric TBI is characterized by some distinctive principles that are attributed to anatomical and physiological differences, as well as injury mechanisms. In this interactive discussion, we will explore and test your pediatric TBI assessment skills and highlight the critical components of management.

Catastrophic Non-Traumatic Hemorrhage - A Case Review
Cody Winniford, BA, EMT-P, CCP-C, FP-C; PHI Air Medical

CCT Teams are often asked to facilitate the movement of patients who are either on the brink of a catastrophic non-traumatic hemorrhage, or are already suffering from it. These cases present several challenges to transport teams and this presentation will serve to highlight some of those challenges and provide some solutions for how to address those challenges. It will provide CCT teams with tools to enhance their mental models for the movement of these critically ill patients and ask the question: too sick to transport?

The Bottom Ten List: Articles from 2022-2023 That Russ Missed!
Michael Jasumback, MD; PHI Air Medical

Dr. Russell MacDonald's "The Top Ten List" has been a mainstay of AMTC for years. In concert with Dr. MacDonald, this will be a discussion of lesser known articles that affect those involved in Air Medical Transport. The volume and quality of prehospital and transport medicine research is voluminous and difficult to parse. This presentation provides a synopsis of ten more obscure recent journals relevant to prehospital and transport medicine, highlighting their relevance and importance to the physicians, nurses, paramedics and other allied health care professionals providing air or land critical care patient transport.

The Pump vs. The Squeeze: The Clinical Use of Vasopressors and Inotropes in the Back of a Helicopter
William Heuser, PharmD, MS, BCCCP, BCNSP, EMT-P, FP-C; Northwell Health/Hofstra University

Managing hemodynamically unstable and crashing patients in the back of an ambulance or 10,000 feet in the air with the use of vasopressors and inotropes is very stressful and tricky. Although only a subset of our patients present with hemodynamic collapse and shock, a fundamental understanding of the use of inotropes and vasopressors is imperative to ensure good patient outcomes and reduce morbidity and mortality. This lecture will discuss the use of these pharmacological agents in differentiated (e.g., cardiogenic, distributive, hypovolemic, etc.) and undifferentiated/mixed shock states and ideal vasopressor/inotrope(s) to use as primary resuscitative agents. The most recent EMS literature surrounding these agents in different clinical scenarios will also be presented to ensure adequate understanding and comprehension.

3 Lies and A Truth - Mediastinal Anatomy and its Correlation to Clinical Pathology
Jeffrey Thomas, RN, BSN, NREMT-P, CCRN, CFRN; University of Michigan Survival Flight/West Michigan AirCare

Mediastinal pathology is concurrently subtle and overt. Hemodynamics have beat to beat variability, multiple organs are simultaneously failing and the patient’s symptoms may be masked by other or simultaneous medical pathologies. In this case based presentation, we will discuss the anatomical, diagnostic and treatment aspects of critical care transport when differentiating, treating and transporting critically ill patients with disease processes occurring in the “middle” thorax.

When Capacity Isn't About Aircraft Lift: Determining Your Patient's Medical Decision Making Capacity in Critical Situation
Dustin Calhoun, MD, FAEMS; University of Cincinnati / Air Care and Mobile Care

Patients fundamentally have the right to make their own medical decisions. As medical professionals, it is incumbent upon us to do all we can to support that right. Along with that responsibility comes the duty to ensure that patients have both the necessary information presented at a level of complexity appropriate for them as well as the ability to absorb and process this information and produce a decision consistent with their values and desires. This ability can be hindered by many things including shock, electrolyte disturbance, blood glucose abnormality, intoxication, infection and primary psychiatric disturbance. This session will provide an objective framework for evaluating a patient, regardless of pathology, and making a reproducible and defensible decision about their medical decision making capacity. This skill is crucial in the acute care and critical care transport environment where we are often faced with patient we're meeting for the first time, on the worst day of their lives and in a situation that often calls for highly impactful decision to be made by both the provider and the patient.

Who Turned Up the Heat? Hyperthermic Emergencies
Michael Gooch, DNP, APRN, CCP, ACNP-BC, FNP-BC, ENP-C, CEN, CFRN, CTRN, TCRN, NRP, Vanderbilt University Medical Center

You are called to transport a patient with altered mental status and an elevated core temperature. As the transport clinician, how will you manage this patient? What are your differentials- is it simply a fever, an environmental exposure, or perhaps a medication reaction? These are some of the aspects which will be covered as we review the differentials and management options for the hyperthermic patient in transport.