Head in the clouds

Here I am, sitting at 35,000′ on a 737 on my way back to the cornfields that I call home. Ain’t technology grand? I’m headed back after a long weekend in Washington DC. The primary purpose of this “vacation” was to attend a weekend of critical care education being provided by East Coast Helicopter Operations (ECHO). In short, ECHO is a grassroots organization that was born out of frustration at the lack of affordable, quality training and the way that neighboring HEMS programs kept their thoughts, knowledge and training in their respective silos. It’s something that I think we can all identify with within our own specialties and geographic areas. A couple years ago ECHO sponsored a small event that lured in local programs with the promise of free food. Attendance exceeded expectations and something very special and unique was born. Today, ECHO provides multiple trainings every year, all 100% free of cost to members. The only requirement of membership is that the individual is a member of a civilian or military flight crew (not just medical; ECHO also provides training to enforcement, rescue personnel and even pilots), regardless of geographic location.

On Saturday, Children’s National Medical Center provided their Pediatric Difficult Airway course to EMS personnel for the very first time. Sunday’s agenda consisted of several critical care topics including burns, advanced ventilator management, everyone’s favorite medication– ketamine, and the use of ultrasound in the field (ah, yes, there’s the relevance). Quite honestly, this was some of the highest quality training I’ve ever received in a single weekend, regardless of cost. I don’t have the words to express how happy I am to see the FOAM concept crossing into the “real” world. It’s also refreshing to know that there are plenty of individuals supporting FOAM, whether they know it or not, who are not active in social media. Yet.

I feel a big “thank you” is due to the main sponsors of the weekend: Physio-Control, Hamilton and SonoSite. I also want to thank Jon Kaminski and the rest of the ECHO crew for opening up their geographic borders and letting me come back to my native coast and participate. It is worth noting that ECHO will be hosting their annual conference in Virginia Beach, VA, September 28-30. There is no cost to attend and the conference hotel is providing ocean-front suites for $79/night. I strongly encourage any flight crew members that may be reading this to check it out and consider attending. A program for the conference is due out in early August, and word on the street is that some major players in FOAM may be involved.

That being said, you’re here for POCUS. Something I’ve noticed from speaking with the EMSPOCUS crew in our formal (or at least as formal as EMS can manage, especially across the miles and time zones) weekly meetings is that we’re having very similar experiences in talking to our own contacts and colleagues. We’re quickly discovering that there is enormous interest in our mission, but it’s typically at the level of the individual: one or two clinicians here and there who want to push their practice further and harness the technology that is available in order to improve patient outcomes, but have no local support. I don’t typically like to do this, but I’m going to dare to speak for the entire team and say that this is the way we’ve all felt for a long time, in all aspects of prehospital emergency medicine and critical care. SMACC Chicago was the catalyst needed to bring EMS providers of all levels and nations together in the same room and realize that we’re not alone in our attitudes, goals and dreams. For that, I cannot express my level of gratitude toward the SMACC organizing comittee and everyone else who put in the hard work to make it possible.

It’s worth being explicit and stating that not a single individual in our core group had any real experience with sonography before the EMSPOCUS project was born, and the level of knowledge any of us possessed was elementary at the very best. I’d never even held a transducer in my hand myself. There is little to no research experience amongst ourselves either, which is tragically typical of EMS providers, especially in the United States. As much as this feels like true insanity when I stop and think about it, there is also a very interesting benefit here: we’re experiencing the most extreme early adopter scenario possible. We’re going to face all the same problems that anyone else will when trying to learn and apply prehospital sonography. This is going to force us to be experts on the subject of learning, training and adopting a practice changing diagnostic tool. As daunting as it is to attempt to learn both sonography and the basics of valid scientific research simultaneously, we’re paramedics: we live to perform at the highest level in the most disadvantageous contexts. Personally, I hope that this project inspires others to act on their own goals just as much I want it to change the prehospital game.

Back to this weekend. Denise Baylous, a flight nurse with Nightingale Regional Air Ambulance in Virginia, gave a great session on field sonography. Interestingly, Nightingale is currently in the midsts of their own research on the effects that ultrasound has on patient care, both in the field and in the initial phases of in-hospital resuscitation upon handover. Some very intersting preliminary numbers were mentioned. I am looking forward to seeing the published results of their experience.

It was during this session that I finally had my first hands-on experience with ultrasound with the SonoSite NanoMaxx. As I expected, some of the views of the eFAST took some real thinking about what I was seeing on the screen versus my “internal picture” of the simulated patient’s internal anatomy. It was somewhat difficult to obtain some views, but this was with no formal training. I will say that the subxiphoid cardiac view was very intuitive and I was able to obtain a high quality view in just a few seconds. After this very brief experience, I feel confident that a high level of success by most prehospital providers will be possible with an appropriate regimen of introductory and continuing education. Interestingly, as part of this session, I met crew members from another regional program who had thoughts of their own on creating a study on sonography but were stymied by their own circumstances. It was great to see further proof from outside the FOAM world that there really is a demand for this project.

Mr. Kaminski’s business card includes an interesting quote on the reverse:

We are all tired of sitting back and hoping. It’s safe to say that despite the enormous challenges we are facing head on, we are on the right path.

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