ECHO 2017 Critical Care Weekend Beth Israel Deaconess Medical Center And Brigham and Women's Hospital Boston, Massachusetts

Pre-Conference Workshops March 24th Mechanical Ventilation Workshop – 0800- 1800 ECHO and Eric Bauer of FlightBridgeED have partnered to bring you his world-class workshop on mechanical ventilation. (8 CEU hrs awarded)

Advanced Airway Management Workshop 1300-1700 The workshop starts with an updated evidence based prehospital airway management lecture and round table. The workshop will transition from lecture to advanced hands on skills lab. Attendees will have the opportunity to get hands on with multiple advanced video laryngoscopy devices and scenarios, preform surgical airway and learn techniques with current alternative airway devices. This course is perfect for those who want to assist in airway management to the critical care provider looking to improve their skills. (4 CEU hrs awarded)

EMSPOCUS 0800- 1200 POCUS (point of care ultrasound) is a severely underutilized tool in the prehospital and retrieval environment. Discover how this diagnostic modality can be implemented to positively impact patient care in big ways. Topics include overcoming deployment and training issues, vascular access and medical indications, such as differentiating occult causes of shock and the utilization of POCUS in cardiac arrest for both treatment and prognostication with a hint to the possible future of EMS care in strokes and preventative medicine. (4 CEU hrs awarded)

Petrillo’s Pit of Pain 1300-1500 An interactive pediatric case simulation led by Children's Healthcare of Atlanta intensivist and transport medical director Dr. Toni Petrillo. Teams of 4-5 will take on the challenges of a complex, real-life pediatrics case simulation, followed by group debrief after each case. (2 CEU hrs awarded)

Brigham & Women’s Hospital STRATUS Simulation Center 0800- 1130 Participants will be given a tour of the technologically advanced STRATUS simulation center. In addition, targeted simulation scenarios will be planned, conducted, and debriefed. An excellent opportunity to see what STRATUS has to offer, and an excellent introduction to simulation as a tool.

Wilderness Survival Workshop 0800-1600 John Tierney of Lifeflight of Maine will lead an intensive wilderness survival workshop, that will cover topics such as shelter building, cold weather survival, fire making, and use of aircraft and medical equipment for survival.

Tightening the Circle: Developing mastery based training and increasing precision. 1300-1700 Fred Jefferies from Boston MedFlight brings us this unique workshop on human performance. During this workshop, you will work as a group to begin building and understanding avenues to improve your performance across any of the human performance domains. Through the exploration of arousal control, leadership and followership, equipment mastery, risk management, discipline, knowledge base, and skill performance we will explore how to build training programs for ourselves or our team that will focus on error control and maximizing safety in our operational and clinical practice. Participants will leave the workshop with the beginning of a personalized plan, and a roadmap for implementation.

WELCOME TO BOSTON!

Join us Friday night at The Banshee 934 Dorchester Ave, Boston, MA (Less then a mile from the host hotel)

Come out and meet your fellow attendees and the ECHO team at a true south Boston Irish pub 1830- they throw us out

2017 Critical Care Weekend March 25th 0700-0800

Registration and Breakfast

0800-0830

Opening remarks & The ECHO Plan Jon Kaminski- ECHO President Matt Libby – Boston Medflight, MA

0830-0900

Social Media Meets Air Medical – Sam Matta – PHI Air Medical, MD

Jedi Mind Tricks: Anticipation, Pathophysiology, and the Secret to Emergency Medicine 0900-0930 John VonRosenberg- WakeMed, NC Matt Adams – Duke Life Flight, NC 0930-1000

Break/Vendor Visits



Beth Israel Deaconess

Brigham and Women's

1000-1030

“Perfusion-protective" strategies during RSII Dr. Sam Galvagno – Shock Trauma, MD

Why your CRM sucks. Fred Jeffries- Boston MedFlight, MA

1030-1100

Preparing for Disaster, Tips and Tricks for the Difficult Intubation David Olvera- Air Methods, CO

Why Does My Pilot Fly Differently Than Your Pilot? Dan Foulds –helicopterEMS.com

1100-1130 1130-1300 1300-1330

1330-1400

1400-1430 1430-1500 1500-1630

Diagnosis and Management of Too Sick For Transfer: Our Failure Massive Pulmonary Embolism and Our Fallacy Dr. Daniel Haase- Shock Trauma, MD Vahe Ender – Boston MedFlight, MA Lunch Undifferentiated Hypotension Daniel Rauh – UC Aircare, OH

Magnifying the Genius In Others Eric Bauer – FlightbridgeED, KY

Let’s Try This! Toxicology interventions that are so crazy they Unmanned Systems Airspace just might work. Integration Concepts and Challenges Michael Frakes – Boston MedFlight for Civilian Helicopter Operations Point of care testing in Pre-Hospital David Barnhard- Kutta Technologies environment Dr. Sam Galvagno – Shock Trauma, MD Break/Vendor Visits Critical Care Panel Dr. Jason Cohen – Boston MedFlight, MA Dr. Sam Galvagno – Shock Trauma, MD Dr. Daniel Hasse- Shock Trauma, MD Dr. Steve Carroll – Grady Health, GA

The Down for Weather Bash

The Down For Weather Bash is proof that ECHO believes in playing as hard as we work! The event will take place at District Hall an amazing space develop by the city of Boston and local business to connect communities and foster innovation. This is a perfect fit since ECHO was founded to bring together the public safety aviation community in order to improve, innovate and educate. District hall is located at: 75 Northern Ave, Boston, MA (Only a few miles from the hotel) 1830-2230 Remember you need to register for the bash on the registration site so we have a good head count. Please feel free to bring your significant other you just need to register them.

2017 Critical Care Weekend March 26th



0900-1000

Offshore Rescue in the German bight / Facing the challenges Klaus – Dieter Berner - Johanniter-Unfall-Hilfe, Germany

1000-1030

Break/Vendor Visits



Beth Israel Deaconess

Brigham and Women's

1030-1100

Aortic Disasters Dr. Steve Carroll – Grady Health, GA

Pediatric status asthmaticus Dr. Jordon Rettig – Boston Childrens

1100-1130

LUCAS to the Cathlab Dr. David Gaieski – Jefferson, PA

Sweet Little Kids Jason Clark – LifeForce, TN

1130-1300

Lunch

1300-1430

Pediatric Transport Panel Dr. Toni Petrillo – Childrens Healthcare of Atlanta, GA Dr. Jordon Rettig – Boston Childrens, MA Dr. Nga B Pham– Childrens Healthcare of Atlanta, GA Dr. Serguei Roumiantsev - Massachusetts General Hospital for Children

1430-1500

Break/Vendor Visits



Beth Israel Deaconess

Brigham and Women's

1500-1530

Is It A Killer Cooler? The Trouble With Transfusion. Michael Frakes – Boston MedFlight

Feed and Grow your Neonate Transport Program : The BMF Experience Matt Libby – Boston Medflight, MA

1530-1600

REBOA – lessons learned Dr. Zaf Qasim- Christiana, DE

ICP management Dr. Nga B Pham– CHOA, GA

1600-1630

The Greatest Story Ever Told: War Stories as a Coping Mechanism Jason Boitnott

Neisseria Meningitis: A Case Study Erin Reading - Geisinger Life Flight, PA

Presentation Descriptions

March 25th

Social Media Meets Air Medical If you are like me HEMS was your dream job. I thought this is where you go to be challenged every day and to never stop learning. While this maybe true at the beginning of your career I would argue that if you do not work at it working for a HEMS program can be the most detrimental move for your learning and education. In the hospital or on the truck we would either directly of indirectly see many many patients on any given day. The typical HEMS crewmember sees 10-12 patients a MONTH! So how do you stay current? Personally I use social media and the FOAMed world to help me. This presentation will be a brief discussion of FOAMed , leveraging social medial for continuing education and how it has influenced my practice and ECHO. Jedi Mind Tricks: Anticipation, Pathophysiology, and the Secret to Emergency Medicine: The pursuit of excellence in patient care is a worthy and admirable challenge for all of us as clinicians. So what is the best method of developing fluency in medical knowledge and performance? Is the secret in experience, patient contact, and “putting in our time”? Should we focus our attention on academic superiority, the study of case reviews and research articles? This presentation will address the question of experience versus education and its impact on the dynamic relationship of flight crew teams Why your CRM sucks. CRM extends well beyond the aircraft, but is seldom discussed in our clinical contexts. What are the problems that CRM is seeking to solve and are we doing that? I would argue that much of CRM misses the point. A renewed focus on why we need it, and how it helps with workload management, maintaining situational awareness, and team communication in and out of the aircraft is the subject of the talk. “Perfusion-protective” strategies during RSII Rapid sequence induction and intubation is a perilous procedure, especially for hemodynamically unstable patients. In this talk, the relevant physiology will be reviewed as well as several evidence-based recommendations to help avoid hemodynamic compromise during or after institution of mechanical ventilation. Preparing for Disaster, Tips and Tricks for the Difficult Intubation At some point in our career one will experience a difficult airway. Was it difficult because of the attempt or saturations? This presentation will focus on updated evidence based practice in assessing for the difficult airway in the prehospital setting and determining what is more important; first pass success or preventing desaturation? Additionally, we will review the utilization of the cutting edge, evidence based HEAVEN criteria in determining difficult airway and proper steps to achieve the highest level of saturation prior to the attempt.

Why Does My Pilot Fly Differently Than Your Pilot? Not understanding why your pilot does what he or she does, or does NOT do what they should, can cause anxiety, discord, or even damage to an aircraft or injury to those on board. Breaking down the barriers between aviation and medicine are key to long-term success in HEMS/HAA operations, but working through these issues requires a set of soft-skills that requires practice, perseverance, and professionalism. Diagnosis and Management of Massive Pulmonary Embolism Understanding and correctly diagnosing severity of pulmonary embolism is critical to choosing therapeutic options and transfer to a higher level of care. This lecture will explain the current definitions of PE, demonstrate the utility of bedside echo in making diagnoses, and describe the current best practices on therapeutic options for massive and submassive PE. Too Sick For Transfer: Our Failure and Our Fallacy We explore the fallacy of instability as an exclusion for transport and explore our responsibility and duty which we have towards our most critically ill and injured patients. I will discuss organizational and personal approaches to dealing with this patient set and ultimately push us to advocate for our patients when no one else is. It’s my hope that this talk inspires providers and hospital staff to reframe how they perceive the critically ill, peri-arrest patient. Magnifying the Genius In Others How much do we invest in our own personal pursuit to greatness? Often times in our life and career, we have times of growth and times of stagnant, unproductive growth. Why is that? Why do we start out of the gate so well and then due to life events, circumstances, surroundings, and culture we fail to pursue our dreams? We fail to see the future as empowering. How can we become leaders in our craft? What sets people up for success? What allows people to become the best in their field? We’ve seen many people in our lifetime that are “Pioneers” in their respective fields. What’s that secret ingredient they possess? In an attempt to answer those questions we will look at my top 10 core objectives for “Magnifying the Genius in Others”! Let’s Try This! Toxicology interventions that are so crazy they just might work. Patients with massive overdoses can present extraordinary management challenges, as the pharmacology overwhelms our best attempts at resuscitation. Some of the most effective interventions for these complex patients are the dusty medications at the bottom of your drug box, some things that don’t make sense, and some things you had never imagines. In this presentation, we’ll talk about how things that sound more like a good meal – salt, fat, glycemic agents, alcohol, and a methylene blue chaser may be great options for managing the sickest overdose patients. Point of care testing in the prehospital environment. With the advent of portable laboratory monitors, point-of-care testing is now feasible in the prehospital environment. In this lecture, the capabilities of these monitors will be reviewed. Clinical conditions warranting point-of-care laboratory testing in the field will be discussed.

Unmanned Systems Airspace Integration Concepts and Challenges for Civilian Helicopter Operations The purpose of this discussion is to provide the audience with a comprehensive and current view of Unmanned Aerial Systems (UAS, Drones) and the various factors that impact operations around these systems. The discussion will include basic history of Unmanned Aerial Systems, current regulations, briefings from recent incidents and lessons learned, as well as future technology and procedures that could be useful in minimizing the risk these systems present to the Helicopter Community. Trauma/Critical Care Panel The panel will be a chance to pick the brains of subject matter experts in the field of critical care and resuscitation medicine. Topics in the past have included ECMO, ARDS, Sepsis, heart failure, massive transfusion, TBI and airway management. This time around the panel will be presented with cases submitted by attendees and members. If you are interested in offering up a case to be discussed check our social media profiles to find the details.

March 26th

Offshore Rescue in the German bight / Facing the challenges An overview of the operations of the HEMS/rescue system that serves the German Bright and the hundreds of wind turbines and transformer platforms that sit off shore. LUCAS to the Cathlab A disccussion of the use of mechanical CPR devices to deliver a patient both to and through the hospital to difinative care. Aortic Disasters Understanding the diagnosis and treatment required to successfully care for the patient with aortic pathology takes a high level of suspicion, aggressive yet nuanced management, and a team approach. No matter if it is a stable AAA that the patient has had for years or a rapid onset type A dissection if you don’t respect the aorta it will ruin your day. Pediatric status asthmaticus Status asthmaticus is one of the most complicating pathologies to treat out there because may times it’s management seems to be counter to what we want to do. To successfully treat these diseases requires finesse and skill. This talk will provide pearls to successfully treat this scary population. Sweet Little Kids The critical care transport clinician can be faced with a multitude of critical pediatric illnesses. Pediatric diabetic ketoacidosis is a condition that requires transport clinicians to have thorough understanding of the pathophysiology of DKA and how it affects the body as a system. Management of acidosis, fluid resuscitation, ventilator management, and many other decisions should go through the minds of the transport team and actions must be taken following a welldeveloped plan. This lecture will cover the latest research based care regarding pediatric DKA and is designed to increase the comfort level of providers when faced with caring for these pediatric patients.

Pediatric Transport Panel With more and more “adult” teams being asked to transport ever more complicated pediatric patients this will be an opportunity to discuss cases with subject matter experts from the pediatric critical care and transport medicine community. Just like the Trauma/Critical Care panel the cases will be summited by ECHO members and attendees. If you are interested in submitting a case fro review please visit out social media profiles to find more details. Is It A Killer Cooler? The Trouble With Transfusion. If you’re not carrying blood, you’re not sitting with the cool kids at the transport meetings. It seems pretty clear that people who are bleeding or anemic need transfusion, and the more is probably better. This talk will ask you to re-think your “two units on pressure bags” approach and consider the actual outcomes associated with transfusion, both short and long-term. After a fair and balanced review of the medicine, including the transport-specific outcomes, we will consider the best role for blood product administration by critical care transport programs. REBOA – lessons learned REBOA is a new and promising tool in the management of the critically injured patient currently being used in level 1 centers in the US. However, is it ready for primetime? What do you need to know about it and what implications does it have for critical care transports? The Greatest Story Ever Told: War Stories as a Coping Mechanism Ever heard those war stories from coworkers that made you roll your eyes because the person telling the story is always the hero of the story? This would be a talk about how those stories and the hero creationism of the people who tell them, they are actually using those stories as a coping mechanism for events where they were out of control, messed up, or failed in some sort of way. The hero story is as old as civilization and our individual hero stories are very telling of us and our emotional states as providers. Feed and Grow your Neonate Transport Program : The BMF Experience A discussion of how BMF added Neonate transport to there mission profile and the growing pains they experianced. Neisseria Meningitis: A Case Study This was a transport I was on that needed to be done by ground due to bad weather. The patient was a 5 month old with possible meningitis that we needed to secure the patient’s airway and start vasopressors. The patient had a 60 minute transport to our PICU and had a rapid onset of symptoms. The patient made a full recovery and was discharged from the hospital 23 days later. This presentation will discuss what the hospital did for the patient, what the flight crew did, the transport and how the patient did through her hospital stay. The presentation will then review Neisseria meninigitis, its signs and symptoms and current treatment regimen along with complications i.e. purpura fulminans and DIC. The presentation will also discuss the patient’s survival and how rapid treatment and transport helped improve this patient’s outcome.