We are pleased to host the Transport Medicine Competition once again at CCTMC (TMC@CCTMC).  This is a Critical Care Simulation & Skills Competition for Critical Care Transport Teams. The competition will take place during CCTMC, April 17th – 19th in Denver, CO.  We are seeking 8 critical care transport teams to compete in multiple scenarios in various settings.  These should be teams of 2 and may include paramedics, nurses, physicians, respiratory therapists, and nurse practitioners.  The competition will include multiple rounds of competition in front of a live audience using high-fidelity simulation to test skill, knowledge, critical thinking, and communication. Teams will be selected by random lottery.  Entries must be received by February 24^th. Come compete with us in the mountains!

Mechanical ventilation is now a standard of care for all intubated patients within the critical care transport environment. Pediatric asthma patients are very difficult to treat. Difficulties are compounded by the eosinophilic subtype, lower occurrence, and high acuity. These facts make it difficult for the transport team provider to become comfortable with the critical decisions related to mechanical ventilation in these patients. This can be deleterious for the patient and lead to poor patient outcomes. This talk will break down common mistakes in mechanical ventilation strategy. We will look at a case study highlighting numerous factors that drive decision-making in ventilation strategy for patients suffering from eosinophilic asthma within the pediatric population.

They are not just old kids but they can severely challenge your diagnostic, treatment, and destination decisions. Elderly patients are taking over, living longer, having more problems and creating more challenges. This presentation is geared to giving you some tools and insights to help with these difficult patients.

One of the more challenging patients to put on the ventilator- the Obstructed Patient! While we all have heard, we should try to do our best not to intubate these patients. Unfortunately, you may still find yourself in a situation where you will need too.
Just because you don’t want too. Doesn’t mean you won’t have too!
These patients should be placed on a ventilator and not just a BVM to properly manage their condition. We will discuss the do’s and don’ts of mechanically ventilating these patients to help you and your patient both survive this challenging situation!

With the increase in transport of patients with LVO stroke syndromes several new questions have come up. What are the time frames? How can I tell if it is an LVO Stroke? If I am transporting an LVO stroke from one facility to another, what should I do? What are my goals with respect to blood pressure. Do I use pressors? Vasodilators? HELP!! This lecture hopes to clarify the answers based on the current literature and best practice.

This is the core HROB lecture. It is impossible to recognize pathology in an obstetric patient without understanding the normal physiologic changes. These changes allow the HROB patient to mask common presentations of critical maternal deterioration. This lecture includes key assessment pearls that will allow the clinician to have a more reliable maternal and fetal risk assessment.

The concept of lung protective strategy is often underestimated when transporting pediatric/adult ventilated patients. Most of the attention is given to lowering tidal volumes, however little if any attention is given to the driving pressure in the prehospital realm. This presentation will describe what driving pressure is, how to obtain it, how to use it and describe the most up to date research data on it’s impact on patient mortality. In this way ground and flight units can bring a little bit of the ICU to prehospital transport.

Patients requiring interfacility transport have worse outcomes than patients directly admitted to the same hospital. Have you considered why? Social Determinants of Health are social, societal, and environmental factors that worsen patient outcomes and increase their cost of healthcare system engagement.

Initiation of arterial lines by critical care transport crews is safe and reasonable. For many patients, blood pressure cuffs are both imprecise and inaccurate. Close, second-to-second, hemodynamic monitoring is important to managing many patients and is considered a standard of care in the ICU. Given that many hospitals and other organizations already allow non-physicians to obtain arterial sample for ABGs, the vascular access skills of most nurses/paramedics/RTs, and the proliferation of ultrasound (specifically ultrasound guided IVs), CCT crews should strongly consider adopting arterial access as a standard procedure.

During this session, we will dive into a Pediatric Near Drowning case and complete a case study. We will look at Airway Management and Ventilator Management Strategies for these patients. We will also discuss resources and effective communication for dealing with difficult referring providers.

Stress and emotions run high during medical emergencies such as Code Blues, Trauma activations and Code 3 responses. During these emergencies clinicians may be unaware of poor stress coping and how it affects their decision making and overall mindset. This session will explore common responses to stress and how to overcome the negative consequences. Proper preparation, simple in the moment techniques and team communication as a foundation for optimizing performance and decision making will be discussed.

You are dispatched to a patient who ingested multiple medications and is now on an epinephrine and a lipid infusion; wait, a what? Transport clinicians are called to manage various types of ingestions and exposures. Some toxicities may require unique treatment plans. During this presentation, the typical toxidromes as well as a wide range of toxins, medications, and substances will be discussed. Newer treatment strategies will be reviewed so when you find the patient receiving lipid therapy because of an overdose you won’t be asking wait, what?

With over 1/2 of EMS providers self-reporting that they are currently experiencing moderate to extreme levels of burnout in our industry, how do we recover? Burnout is insidious yet silent. It can be deadly and lead to other mental health issues if not caught soon enough, and feel as though your life has stalled out. In his riveting and raw talk Eject Eject Eject | Recognizing Your Inner Flat Spin Chris shares his personal struggles and recovery from extreme burnout following in-patient treatment in early 2022. Providing attendees the tools to not only self-recognize the signs but be able to self-recover from burnout while emphasizing “it’s ok to not be ok” and removing the negative stigma of mental health.

Let’s face the facts. Organizational Culture impacts employee retention, enthusiasm, performance, and general well-being. If value and worth of an individuals talent is not see, or nurtured, then they lose faith in themselves and feel they have nowhere to go. Shaping future leaders should be front-and-center and providing direction is key. The responsibility to maintain a positive organizational culture not only falls on leadership. Everyone must work for the common mission, despite their title. Those “Karma Chameleons” may lurk on both sides; causing loss of some great talent.

Is it possible that you have something to offer your patients that can be just as powerful as an opioid drug? And what if this thing helped saved your life as well as helping the life of the patient? In this inspiring evidence-based lecture and discussion, we’ll look at the science of kindness and show why you need your compassion as much as your patient does.

Providing education in our current cultural climate is difficult when our learners have become accustomed to fast-paced and highly edited clips offering viewers full content in 60 seconds or less. The advent of TikTok has conditioned our students to learn entirely new concepts- from how to get the best tax return to how to put your duvet cover on without actually crawling inside it- and the expectation is for us to wholly captivate our audience.

In this session, Gwenny will introduce ideas for how to develop and present content in a way that will maximize learner engagement and promote retention of concepts taught. As well, we will explore the psychology of our learners and how the forced adaptations of our industry and our culture over the last two years have changed learning styles and brain functioning.

Listeners will leave this session better equipped to fulfill their roles as EMS educators.

“Of course it’s an MI! What do you mean it wasn’t an MI? And what does that have to do with an octopus!?” Takotsubo Cardiomyopathy is a great deceiver. This lecture with case studies will review what this cardiomyopathy is, how to recognize it in the field, and what course of action to take.

Do you know when pelvic binding is worth the squeeze? Come join in this eye-opening presentation sharing a researchers novel research evaluating the effectiveness of prehospital pelvic binding. Come understand the limitations of pelvic fracture assessments, the how well pelvic binders actually reduce fractures, and if they change patient outcomes!

Adaptive Support Ventilation (ASV) is a richly discussed topic within the transport arena. There is a lot of stigma, fear, and misunderstanding of how ASV works, and appropriate clinical applications. This presentation will provide an overview of how ASV works, and ideal patient applications for success.

This lecture will discuss the management of refectory hypoxemia on transport ventilators. This lecture will help the provider understand how much PEEP is efficient and when to stop turning up the PEEP. It will discuss the importance of driving pressure and why you should use it. Lastly, it will discuss advanced vent strategies such as APRV and how we can mimic these on transport ventilators.

Do you feel as if your gray matter won’t retain anymore information? Is your brain feeling fatigued? Need more “ectopic brains” in your uniform and on your phone? Struggling to learn new information? Tired of seeing blank stares in the audience as you are teaching? It’s not all your fault, adult learners are a unique breed and require TLC, specialized training, and teaching. Whether you are an educator or the learner, there are specific steps you can take to improve your ability to educate crews who are struggling as adult learners and decrease everyone’s cognitive load. Traditional teaching methods fail with most adults, yet we keep teaching the same way, and we know what doing the same thing over and over and expecting different results tells us about ourselves! Come learn what we are doing wrong and what we can do better as facilitators in teaching transport crewmembers.   Learners can identify what they may be doing subconsciously to sabotage their learning and we will help you understand how your cognitive bias may be an obstacle to your own learning.  We will review the most effective delivery of education including sim lab, cadaver labs, chart reviews, and identify why learners and facilitators may be frustrated with their results. It all goes back to adult learning theory, join us and we will give you specific methods for improving the teaching and learning experience with amazing results!

Imagine being born into a world where you are immediately met with adversity: your lungs and circulatory system do not want to support you. This presentation will discuss the identification, management, and treatment of neonates with Persistent Pulmonary Hypertension in the newborn (PPHN). Multiple interventions are required to reverse the symptomatology. This presentation will cover identification of associated illness with chest Xray interpretation and interventions such as oxygenation, sedation/paralysis, vasopressor therapy, arterial blood gas trending/correction, ventilator management, inhaled nitric oxide, and preparation of ECMO cannulation.

This rapid-fire session will seek to test the mettle of both experienced critical care providers and those who are new to the trenches. Peri-intubation resuscitation is an essential skill that must be mastered by critical care providers in order to provide safe and effective airway management. Using scenario-based teaching the instructors will facilitate an interactive session that will allow participants to work through several patient scenarios that will give them the opportunity to hone their skills and internalize the mantra, “Resuscitate Before You Intubate”.

This presentation will focus on the findings of the the AIR-SED Study: a multicenter cohort study of sedation practices, deep sedation, and coma among mechanically ventilated air transport patients. We will review the core findings of the study, the significance of those findings, the current evidence related to ideal sedation practices for mechanically ventilated patients, and how providers can improve their practice by using evidence-based measures to determine sedation levels and base dosing on those findings.

Air medical and critical care ground transport involves more than just extensive medical knowledge. Learning to provide care outside of the hospital in very unique environments is challenging and requires thinking differently than the in hospital provider. In-situ simulation can help bridge the education gap between medical knowledge and the environment. Being able to simulate that exact environment helps to challenge the learner to care for patients in those small, uncontrolled environments.. This session will show how to take that traditional learning and elevate it to a new level using in-situ simulation.

Come join us in the resuscitation of a 58-year-old female presenting with respiratory failure, deteriorating into a difficult peri-arrest scenario. The focus of this session is to develop clinical decision making through the use of a Choose Your Own Adventure case review. The audience will lead the direction of patient care by answering interactive pole questions prompting discussion surrounding; the treatment of COVID pneumonia, sedation strategies, vasoactive agents, opposing ventilator management strategies, and the treatment of diabetic ketoacidosis.

Cardiogenic shock represents a spectrum of disease which includes the most severe forms of heart failure. Despite many advances in care the high mortality associated with cardiogenic shock has not for over 20 years. In this presentation we will focus on the evaluation and treatment of a patient in cardiogenic shock. We will additionally review the physiology of cardiogenic shock and a present a pragmatic approach to treatment within the critical care transport environment.

Have you ever had a respiratory failure patient too unstable to transport but if you could just get them to a higher level of care you know they would be fine? Have you ever had to just fly fast and hope for the best? Do you wish you had another tool to help these patients? Inhaled Pulmonary Vasodilator Therapy (IPVT) use as a transport bridge or stop-gap measure to deliver the patient to a higher level of care can be an extremely powerful tool. Unfortunately, there are some barriers to the employment of IPVT. Some are real and some are perceived. Our hope is to help you add this tool to your tool kit.

In this interactive lecture, we will go beyond basic VA ECMO and delve into the next level of hemodynamic support when traditional VA setup is insufficient. Three major problems will be discussed: insufficient cardiac output, left ventricular failure and offload, and right ventricular failure and offload. We will also discuss the indications for and implementation of additional assist devices and triple cannulation techniques. In closing, we will navigate an actual patient case study with complex congenital issues complicating the situation and traditional VA setup and additive assist devices still wasn’t enough.

Getting away with short cuts is a good thing right? maybe not so much as can kill you. First coined in reference to the Space Shuttle Challenger disaster this has played out in multiple other industries (including Air Medical) over the years. It requires constant vigilance to guard against. This presentation will discuss what this is and why we are prone to this type of failure and most importantly what we can do to prevent it.

What if you could have an noninvasive way to monitor for increased intracranial pressure (ICP). In the prehospital world and rural medicine setting external ventricular drains are almost non existent. Ultrasound could bridge the gap for our critical transport settings. By measuring the Optic Nerve Sheath diameter you can determine if your patient is experiencing increased intracranial pressure.

You can put a 14g in a fly’s forearm with your non-dominant hand at 120 knots, but does that make you a vascular access master?Come supplement your incredible technical skills with a deeper understanding of the spectrum of vascular access strategies and devices. Where are you going to place your next IO? Is that central line all it’s cracked up to be? How well do you know 19th century French physicist Jean Léonard Marie Poiseuille? Is your program ready to start placing ultrasound guided IVs? Arterial lines? Come find out the answers to these questions and more!

A literature evidence-based review of the indications, successes, and complications of extraglottic rescue airways. In the correct circumstances, these airways can be life saving. However, without careful attention to detail, training, and close monitoring their misplacement and associated complications can kill. This literature review will outline the appropriate utilization and successes of extraglottic airways and also the hidden dangers of their complications. This discussion will provide participants with a better understanding of the frequency, classification, and mitigation of associated complications.

What if you could improve scene times by working smarter instead of harder? Faster scene times improve patient outcomes, but can we do it without sacrificing safety? You bet we can! And the result is better for everyone from patients to customers to employees. Tune in for innovative and entertaining ways to make it happen.

Come on ride along with the Electric Storm Chasers to try and find the elusive VT/VF storm. We will discuss the difference between refractory VT/VF and VT/VF Storm, the medical condition that should be on our radar that would point you in the direction of a VT/VF Storm and the steps to take if you find the elusive VT/VF Storm.

You cannot get to the hospital faster, yet patients still die. The days of large bore IVs and intubating your critically ill patient is over. Damage control resuscitation used for years inside the hospital is the only chance these critically injured patients have for improved survival. This requires a coordinated effort by forward thinking prehospital providers to implement and perform in EMS.

High acuity medicine often relies on a data-driven approach to resuscitation. Trending blood pressures, oxygen saturations and lab values can help guide medical management as well as predict acute decompensation, but what if the data you base your treatments on is wrong? From the basic blood pressure cuff to the random number generator known as the temporal thermometer, we’ll walk through some common medical devices and measurements and talk about how they might lead you astray and what to do when they do.

At some point in their careers, critical care transport teams will be faced with a no-win situation in which there is no right answer. Those teams are charged with creating solutions where none previously existed in order to facilitate the movement of patients in extremis to tertiary level care. These cases are wrought with situations in which clinicians must choose the least wrong choice out of many bad ideas. In this case we will present the transport of a catastrophic uterine rupture and the patient’s clinical course along with the lessons learned from the case so that when critical care teams are faced with no good options, they can create one.

Have you ever intubated a patient with CHF and thought to yourself, “there’s GOT to be a better way”? Sick of taking off the CPAP mask every two minutes to give another spray of nitro that just doesn’t seem to work? A better way is here! High dose intravenous bolus nitroglycerin is safe, effective, and allows rapid resolution of symptoms by paramedics in the field. Sympathetic Crashing Acute Pulmonary Edema (SCAPE) is one of the few truly time-dependent conditions that we treat in the field. When minutes truly matter, high dose nitro is the way.

More and more frequently, we are observing acts of domestic terrorism within the US. Though much of the terrorism we have seen is from mass shootings, Defense and Intelligence data suggest that increase in the use of explosive devices in terrorism is possible. We also know that these acts of terrorism do not restrict themselves to affecting only adults. This session describes a case of pediatric blast trauma resultant of a terrorism attack. We will discuss the pediatric-specific implications of blast trauma, the common themes and challenges identified from our biggest data source (military conflict in the Middle East), and identify strategies and recommendations for management of these rare yet devastating injuries.

“The views expressed in this sessions are those of CPT Grabowski and do not reflect the official policy or position of the US Army, Department of Defense or the US Government.”

Ventilators can be one of the most dangerous pieces of equipment on the helicopter. However, there are systematic approaches to using vents. From basic settings to advanced ventilator strategies, we’ll discuss how and why to choose specific settings. Leave the conference feeling more confident in managing your ventilated patient and providing exceptional care.

Critical Care Literature Review 2023

We all know the saying, “sticks and stones may break my bones, but words will never hurt me.” But is this true? What do you think of when you hear the words drunk, stoner, pothead? What picture does do these words conjure in your mind? I Narcanned Your Honor Student seeks to acknowledge that our discursive framing of our patients elicits bias in both us and other caregivers. Furthermore, we explore how these biases may, ultimately, impact patient outcomes. Finally, we will task ourselves with mitigating the impact of bias on our patients.

This presentation will discuss the art of mechanical ventilation as it relates to various disciplines . The combination of experience and energy between a Critical Care Flight Paramedic, Critical Care Flight Nurse, and a Registered Respiratory Therapist will illustrate, yet at the same time demystify, the complexity of mechanical ventilation. This unique presentation not only brings clarity to the management of mechanical ventilation, but also exemplifies the value of interdisciplinary collaboration.

Do you ever wonder where all those tidbits that are touted as fact come from? Do you wonder if they are actually fact? How did they get started and why do we still believe things like “every single needle decompression buys the patient a chest tube”!! We will discuss common medical myths related to critical care transport and prehospital medicine, where they came from, why they continue and what you can do to bust them!

Refresh your knowledge of gestational age viability, neonatal outcomes, management of preterm labor and ethical factors of maternal and neonatal transport of the periviable patient(s). End with a case presentation of a periviable maternal transport in a rural healthcare setting.

This presentation will discuss the physiological changes of pulmonary hypertension with right ventricular failure. The audience will learn clues seen in the physical exam, chest CT, EKG, and ECHO to assist or confirm right ventricular failure. The flight/transport crew will learn to detect reversible causes and initiate treatment measures and/or stabilization measures for transport.

Despite decades of advances to in-hospital trauma care, we have not moved the needle on survival of patients arriving to trauma centers in hemorrhagic shock. A significant proportion of potentially preventable death occurs in the streets from torso hemorrhage. We must change our approach to identifying and managing these patients so that they can receive effective advanced resuscitative care closer to the point-of-injury. This talk will outline the problem and some potential solutions to change the existing paradigm.

Transporting children often increases our anxiety as providers, and placing a pediatric patient on a ventilator adds even more stress. Together we will review the important ways in which we must modify our approach to mechanical ventilation for pediatric and neonatal populations, identifying how and when it’s safe to use transport ventilators for our smallest patients. We will discuss dead space elimination, ways to identify CO2 rebreathing, key differences in settings, and sedation/analgesia strategies for pediatric patients.

This lecture will utilize real life case studies to examine the pediatric seizure patient. It will discuss the prevalence and etiology of the pediatric seizure. The different types of seizures will be defined and discussed. in addition, the intricacies, and difficulties of assessing the pediatric seizure patient will be addressed. The discussion will conclude with a conversation of how utilizing a collaborative team approach to stabilize a patient prior to transport, and then continued management of the seizure patient during short vs longer transport times.

Burns are among the top 5 injuries sustained worldwide and represent a common reason for activation of EMS and critical care transport. This presentation will highlight the down-and-dirty of emergency evaluation and management of burns in the field and during transport, including initial resuscitation, stabilization, and treatment of potential emergent complications.

Epo is that drug we give when we can’t get someone’s SpO2 up right? In Three Letters Five Life Saving Uses Critical Care Transport Educator Jen Wheeler will discuss the non traditional life saving uses of Epoprostenol. Jen will discuss the role of Epo in complex ECMO cases, R sided heart failure, pulmonary emboli, complex metabolic and respiratory diseases process. This presentation will not only educate providers on this multi faceted tool but work to stimulate a discussion on the many benefits of utilizing this medication more frequently in the transport setting.

TU-BE or not TU-BE, That Really is the Question! Critical care transport decisions can have a profound impact on patient care and outcomes. In the context of Covid-19, there were many decisions that had to be made with respect to invasive or non-invasive ventilation modalities. Those same decisions need to be addressed in the non-Covid-19 respiratory failure patient. This presentation will focus on the invasive and non-invasive approaches to ventilation and highlight the success and predictors of failure in these patients. A case study will also be discussed.

OB transports are infrequent and challenging for generalist teams – the physiology is different, the diseases sometimes unique, and there can be a second patient along for the ride. Often, our training is incomplete, outdated, or sometimes wrong. This talk will provide a solid foundation in obstetrical critical care, including clear management strategies and correction of your misperceptions.

Are you a transport clinician that gets a funny feeling in your stomach every time the request includes “Be advised the patient has a Intra-Aortic Balloon Pump”? In this time we will be sharing lessons learned over a 20 year career caring for, transporting, and providing QA for transports of patients receiving IABP therapy. What are those tricks to keep us out of the traps of IABP transport.

Built around EMS operational challenges, this session will describe the EMS Code Lavender Program, which provides support and acts of kindness to providers after stressful events, and offer agencies a template for a realistically sustainable program.

A 15-year old patient with known food-borne allergies returns home from school showing signs of anaphylaxis. By the time EMS arrives the known asthmatic, is now also in a full blown status asthmaticus. Prior to flight team arrival the EMS crew has had to RSI the patient, leading to significant difficulties ventilating. What do you do next? This discussion will review the epidemiology, pathophysiology, evaluation, and what the literature says about treatment strategies.

The use of High Flow Nasal Cannula (HFNC) therapy has exploded across neonatal, pediatric, and adult populations, and now you are receiving requests to transport these patients. What patients require HFNC to be continued in transport? How do you decide when it’s safe to transport versus intubate? Is it possible to transport heated, humidified HFNC in an aircraft? Where do you start? This talk will give you confidence to help your program find the right answers.

Remember when your greatest fear was to care for a high-risk OB patient? What could go wrong now that she has delivered? The United States is one of the LEADING industrialized nations in maternal mortality. How can this be, and how can we do better? Come to this fast-paced and terrifying lecture to learn how to recognize better and mitigate postpartum

The move into a management role, whether “Buddy to Boss” within your own organization or taking the reigns as the new manager in a different company, the “transitional period” is one of the most crucial and can set you up for success, or start you off at the bottom of an endless uphill climb. During our session we will discuss some management strategies for success and pitfalls to failure to send you on your new managers path with the best foot forward

Children with special health care needs account for approximately 1% of the population. When these children with chronic medical complexity get sick, EMS is often called upon to treat and transport them. Caring for these children require the provider to recognize a specialized approach to assessment and treatment. Through this presentation, and case scenarios, a provider faced with caring for this special population will be better able to identify assessment and treatment considerations, recognize transport challenges, and have a basic understanding of some medical devices that may be encountered.