The 2009 edition of theMaryland Medical Protocols forEMS Providers, effective July 1,2009, contains many revi-sions, as well as new proto-cols that have direct impacton all levels of EMS providers.Below is a sampling of proto-cols that have either beenadded or have undergonemajor revisions. For the com-plete list, see the moredetailed Protocol UpdateSummary spreadsheet thatlists each individual protocolrevision by page and line

numbers and protocol title. This Update Summary will beavailable in PDF format on the MIEMSS web pagewww.MIEMSS.org.

Sampling of New or Revised Medical Protocols for EMSProviders for 2009• New “Nausea and Vomiting” Protocol.• New medication “Ondansetron (Zofran).”• Replacement of diazepam with new medication “mida-

zolam” for all indications except nerveagent/organophosphate exposure, where either medica-tion may be of benefit (diazepam is part of the CHEMPAC inventory).

• The purchase of a circular magnet for use in the eventof the failure of an Implantable CardioverterDefibrillator (ICD).

• General Patient Care (GPC) “Transition of Patient CareALS to BLS” section contains new text.

• GPC modification of “priority definitions”:o Priority 1 - Critically ill or injured person requiring

immediate attention; unstable patients with (deleted potentially) life-threatening injury or illness.

o Priority 2 - Less serious condition yet potentiallylife-threatening [added] injury or illness, requiringemergency medical attention but not immediatelyendangering the patient's life.

• Removal of endotracheal medication administrationonly for adults.

• Allowing “Nurse Practitioners” to sign for EMS/DNRforms and providing verbal EMS/DNR orders if onscene.

• New site (proximal humerus) for mechanical IO inser-tion can be used when other sites not available.

• CPAP is no longer an Optional Supplemental Protocol.CPAP, now a Standing Order for ALS providers, wasmoved to the Procedure Section.

Sampling of New or Revised Optional SupplementalProtocols• Protocol for impedance threshold device (prevents air

from entering the chest during chest recoil: doublingblood flow back to the heart during CPR) was added.

EMS NewsFor All Emergency Medical Care Providers

Maryland

Vol. 35, No. 5 February 2009

2009 Edition of EMS Protocols

Availability of 2009 MarylandMedical Protocols for EMSProviders

Will be able to be downloaded from the MIEMSSwebsite at www.miemss.org:• 2009 replacement pages (containing any revi-

sions, additions and/or deletions) to be insertedinto the binder of the complete Maryland MedicalProtocols for EMS Providers.

• The most current, complete Maryland MedicalProtocols for EMS Providers can be downloadedfrom the MIEMSS website and placed in a binder.

Will be distributed free by MIEMSS to every EMSprovider:• 2009 Abridged Pocket Protocols that have the core

protocol changes for quick reference and review.

It is the responsibility of each EMS provider toensure that he/she is familiar with all the revisions,additions, and deletions contained in the 2009Maryland Medical Protocols for EMS Providers. Priorto July 1, 2009, all EMS providers (BLS and ALS) mustcomplete a protocol rollout session that will coverthe new material. Further information on the rolloutwill be available in March.

(Continued on page 2)

Maryland EMS News

Rear-Facing Car Seats: What’s the Big Deal?

2

Across the state of Maryland, asmall but passionate group of peopleknown as CPSTs (Child PassengerSafety Technicians) work to educateparents and guardians about how toproperly restrain children in carseats and booster seats. The goal isto ensure that children are riding inmotor vehicles in as safe a manner aspossible. CPSTs see EMS providers asthe perfect partners in delivering thisimportant message to families. EMSproviders interact with parents everyday and, therefore, have an opportu-nity to share this information thatcan help keep children safe and savelives.

Speaking of car seat safety . . .safer than children in forward-facingcar seats? Did you know that chil-dren should not automatically beswitched from rear-facing to forward-facing as soon as they turn one yearold? If you have children or knowfriends who have young children,

then continue read-ing this article tolearn why rear-fac-ing is best.

When educatingparents on the topicof car seat safety,one of the mostimportant messagesto convey is thatrear-facing is safest.Infants start out inrear-facing car seatsbut, unfortunately,many parents aretoo eager to turntheir children for-ward-facing. In thepast, parents weretaught that childrencould be turned forward-facing oncethey reached one year of age. Thisthinking is a way of the past and hasbeen changed by research thatshows that rear-facing is safer thanforward-facing for children wellbeyond one year of age.

In fact, the American Academy ofPediatrics (AAP) recommends thatinfants should ride rear-facing to themaximum weight or height of therear-facing convertible (or toddler)seat because it provides the bestprotection. Rear-facing provides bet-ter protection than forward-facingbecause infants and young childrenhave weak neck and shoulder mus-cles and soft, immature bones. Carseats, especially in the rear-facingposition, safeguard these fragileparts and provide maximum protec-tion during a collision. When posi-tioned rear-facing, the back of the carseat absorbs much of the energy ofthe crash, cradling the child's headand neck. This helps prevent brainand spinal cord injuries. Most con-vertible car seat manufacturers rec-ognize the value of rear-facing, so car

seats are continually being modifiedto allow children to rear-face as longas possible. Convertible car seats,depending on the brand, allow forchildren to sit rear-facing until theyweigh 30 pounds or more. For thevery best protection, children shouldride rear-facing until they are at least18-24 months old.

If EMS providers partner withCPSTs and injury prevention advo-cates to spread this important mes-sage about rear-facing, the resultcould be amazing – fewer childrenwith brain and spinal cord injuries asa result of motor vehicle collisions.This is a result that we should all beworking to achieve!

To help spread the messageabout rear-facing, the ChildPassenger Safety & OccupantProtection (CPS 7 OP) HealthcareProject at MIEMSS is hosting a freeconference call on Tuesday, February24, from noon to 12:30. A local CPSexpert will be discussing the evi-dence for rear-facing and how best toshare the message with parents.

• Laryngeal Tube Airway Device(King LTS-D™) was added as anadjunct or alternative toCombitube or EASY tube).

• Certified First Responders are nowallowed to administer MARK I Kitsas “buddy aid.”

New Pilot Protocol• Protocol for Using the Pelvic

Stabilization Binder Device forSuspected Pelvic Fractured

If you have any questions regard-ing the additions or revisions con-tained in the update, please contactState EMS Medical Director RichardAlcorta, MD, at 410-706-0880.

2009 Edition of EMSProtocols(Continued from page 1)

Rear-facing convertible car seat: allow toddlers to rear face up to35 pounds (weight limits differ by brand).

(Continued on page 3)

Slides and audio from the presentation will be posted onthe project website:http://www.miemss.org/EMSCwww/CPSHome.htm.

Also, keep an eye out for the CPS & OP interactivedisplay at the upcoming Miltenberger conference onSaturday, March 14, 2009. We will be handing out lots offree, up-to-date child passenger safety and occupant pro-tection resources!

◆ Pamela Homiak, RN, BSN, MPH, CPS-TCPS & OP Healthcare Project CoordinatorEmail: phomiak@miemss.org

3Maryland EMS News

Rear-Facing Car Seats: What’s the Big Deal?

(Continued from page 2)

Rear-facing infant seat: for newborns and young babies (weight lim-its, from 22-30 pounds, differ by brand).

Promote Poison Prevention Week

National Poison Prevention Week (March 15-21) is fastapproaching! The Maryland Poison Center encourageshealth care providers, educators, and other communityorganizers to take part in activities to promote poisonprevention during that week. For more information onNational Poison Prevention Week, including ideas foractivities to promote poison prevention awareness toyour patients, clients, students, and community, go tohttp://www.mdpoison.com/publications/pdf/Natl%20Poison%20Prevention%20Week%202009%20info.pdf .

To order materials, go to www.mdpoison.com andclick on “Online Store.” Call Angel Bivens at 410-563-5583for more information.

A Proud Partner in Your Community:EMS Week 2009 Is May 17-23

National Emergency Medical Services Week bringstogether local communities and medical personnel to pub-licize safety and honor the dedication of those who pro-vide the day-to-day lifesaving services of medicine's "frontline." This information can be used throughout the yearfor public education and safety programs. For additionalinformation, contact emsweek@acep.org.

Call for Award Nominations

Just a reminder! Don't miss the deadline for nomina-tions for the Maryland Stars of Life Awards and the RightCare When It Counts Awards! All nominations must bereceived at MIEMSS by March 30, 2009. See the MIEMSSwebsite www.miemss.org (click on Maryland EMS underWhat's New) for nomination guidelines and forms.

Three Certified Flight Communicator (CFC) trainingclasses recently were held for Maryland State Police(MSP) Aviation Command (AC) personnel and MIEMSSCommunication Operators. As of January 30, 2009,SYSCOM is 100% staffed by Aviation CommunicationsSpecialists. A total of 35 MIEMSS and MSP personnel nowhold CFC credentials.

The Certified Flight Communicator course providedby the National Association of Air MedicalCommunications Specialists (NAACS) is recognized by theFederal Aviation Administration (FAA) as the standard forcommunications specialists operating in helicopter EMSoperations. The training and certification of the MIEMSScommunications operators and MSP duty officers is thefirst step in the process to qualify SYSCOM as a HelicopterEMS Operational Control Center under MSP's proposal tothe FAA.

Course topics included resource management, FAAregulations, aviation weather, navigation, public relations,stress management, safety, and post-incident response.Instructors included Lt. Walter Kerr, Quality AssuranceOfficer, MSP AC; CP Mike Gartland, Chief Pilot, MSP AC;1st Sgt. Pat King, Support Operations, MSP AC; TFC EricSmothers, CISM Coordinator, MSP AC; Doug Crum,Aviation Communications Specialist, MIEMSS; and JamieEberly, Communications supervisor, PHI Aeromedical,INOVA-Fairfax Hospital, VA.

This training will allow aviation communications spe-cialists in SYSCOM to make full use of new technologyflight-tracking and weather observation tools currently inoperation. With a primary focus on safety and effectivepublic safety mission management, this training specifical-ly supports the main responsibility of SYSCOM in provid-ing medevac response to the citizens of Maryland.

35 SYSCOM, MSP Staff Now Aviation Communications Specialists

MARMARYLAND YLAND EMERGENCY MEDICAL SEREMERGENCY MEDICAL SERVICES VICES

SYMPOSIUM 2009SYMPOSIUM 2009

“Excellence in EMS”

May 14-17, 2009Annapolis, MD

Annapolis Sheraton Hotel

Presented By:Maryland's Regional EMS Advisory Councils,

The Maryland Institute for Emergency Medical Services SystemsWith the support of

The Emergency Education Councils of Region III and Region V

Maryland EMS Symposium 2009“Excellence in EMS”

May 14-17At the Annapolis Sheraton Hotel

The Program

The first EMS Symposium developed by a statewide planning committee representing EMS partners from across Marylandoffers cutting-edge presentations for prehospital EMS providers, nurses, fire/rescue personnel, and emergency medical dis-patchers. National speakers, hot topics, and an enticing setting make this a “must do” event. A wide variety of pre-symposiumtopics offers a persuasive reason for expanding your stay in our beautiful state capital. Special Events will include aPreakness Celebration and an EMS Week Kick-Off featuring the Maryland Star of Life Awards and the Right Care When ItCounts Awards for Children.

Continuing Education

All workshops are approved by the Maryland Institute for Emergency Medical Services Systems (MIEMSS) for continuingeducation for ALS and BLS providers. EMT-Bs can fulfill all of the 12 hours of didactic (4 Medical, 4 Trauma, and 4 Local)training required for recertification. A 12-hour skills class is also available during the pre-symposium activities. Symposiumstaff will be available on-site to assist attendees with their CEU requirements. For specific questions regarding continuingeducation requirements, please contact the MIEMSS Office of Licensure and Certification at 410-706-3666 or 800-762-7157.

**As an exciting new addition, the Maryland EMS Symposium 2009 will also offer NURSING CEUs for workshops in the“Advanced Practice” track. Nursing CEUs are provided by Franklin Square Hospital Center and co-provided by MIEMSS.Franklin Square Hospital is an approved provider of continuing nursing education by the Maryland Nurses Association, anaccredited approver by the American Nurses Credentialing Center's Commission on Accreditation.

The Hotel

The Maryland Emergency Medical Services Symposium 2009 will be held at the beautiful Annapolis Sheraton Hotel locatedat 173 Jennifer Road, Annapolis, Maryland 21401. Room rates for the Symposium are at the following discounted rates:Single/Double $123/night; Triple $143/night; and Quad $163/night. To receive this rate, you must make your reservations NO LATER than Monday, April 13, 2009. After this date, the room rates will return to the prevailing rate. Please note thatthe Symposium occurs during a very busy week in Annapolis, so it is suggested that you confirm hotel reservations as soonas possible. The block of rooms for Symposium participants will fill up quickly. For more information or to make your reserva-tions, call 1-888-627- 8980 or visit the Annapolis Sheraton website: www.sheraton.com/annapolis

Stay for the Fun!

The Symposium is located within easy reach of some of the greatest attractions that Annapolis, Maryland offers. The USNaval Academy, the Maryland State Capitol, and the historic waterfront district are just a few miles away and can be easilyaccessed by the hotel's free shuttle service. The hotel is within easy walking or driving distance of the Westfield Mall, FestivalPlaza, and the Annapolis Harbour Center, as well as several of the area's finest golf courses. And don't forget the great foodexperiences available at some of the area's finest restaurants, such as the Sheraton's Annapolis Bar and Grill, the ChartHouse, Carrol's Creek Waterfront, the Cheesecake Factory, and the Melting Pot.

Fees and Expenses

Registration fees will be $160 for the Saturday and Sunday sessions or $90 for one day (either Saturday or Sunday). The feeincludes all expenses for workshops, lectures, AV material, and printing costs. Also included are a continental breakfast andfull lunch on Saturday, a full breakfast and lunch on Sunday, as well as snacks on both days. Those registering for the two-day symposium in groups of five or more will receive a discount of $10 per attendee (see registration form for details). Pre-symposium workshops are offered for an additional fee as indicated on the attached registration brochure.

Registration

Registration is limited and on a first-come, first-served basis. Attendees whose registrations are postmarked by April 10,2009 will receive a free conference tee shirt. All registrations received by May 4, 2009 will receive written confirmation let-ters. Confirmations for those received after May 4th may not be available prior to the Symposium. Upon receipt of your confir-mation, please review all workshop selections carefully. Any requests for changes to your schedule must be received prior toMay 8, 2009, and should be emailed to MD_EMS_Symposium@miemss.org. Requests for refunds must be submitted inwriting prior to May 8th. All cancellations are subject to a $25 processing fee. Returned checks are also subject to a $25 pro-cessing fee.

Walk-in registrations will be accepted at the Symposium pending availability of space.

Directions

A map and written driving directions will be mailed with your registration confirmation.

For More Information

Contact the MIEMSS Region III Office at 410-706-3996, or visit the Emergency Education Councils' web sites at:www.eecreg3.org or www.eecreg5.org.

Pre-Symposium ActivitiesThursday and Friday, May 14 and 15, 2009

EMT-Basic 12-Hour Skills Refresher (Thursday, 6 -10 PM; Friday, 8 AM-5 PM)This course is a required part of recertification for all EMT-Bs. By coupling this course with careful selection of sympo-sium breakout sessions, EMT-Bs can meet all requirements necessary for recertification. This class will be offered at anoff-site location. Enrollment is limited to 25 registrants. {12 hrs Cat S}

Thursday, May 14, 2009Communications with Special Populations (9 AM-5 PM)Communication can be difficult for anyone in an emergency situation, but what if your patient already has communica-tions challenges? This workshop will cover three groups of individuals with communications differences: the deaf com-munity, those dealing with autism, and the sensory changes that come with aging. Brenda Kelly-Frey, Director of theTelecommunications Access of Maryland, Maryland Department of Information Technology, will talk about deaf cultureand provide valuable tools to help you help people who are deaf or have hearing loss. She will also focus on the use ofMaryland Relay during her morning presentation. LTC Scott Campbell will begin the afternoon with a focus on patientswith Autism Spectrum Disorder, providing valuable tips on safely interacting with autistic patients. Finally, Leona Rowe,NREMTP, from MIEMSS, will help students, through a series of practical exercises, to experience and understand thesensory changes that aging brings. {7 hrs Cat 2/L}

Look Out Behind You! (8:30 AM-5:30 PM)You have heard of “Roadway Incident Safety for Emergency Responders.” Now “Look Out Behind You,” an 8-hour lectureand hands-on training workshop, provides an overview of the safety hazards often found at roadway incidents, as well as“best practices” designed to help save lives and prevent injuries to emergency response personnel. This program isdesigned for safety and training officers, chief and line officers, and EMS providers. Attendees will receive training mate-rials that they can later modify and customize to fit their department, geographic area, roadways, and resources. It is thegoal of the program that attendees will instruct personnel in the best practices. The program aims to create awarenessof the risks facing personnel operating at crash scenes or fires near roads and highways and of the need to developtraining and safe operating procedures. Although beneficial, previous attendance at a Roadway Incident Safety class isnot a requirement to attend this class. Jack Sullivan, CSP, CSPS is the director of training for the Emergency ResponderSafety Institute. He retired from active firefighting as a lieutenant and safety officer with Lionville (PA) Fire-Rescue. Hehas more than 30 years experience with the fire service in three different fire departments and is nationally recognizedfor his work on roadway incident safety for emergency responders. Enrollment is limited to 40 registrants. This work-shop will be repeated on Friday, May 15. {8 hrs Cat 2/L}

Quality Improvement Continuing Education Workshop (9 AM-5 PM)Part 1: Quality Improvement Lessons Learned Across the State: Experienced Quality Assurance Officers from career,volunteer, and commercial services will share their successes and failures in this networking session. Highlights willinclude an overview of the Region IV preceptor QI project, the utilization of existing data to improve your system, andother lessons learned.Part 2: So Your Providers Would Benefit from Remediation and/or Mentoring? Explore the best ways to provide theassistance your personnel need to help them develop professionally. Michael Cooney, Clinical Coordinator of EmergencyHealth Services at the University of Maryland Baltimore County, will conduct this valuable workshop. {7 hrs Cat 2/L}

Friday, May 15, 2009Look Out Behind You! (8:30 AM-5:30 PM)Repeat of Thursday's Course. See description above. Enrollment is limited to 40 registrants. {8 hrs Cat 2/L}

Emergency Medical Dispatcher Continuing Education (9 AM-5 PM) Join Kevin Willet, of Public Safety Training Consultants, for a fun and informative day of news and views that every emer-gency telecommunications staff member can use. Get a fresh look at everything from attitude and performance to proto-col compliance. Known for his humor and passion for the 9-1-1 profession, Kevin will use lessons learned from the bestand the worst in emergency medical dispatching. Quality improvement and customer interactions will be discussed,along with new tools on calming hysterical callers. Can we “be nice,” save lives, and still be professional and efficient?Kevin will show us how to make it all happen! {7 hrs Cat 2/L}

Building a High Reliability Organization: A Leadership Workshop for EMS and Quality Assurance Officers (9 AM-5 PM)During hard economic times, as we struggle to do more with less, it is critical that we develop an effective organizationto fulfill our critical missions. Back by popular demand, Paul LeSage, Assistant Chief of Tualatin Valley Fire and Rescuein Oregon, will address the high reliability organization. He will focus on the role of the “just culture,” critical decision-making, and team communication using scenarios and examples from the fire/rescue services. This course is a must forEMS and Fire Officers, Quality Assurance Officers, and others interested in change. {7 hrs Cat 2/L}

EMSC Pediatric Vascular Access Workshop (9 AM-5 PM)This workshop is designed to provide technical updates on vascular access in children for ALS providers. Throughdidactic sessions, video demonstration, and hands-on practice, participants will gain experience with IV, IO, and implant-ed vascular access. When to, how to, and most importantly why to start medication and fluid administration for childrenin emergent situations will be discussed in both case examples and simulation. This workshop is being sponsored by theEMSC Partnership for Children Grant with support from the pediatric specialty centers in Maryland.{7 hrs total; 3.5 hrs Cat A/M and 3.5 hrs Cat B/T}

8:00 AM-9:30 AMOpening Ceremonies and KeynoteAddressTrauma Triage and MedevacTransport: Critical Decisions in theFieldMIEMSS Executive Director Robert R.Bass, MD, FACEP will discuss both thescience behind the Trauma DecisionTree and its practical field application.He will also discuss how field providerscan use this tool to make sure allpatients who need a trauma center aretaken to one by the most appropriatemeans of transport, air or land.{1.5 hr B/T}

10:00 AM-11:30 AM Breakout 1:

(1A) Kids and Falls:The Long andShort of ItThe number one reason for injury trans-port in children is falls. Some are report-ed to be from great heights and othersfrom a couch or bed. Which ones aresevere? Which ones are unintentional?Which ones are suspicious? Throughcases and multi-center reports, Dr. AllenWalker, of MIEMSS and Johns Hopkins,will teach you how to triage and treatchildren who “fall down.” {1.5 hrs B/T}

(1B) Unrecognized CardiacEmergencies in ChildrenPediatric cardiac emergencies presenta unique challenge to EMS and EDproviders because many of the patientsare so young that they cannot describetheir symptoms. Chest pain, hypoxia,and cyanosis mean different things inthe very young. A Pediatric Cardiologyteam will present both simple and com-plex cases, with keys to early identifica-tion of pediatric cardiac emergencies.This workshop is in response to yourrequest for “beyond PEPP and PALS.”{1.5 hrs A/M}

(1C) Crisis in the Field: Assessingand Managing BehavioralEmergenciesThese calls can be frightening and dan-gerous. Professor Dwight Polk, of theEmergency Health Services Program atUniversity of Maryland BaltimoreCounty and co-author of PrehospitalBehavioral Emergencies and CrisisResponse, will share his expertise onthis challenging topic. {1.5 hrs B/M}

(1D) Rescues in Raging RapidsLt. Michael Berna, from the BaltimoreCounty Fire Department SpecialOperations Division, will assess theroles of both BLS and ALS personnelwhen interacting with a technical res-cue/swift water team. Emphasis will beplaced on understanding swiftwater/flood emergencies with a focuson responder safety. In addition, thepathophysiology of drowning andimmersion hypothermia will beexplored, as well as managing the reha-bilitation of swift water responders. Lt.Berna will be joined by Battalion ChiefJim Resnick, who will share his experi-ences as Incident Commander at thisyear's dramatic rescue on River Road inMontgomery County. {1.5 hrs 2/L}

(1E) Critical Incident Stress and theEmergency Services ProviderSome stress keeps emergency medicaldispatchers and other EMS providersalert and ready to go, but excessivestress can compromise health and per-formance. This presentation will focuson how to identify signs and symptomsof critical incident stress and methodsof stress management for emergencyproviders. Jeffrey Mitchell, PhD, co-founder of the International CriticalIncident Stress Foundation and co-author of Prehospital BehavioralEmergencies and Crisis Response, willpresent this topic. {1.5 hrs B/M}

12:45 PM-2:15 PM Breakout 2:

(2A) The Deadly Combo: CO andChildrenHouse fires are one of the leadingcauses of childhood death and injury.Despite a decade of prevention efforts,carbon monoxide poisoning is often thecause of death. Dr. Karen O'Connell,Region V Pediatric Medical Director,and Major Dennis Woods, PrinceGeorge's Fire and EMS, will teach youhow to recognize carbon monoxideexposure in children before it is too late.The latest technology and laboratoryfindings will be discussed, along withrapid treatment and transport protocols.{1.5 hrs B/T}

(2B) The Iceman Cometh:Hypothermia and Cardiac ArrestIce-cold IV fluids and ice packs for thecardiac arrest victim with a ROSC (apulse)? New trends in post-resuscitation

care show that induced hypothermialeads to better outcomes in neurologicalstatus. Mary Alice Vanhoy, RN, MSN,NREMTP is an educator from ShoreHealth System and United CommunitiesVFD. Michael Millin, MD, MPH, FACEPis Medical Director at theBaltimore/Washington InternationalAirport Fire and Rescue Department.He also serves as an Assistant MedicalDirector for MIEMSS Region III.{1.5 hrs A/M}

(2C) Managing the Bariatric PatientTim Perkins will present on variousaspects affecting bariatric patients suchas anatomical and physiological anom-alies, as well as injuries and illnessescommon to bariatric patients. He willalso discuss many of the “new” types ofsurgical and medical interventions forthe morbidly obese and how EMSproviders may effectively treat thesepatients. Tim Perkins, EMS SystemsPlanner for the Virginia Office of EMSin Richmond, has been involved in EMSfor 19 years. Tim is a graduate of theEmergency Health ServicesDepartment at the University ofMaryland Baltimore County. He hasworked in several different EMS sys-tems in the eastern United States.{1.5 hrs B/M}

(2D) Incident Management Team:How May We Help You? Since 9/11/01, millions of federal dollarshave been provided to our regions toenhance our medical emergency pre-paredness. In addition, the NationalIncident Management System (NIMS)has mandated both training andresponse capability. The regionalapproach to incident managementthrough the Incident Management Team(IMT) is a proven concept that hasworked to manage incidents rangingfrom LODD funerals to inaugurationevents to the polar bear plunge! DeputyChief John Scholz, Chief of Operations,Anne Arundel County Fire Department,serves as the team leader for the 50+member Baltimore Regional IncidentManagement Team (BRIMT) (a FEMAType III recognized team). He willexplain the team concept and deploy-ment, including what the team can pro-vide to your major incident, as well ashow it focuses on your success in man-aging a local incident. {1.5 hrs 2/L}

Saturday, May 16, 2009

Program Descriptions

(Continued on Page 8)

(2E) Training Films and OtherFirehouse LessonsWould you like to be able to gainContinuing Education Credits for your in-station EMS drills? Do you need someguidance in developing EMS drills foryour members or employees? Wouldyou like exposure to educationalresources for use in EMS companydrills? If the answer to any of thesequestions is yes, then this presentationis for you. Peter Fiackos, EMSEducation Manager at MIEMSS, willteach what the requirements are for

your company drill to gain approval forcontinuing education hours. By introduc-ing easily accessible resources, such asthe new “Lower Extremities Resourcefor EMS Providers,” Pete will lead stu-dents through the steps of planning,teaching, and then obtaining continuingeducation hours for the class. This work-shop is perfect for experiencedproviders, training officers, and instruc-tors. Each student will leave with anapproved lesson plan to teach or use asa template to develop additionalapproved company drills. {1.5 hrs 2/L}

2:30PM - 4:00 PM GeneralSession:

Pain:The Invisible EmergencyEd Racht, MD will focus on the factsand fiction about managing pain in theout of hospital setting. Dr. Racht is anationally recognized EMS speakerwho is the Vice President of MedicalAffairs and Chief Medical Officer atPiedmont Newnan Hospital in Georgia.Prior to that, he served as MedicalDirector of the Austin/Travis CountyTexas Emergency Medical ServicesSystem. {1.5 hrs B/M}

Sunday, May 17, 2009

8:00 AM-9:00 AM Breakout 3:

(3A) Seize Midazolam!Determining the neurological status of achild is often difficult, and seizures occurfor different reasons at different ages.The Johns Hopkins Pediatric Neurologyteam will discuss the causes, symp-toms, and field treatment for seizures ininfants, children, and youth. Rememberthat on July 1, 2009, the Maryland EMSprotocol for seizures requires a changein medications.{1 hr A/M}

(3B) Trauma Care in IraqAs the military's experience has grownover the last six years, so has the carebeing provided by emergency physi-cians and surgeons. Trauma care beginsat the “point of injury” and is continueduntil arrival at a facility with surgicalcapabilities. Current doctrine advocatesfor rapid transport, early resuscitation,operative management, and transport tohigher level of care. This discussion willprovide a general overview of the cur-rent trends in trauma care provided dur-ing Operation Iraqi Freedom and high-light some cases seen by an emergencyphysician during a recent deployment.Ricky Kue, MD, MPH, an emergencyphysician at the Johns Hopkins Hospitalin Baltimore, began his career in EMS inMaryland as an EMT. He achieved CRTand paramedic licensures, and is cur-rently the Medical Director for HopkinsLifeline. {1 hr B/T}

(3C) Diabetes in the 21st Century:Keeping Up with the High-TechDiabeticDeputy Chief Chuck Barton, NREMTP,of the Ocean City Fire Department,Career Division, will bring you up-to-dateon the latest equipment that diabetics

use to monitor and control their health.Chief Barton brings his expertise bothas an EMS instructor and as the parentof a diabetic to this lively and informativesession. {1 hr B/M}

(3D) MAYDAY: Firefighter DownIn May 2008, fire and rescue personnelfrom Loudoun County responded to astructure fire in Leesburg, Virginia.During the course of the incident, sevenresponders were injured. Of thoseinjured, four firefighters received signifi-cant burn injuries, two firefighters sus-tained orthopedic injuries, and one EMSprovider was treated for minor respirato-ry distress. Given the severity of theinjuries and magnitude of the event, anindependent Investigative Team wasassembled to review the incident. Theresults of that review have importantimplications for everyone in the fire/res-cue service. Using a lessons-learnedapproach, Acting Chief Ritchie Bowers,of the Montgomery County Departmentof Fire/Rescue Services who was theteam leader during the review of theMay 2008 incident, and Battalion ChiefJennie Collins, of the Prince WilliamCounty Department of Fire/RescueServices, will discuss what went rightand what did not. {1 hr 2/L}

(3E) 9-1-1 Fun (2 hrs)The training involved in working at a 9-1-1 Center can be lengthy, sometimestedious, and frequently overwhelming.To give students a rest from the repeti-tive practice often involved in memoriza-tion, we have developed games that notonly test their knowledge of terminology,event types, abbreviations, interstates,etc., but are actually fun and buildcamaraderie between students. Carol A.Redding, of the Baltimore County 9-1-1Center, is trained as a fire dispatcher

and 9-1-1 call taker. She has served for23 years and managed the TrainingAcademy for 5 years. Samantha Flaterhas been at the Carroll County 9-1-1Center for 12 years, serving as a trainerand QA officer for the last three.{2 hrs 2/L}

9:15 AM - 10:15 AM Breakout 4:

(4A) Stepwise Approach to OxygenTherapy for KidsOxygen is a medication, sometimesadministered alone and sometimes incombination with other medications. Lowflow, high flow, nebulized, intubated –challenging cases will be presented andtechniques demonstrated by Liz Berg,PICU Transport Coordinator at theJohns Hopkins Children's Center.{1 hr B/M}

(4B) Not from the Heart: Non-CardiacChest PainRapid, efficient, and effective care forvictims of heart disease is one of the pri-mary goals of Advanced Life Support.But there are other important and dan-gerous causes of chest pain that are notfrom the heart. This discussion reviewsthose causes and outlines the differ-ences between those presentations(signs and symptoms) and the presenta-tion of patients with acute coronary syn-dromes. Dave Denekas, MD, FACEP isthe Medical Director of Calvert EMS andPast Director of the EmergencyDepartment at Calvert Hospital.{1 hr B/M}

(4C) Wilderness Medicine: Packingfor the UnexpectedThis workshop will focus on essentialsurvival strategies for those providingcare and rescues in remote settings.

Saturday, May 16, 2009 (Continued)

(Continued on Page 9)

Enjoy an interactive discussion withprops, etc., on topics such as emer-gency shelters, starting a fire, water, andsignaling techniques. In addition to beingan active member of the WildernessMedical Society, Dr. Vincent Cantone isan avid hunter, fisherman, and outdoors-man. He is the Medical Director forWashington County and PediatricMedical Director for MIEMSS Region II.{1 hr B/T}

(4D) Mass Evacuation: Are YouPrepared?Given our aging population and theemergence of assisted living facilities,nursing homes, and large senior livingcommunities, what issues do we face indealing with the evacuation of large pop-ulations? What is the role of EMS vs.other assisting agencies? Does thisaging population have social/welfareneeds? Lt. Mark Demski, NREMTP, ofthe Baltimore County Office ofEmergency Management andHomeland Security, will provide insightinto these issues through a "casestudy/lessons learned” approach rele-vant to several major incidents that haveoccurred. {1 hr 2/L}

10:30 AM - 11:30 AM Breakout 5:

(5A) Don't Call Me Honey!Communicating with Elderly PatientsMost EMT and Paramedic programsspend significantly more time discussingpediatrics than geriatrics, even thoughthe percentage of the US populationover the age of 65 is rapidly increasing.Advancements in medicine and pharma-ceuticals have pushed the average lifeexpectancy to almost 80. An overview ofspecific “pearls and pitfalls” in assessingand treating geriatric patients will becovered, including important physical,social, and cognitive facets that everyEMS provider should be familiar with.Common assistive living equipment uti-lized in home care will be reviewed, aswell as relevant topics such as the in’s(and out’s) of hospice, the uniqueness ofgeriatric trauma, recognizing elderabuse, and being sensitive to end-of-lifeconcerns. This presentation will touch ona wide variety of medical care issuesspecific to the geriatric population andwill hopefully instill a new respectful per-spective on the challenges facing thesepatients. Raphael M. Barishansky is cur-rently the Program Chief for PublicHealth Emergency Preparedness for thePrince George's County (MD)Department of Health. {1 hr B/M}

(5B) Intubation vs. Non-InvasivePositive Pressure VentilationIntubation has been described as the“gold standard” in airway and ventilationmanagement. Although no one disputesthe utility of endotracheal intubation inairway protection, some patients maybenefit from the positive pressure venti-lation strategy that intubation provideswithout the risks of the procedure itself.Ricky Kue, MD, MPH, an emergencyphysician at the Johns Hopkins Hospitalin Baltimore who began his career inEMS in Maryland as an EMT, and laterobtained licensures as a CRT and para-medic, will review the physiology of ven-tilation and discuss the merits (andproblems) with non-invasive positivepressure ventilation (NIPPV) in the out-of-hospital setting. Current technologieswill also be reviewed, as well as com-mon pitfalls in initiating NIPPV. With therecent MIEMSS protocol updates thatrequire NIPPV capabilities by all EMT-Pservices, this lecture will convince youwhy non-invasive may be the way to go.{1 hr B/M}

(5C) Baby on BoardTransporting pregnant women is astressful situation. What happens whenthe mother is considered “high-risk?”How is this defined and what concernsshould you have when evaluating such apatient? This lecture will provide areview of high-risk obstetrics for theEMS provider and include topics suchas pre-eclampsia, eclampsia, theHELLP syndrome, placental abruption,and placenta previa. Emphasis will beon the assessment, treatment, and doc-umentation of the high-risk transport.Cathleen Witt Vandenbraak, RN, is aCritical Transport Nurse at the JohnsHopkins Hospital. Previously she hasworked as an emergency departmentnurse, surgical nurse, and flight nurse.She began her career as a paramedic.{1 hr B/M}

(5D) When 2-5 Million People AreExpected: Inaugural PlanningBattalion Chief Henry Lyles, DCFire/EMS Department, will discuss thenuts and bolts of planning forEmergency Services with an alphabetsoup of participating agencies. {1 hr 2/L}

(5E) Emergency Medical Jeopardy This “Game Show” will feature teams ofemergency medical dispatchers, as wellas BLS and ALS providers. Theseteams will have to work together (as inthe real world) to solve problems, score

points and, hopefully, earn “Big Prizes.”{1 hr 2/L}

12:45 PM - 1:45 PM Breakout 6:

(6A) Pediatric Medical Cases:The“Once in a Career Call”Returning at your Request! Children doamazing things and get into many envi-ronments. Pediatric experts will presentunusual pediatric emergencies throughcase studies. Early recognition and rapidassessment, along with appropriatetriage and transport, will be included.{1 hr B/M}

(6B) Maybe It's All in Your Head!EMS providers and emergency depart-ment physicians often miss subtle headinjuries. Those patients may developpain or changes in cognition, motorskills, or affect. Jerry Fleishman, MD,L.Ac, Chief of Neurology and Director ofClinical Neuro-physiology at FranklinSquare Hospital Center, will discusshow those patients present at the neu-rologist's office and how your field reportmight assist in an earlier diagnosis.{1 hr B/T}

(6C) Pelvic Trauma: Holding It AllTogetherClifford H. Turen, MD, of the R AdamsCowley Shock Trauma Center, will dis-cuss the new pelvic trauma binderapproved for field use in the July 1, 2009Maryland Protocols. {1 hr B/T}

(6D) Just Add WaterWhether in water bordering the thou-sands of miles of Maryland's shorelineor in a “riptide” current “down the ocean,”Maryland's EMS responders maybecome involved in a rescue incident ontidal waters. The ocean, the bay, therivers, and even our lakes presentunique concerns for responders regard-ing access and packaging and recovery.Lt. Eric Peterson, NREMT-P, of theOcean City Fire Department, will providesome insight into the role of the EMSresponder. {1 hr 2/L}

(6E) It's All in the Cards! (2 hrs)Roger Stone, MD, MS, Operational andEMD Medical Director for multipleMaryland jurisdictions, and Lt. CaryBeall, QA Officer for the MontgomeryCounty Fire/Rescue CommunicationsCenter, will explain EMD decisions toEMS providers while updating EMDs onthe challenges of the five most challeng-ing EMD cards. {2 hrs 2/L}

Sunday, May 17, 2009 (Continued)

(Continued on Page 10)

1:45 PM - 2:45 PM Breakout 7:

(7A) Too Young to Die,Too Old toRock and RollBetter health care, healthier lifestyles,and the graying of the baby boomers allcontribute to our aging population. By2030, over 60 million people will fit thatcategory. Steve Johnson, MD, Directorof Critical Care Medicine at theUniversity of Maryland Medical System,will discuss assessment and care ofgeriatric trauma patients. {1 hr B/T}

(7B) First Responders and theOutcomes of Interpersonal ViolenceInjury: Could Less Be More?There has been a trend towardincreasing interpersonal violence overthe past several years and not surpris-ingly, outcomes are affected by thisactivity. In addition to primary violenceprevention measures, is there a rolefor reexamining prehospital protocolsgoverning the management of thesepatients? Insight into this interestingtopic will be presented by David T.Efron, MD, FACS, FCCM, the Chief ofthe Adult Trauma Service, JohnsHopkins University Hospital. {1 hr B/T}

(7C) What's Happening Now: NewDrugs on the StreetThe drug scene is constantly changing.Users and dealers are always searchingfor easily accessible and sometimes

legal ways to get high. This session willreview new and emerging drugs ofabuse, including plants, synthetic and“designer drugs,” and old drugs beingused in new ways. The toxic effects seenwith their use and treatment strategiesfor those effects will be discussed. Thisworkshop is presented by Lisa Booze,PharmD, CSPI, the clinical coordinatorat the Maryland Poison Center at theUniversity of Maryland School ofPharmacy. She is a clinical pharmacistand a certified Specialist in PoisonInformation. {1 hr B/M}

(7D) Current Vehicle Design andExtricationNew vehicles are safer for occupants butpresent challenges to those respondingto a crash. Lt. Sam Pearce, of theBaltimore County Fire Department andan extrication equipment expert, will dis-cuss these challenges. {1 hr 2/L}

3:00 PM-4:00 PM GeneralSession:

Leadership in a Time of ChangeRaphael M. Barishansky is currently theProgram Chief for Public HealthEmergency Preparedness for the PrinceGeorge's County (MD) Department ofHealth. Mr. Barishansky has written andlectured extensively on various facets ofEMS, including leadership profiles,administrative/management strategies,

and clinical aspects. His articles havebeen featured in EMS Magazine, theJournal of Emergency Medical Services(JEMS), the EMS Insider, and EMSManager and Supervisor, as well asother publications. He is a regularly fea-tured speaker at various regional, state,and national EMS conferences.{1 hr 2/L}

4:00 PM

EMS Week Kick-Off and Presentationof the Maryland Star of Life Awardsand the Right Care When It CountsAwards for Children

Each year during EMS Week, MIEMSSpresents Maryland Star of Life Awardshonoring EMS personnel, citizens, andEMS programs statewide. In addition,MIEMSS recognizes children and teensfrom each of the five Maryland EMSRegions who assisted in providing a life-saving service to someone, therebyensuring that people had received the“right care when it counts.” Please joinus as we close the 2009 Maryland EMSSymposium and “kick off” EMS Week inMaryland by honoring this year's awardrecipients.

Sunday, May 17, 2009 (Continued)

MARMARYLAND YLAND EMERGENCY MEDICAL SEREMERGENCY MEDICAL SERVICES VICES

SYMPOSIUM 2009SYMPOSIUM 2009“Excellence in EMS”

7:00 AM

8:00 - 8:30 AM

8:30 - 9:30 AM

9:30 - 10:00 AM

Time

10:00 - 11:30 AM(1.5 hrs)

{Breakout #1}

11:45 AM - 12:45 PM

12:45 - 2:15 PM(1.5 hrs)

{Breakout #2}

2:30 - 4:00 PM(1.5 hrs)

4:00 - 7:00 PM

Saturday, May 16, 2009

Registration

Opening Ceremonies

Trauma Triage and Medevac Transport: Critical Decisions in the Field - Robert R. Bass, MD, FACEP{B/T}

Vendor Break

A Generations

B AdvancedPractice

C Street Medicine

D Special

Operations

EOutside the Box

Kids and Falls: The Long and Short of It

{B/T}

Unrecognized Cardiac Emergencies in Children {A/M}

Managing BehavioralEmergencies in the

Field {B/M}

Rescues in RagingRapids {2/L}

Critical Incident Stressand the Emergency

Services Provider {B/M}

The Deadly Combo:CO and Children {B/T}

The Iceman Cometh:Hypothermia and

Cardiac Arrest {A/M}

Managing the BariatricPatient {B/M}

Incident ManagementTeam: How May We

Help You? {2/L}

Training Films andOther Firehouse

Lessons {2/L}

Lunch

Preakness Celebration in Admiral’s Ballroom Vendor Area

General Session: Pain: The Invisible Emergency - Ed Racht, MD {B/M}

Time

8:00 - 9:00 AM(1 hr)

{Breakout #3}

9:15 - 10:15 AM(1 hr)

{Breakout #4}

10:30 - 11:30 AM(1 hr)

{Breakout #5}

11:45 AM - 12:45 PM

12:45 - 1:45 PM (1 hr)

{Breakout #6}

1:45 - 2:45 PM(1 hr)

{Breakout #7}

3:00 - 4:00 PM(1 hr)

Sunday, May 17, 2009

Lunch

General Session: Leadership in a Time of Change - Ray Barishansky{2/L}

AGenerations

BAdvancedPractice

CStreet Medicine

D Special

Operations

EOutside the Box

Seizing Midazolam{A/M}

Trauma Care in Iraq{B/T}

Keeping Up with theHigh-Tech Diabetic

{B/M}

MAYDAY: FirefighterDown{2/L}

Pediatric MedicalCases: The "Once ina Career" Calls {B/M}

Maybe It's All in YourHead {B/T}

Pelvic Trauma: HoldingIt All Together

{B/T}

Just Add Water{2/L}

Too Young to Die, TooOld to Rock and Roll

{B/T}

First Responders and theOutcomes of Interpersonal

Violence Injury {B/T}

What's HappeningNow: New Drugs on

the Street {B/M}

Current Vehicle Designand Extrication

{2/L}

Stepwise Approach to Oxygen Therapy

for Kids {B/M}

Not From the Heart:Non- Cardiac Chest

Pain {B/M}

Wilderness Medicine:Packing for the

Unexpected {B/T}

Mass Evacuation: AreYou Prepared?

{2/L}

Don't Call Me Honey!Communicating with

Elderly Patients {B/M}

Intubation vs. Non-Invasive Positive

Pressure Ventilation{B/M}

Baby on Board{B/M}

When 2-5 MillionPeople are Expected:

Inaugural Planning{2/L}

Emergency MedicalJeopardy

{2/L}

9-1-1 Fun{2/L}

It's All in the Cards:The Top 5 Most

Challenging EMD Cards

{2/L}

Continuing Education Credits - All categories are noted in the brackets {} ALS is first, then BLS. CRT-Is and NREMT-Ps are required to complete continuing education in specific topics. We suggest you review the Re-registration guidelines in the National Registry registration brochures for

Intermediate '99 and Paramedic on their web site at www.nremt.org

Please print your name as you wish it toappear on your name badge:

First Name:

___________________________________________

Last Name:

___________________________________________

Prov. ID:

___________________________________________

Primary Affiliation:

___________________________________________

Address:

___________________________________________

City: ______________ State: ______ Zip: ________

Phone: _____________Fax: ___________________

Email Address:

___________________________________________

Certification/Licensure (Circle One):

FR EMT-B CRT-(I) EMT-P EMD RN Other

Please select the programs that you plan to attend:

Pre-Symposium Workshops:

______ EMT-B Skills ($35)

______ QA Officer Update ($75)

______ Comm. with Special Populations ($75)

______ Look Out Behind You (Thursday) ($75)

______ Look Out Behind You (Friday) ($75)

______ EMD Cont. Ed. ($75)

______ Building High Reliability Orgs ($100)

______ Peds Vascular Access Workshop ($75)

BREAKOUT SESSIONS: (Please circle)

Saturday, May 16, 2009:

Breakout 1: A B C D E

Breakout 2: A B C D E

Sunday, May 17, 2009:

Breakout 3: A B C D E

Breakout 4: A B C D

Breakout 5: A B C D E

Breakout 6: A B C D E

Breakout 7: A B C D

REGISTRATION FEES:

Two-Day (Sat/Sun) ($160): ________

One-Day ($90): ________(Sat. ____ Sun. ____)

Symposium T-Shirt ($15): ________(Free for 2-Day Registrations Postmarked On or Before April 10th.) {Size:________}

Group Discount:Groups of 5 or more 2-day registrations will receive a discount of $10 per attendee. $(-)________

Pre-Symposium Fees: ________

TOTAL DUE: ________

Make checks payable to:Emergency Education Council of Region IIISend checks: MIEMSS Region III; 653 West PrattStreet; Baltimore, Maryland 21201 or fax credit cardregistrations to 410-706-8530.

Pay by Credit Card!VISA: ______ Master Card: ______ Discover: ______Card #: _____________________________________Expiration Date: ______________________________Street # ________________ Zip code ____________(Billing Address Needed for credit card auth.)Signature: __________________________________

PLEASE NOTE!!

• Submit one registration form for each attendee.

• Groups applying for discounts must submit allregistration forms together.

• No refunds will be granted unless a written can-cellation is received prior to May 8, 2009. All can-cellations are subject to a $25 processing fee.

• Returned checks are subject to a $25 process-ing fee.

• Anyone needing special accommodations orhaving special dietary requirements should contact the Region III Office of MIEMSS by May 8, 2009, at 410-706-3996.

Maryland EMS Symposium 2009Registration Form - Count Me In!!!

MIEMSS, Maryland EMS News653 W. Pratt St., Baltimore, MD 21201-1536

Governor Martin O’MalleyLt. Governor Anthony Brown

Copyright© 2009 by theMaryland Institute for Emergency Medical Services Systems

653 W. Pratt St., Baltimore, MD 21201-1536www.miemss.org

Chairman, EMS Board: Donald L. DeVries, Jr., Esq.Executive Director, MIEMSS: Robert R. Bass, MD

Managing Editor: Beverly Sopp (410-706-3248)Design & Layout: Gail Kostas

Photography: Jim Brown, Dick Regester, Brian Slack, Fernando Tosti (unless noted otherwise for specific photos)

March 14, 2009Pre-conferences March 12 - 13, 2009Miltenberger Emergency Services Seminar 2009Rocky Gap, MDContact: Region I Office at 301-895-5934.

March 15-21, 2009National Poison Prevention Week Contact: Angel Bivens at the Maryland Poison Center, 410-563-5583

March 24-28, 2009EMS Today: The JEMS Conference & ExpositionBaltimore, MDInformation: www.EMSTodayConference.com

April 2, 2009Trauma Care: Multiple AspectsSponsored by Hagerstown Community College & Washington County HospitalMerle S. Elliott Continuing Education & Conference CenterHagerstown Community College11400 Robinwood DriveHagerstown, MDContact: 301-790-2800, ext. 236

April 30, 2009Trauma Care 2009Sponsored by the Maryland Committee on TraumaBaltimore Hilton HotelContact: cleidy@umm.edu or call 410-328-3662

May 16-17, 2009Pre-symposium activities: May 14-15, 2009Maryland EMS Symposium 2009Annapolis Sheraton HotelAnnapolis, MDContact: Region III Office at 410-706-3996

May 17-23, 2009Maryland EMS WeekTheme: A Proud Partner in Your Community

EMS Continuing Education Programs