Thursday, July 28th

0800 - 0915 - General Session

EMS and Emergency Medicine Legal and Regulatory Issues. -- Dr. Erica Carney

1 Hour Operations

One of the most important components of patient care is understanding the patient-provider relationship. A provider must understand when this relationship is established, and how this leads to capacity determinations, how this impacts implied consent and/or refusal of care, and how this includes end-of-life care decisions and documentation packets. Understanding a provider's duty to a patient after this relationship is established can also help providers understand malpractice and negligent elements, and certain high-risk situations that are more common than one might think. We will discuss all of this and more using real-life EMS examples and different Medical Directors' perspectives.

objectives are:

  1. Define the (provider) “Relationship”
  2. Discuss Capacity vs. Competence
  3. Consent and Refusal of Care
  4. Malpractice and Negligence
  5. Red Flags: High Risk Situations
  6. Advance Directives
  7. Real Life Examples!

0930 - 1045 -- BREAKOUTS

Pre-hospital and Hospital Integration of Missouri Crisis Intervention Teams (CIT), Alternate Transportation Options and Protective Custody
Dr. Erica Carney & Katherine Probst

1.5 Hours Medical/Psychiatric

This session discusses integration of EMS into Missouri Crisis Intervention Teams (CIT) as well as the legalities of becoming a MoCIT paramedic. It will provide an overview of the training required per Missouri state statute and the state approved protocols available for adoption within agencies. We will also discuss treatment options for behavioral health emergencies and integration of these patients into the hospital setting or alternate destinations.

Losing One of Our Own
George Wright

1.5 Hours Operations

This minute program provides basic information on assisting organization in preparing their organization if they have a member pass away, whether it is a Line of Duty, Non-Line of Duty, or they wish to honor a retiree. It will provide information so organizations can develop a policy / guideline and have it in place. This program shares information about emotions, as well as what is a line of duty death, basic pre-plan, levels of honors, and very basic information about the Federal Public Safety Officers Benefits as well as the Missouri Providers Benefits.

Presentation Objectives:

  1. What is a line of duty vs on duty
  2. Preparing and Preplanning
  3. Public Safety Officers Benefit

After ROSC: Active Management for Improving Cardiac Arrest Outcomes
Kene Chukwuanu

1.5 Hours Cardiovascular/Airway Ventilation

Emergency Medical Services (EMS) respond to approximately 350,000 adult patients with out-of-hospital cardiac arrest (OHCA) each year in the United States. Additionally, almost 300,000 patients each year will undergo in-hospital cardiac arrest (IHCA). Intra-arrest and post-arrest care, both in the field and in the hospital, requires an evidence-based multidisciplinary approach to improve neurologically intact survival. In this session, we will review the recently updated “2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.” The focus of this session will be to identify what we can do as a multidisciplinary team to improve post-arrest management and examine potential advanced therapies for cardiac arrest and refractory ventricular dysrhythmias.


  1. Review the recent AHA updates for the management of cardiac arrest.
  2. Review the recent AHA updates for post-cardiac arrest management.
  3. Discuss recent evidence for non-traditional advanced therapies for cardiac arrest including dual sequential defibrillation and beta blockade.
  4. Review the emerging use of extracorporeal membrane oxygenation (ECMO) for in cardiac arrest.
  5. Identify the optimal patient population for potential use of ECMO in cardiac arrest.

Managing the Lethal Triad in Airway Management
Darick Day

1.5 Hours Airway/Ventilation

Death and disability that occur during an airway management case are often avoidable. Understanding the physiology, pharmacology and physics of airway management can go a long way to avoid these dangerous pitfalls. We will discuss how to identify and mitigate the lethal triad of shock, hypoxia and acidosis.

This course will:

  1. Discuss airway and pulmonary anatomy
  2. Discuss respiratory physiology
  3. Review pharmacologic assisted intubation – RSI/DSI/SAI
  4. Identify risk factors that predispose airway cases to failure
  5. Mitigation techniques to improve airway management success
  6. Discuss pharmacology of common airway management medications

1115 - 1230 -- BREAKOUTS

Organized Chaos: Four Patients and a Medic
Jason Dush

1.5 Hours Trauma/Operations

Should the rescuers move quickly through all the victims making some errors? Or, should they go more slowly, aiming for a higher degree of accuracy? Should they begin treatment, or finish the triage first? Should they start CPR on the victim who is in full arrest? The answers to these questions called for a sensible, orderly triage protocol for MCI’s. A search of paramedic training material and medical literature revealed several applicable concepts, but no specific, step-by-step plans for initial MCI triage for small scale incidents.

The Trails and Triumphs of Establishing an emotional Support Dog for your Department
Katie Eisenbeis

1.5 Hours Instructor/Operations

We as a career field are working hard to change the stigma around mental health. Depending on when you started your career in EMS probably depends on how openly you discuss the bad calls or things that we see in the field.

Trying to change the stigma around mental health awareness, we have an added an emotional support dog to our team. This has been a huge success for our crews after the traumatic calls that we seem to run frequently. In this course we will discuss how to go about getting an emotional support dog for your agency and resources available to obtain the training and certification. We will also discuss the impact it has had on our department.

Learning Objectives:

  1. Recognize the need for awareness regarding the mental health of our responders
  2. Identify how we can create a positive impact on our first responder’s mental health
  3. Identify resources and programs in place to support our first responders in the area
  4. Discuss how an emotional support dog would be beneficial for your EMS agency

Just Intoxicated? Maybe Not...
Rachael Smith

1.5 Hours Medical

Slurred speech, altered mental status, unsteady gait, nausea/vomiting, disinhibition, and a familiar scent on your patient's breath may make us jump to inappropriate conclusions. Sometimes ETOH intoxication is part of the story, but are we getting the whole picture? We will discuss differential diagnoses including metabolic or neurologic origins for when ETOH intoxication isn't the answer.

Noninvasive Mechanical Ventilation
Justin Duncan

1.5 Hours Airway/Ventilation

The world of non-invasive mechanical ventilation in both 911 and transfer settings are becoming more and more popular. Some of us remember the day that CPAP hit the trucks and we thought it was the greatest thing since sliced bread! Now there are multiple different options for non-invasive forms of mechanical ventilation. We will discuss the basics of NPPV in the emergent/911 setting as well as the critical care transport environment.

This course will:

  1. Discuss basic care / assessment / monitoring with NPPV
  2. Discuss the different forms of NPPV (non-invasive positive pressure ventilation)
  3. Discuss uses for NPPV in the world of EMS / CCT
  4. Discuss “terminology” with regards to NPPV and tie it to individual functions
  5. Discuss ABG’s and NPPV (brief discussion due to time; focus on acidotic patients and manipulation of the buffer system)
  6. Discuss COVID concerns and patient/provider safety with regards to NPPV

1330 - 1445 -- BREAKOUTS

Stephen Dunkin, Kayla Riel, Julie Stilley

1.5 Hours Trauma

MO EMS for Children will be sharing data from recent annual surveys about statewide prehospital pediatric care. There will also be a program overview showing the benefits of our free monthly trainings, Prehospital Recognition Program, regional training libraries and online Canvas CEU opportunities.

Missouri CARES Program is sharing data from the CARES registry and offering insights into trends within data and provide support for agencies interested in joining the CARES registry.

Forecasting - Not Just for the Weather
Jason Dush

1.5 Hours Elective

While not an exact science, business forecasting can be challenging and stressful. There is a variety of factors that come into play when planning for the future of your organization. The world of public safety has recurring challenges with staffing issues, decreasing budgets, equipment replacement, community needs, local and national regulations, data collections and much more. Jason will present some ideas, concepts, and challenges for group discussion. This session is designed to share information as a group to help each other work through similar challenges within your organizations and develop new ideas together.

NO, NO, NO, Don’t Eat That: Pediatric Accidental Exposures
Charlene Drealeu

1.5 Hours Medical

Children and adolescents have behaviors that place them at risk of injury. The availability of drugs and the legalization of marijuana is creating unsafe environments for children. Fentanyl exposure fatality rates of up to 48% in children with average ages of 2-4 have been cited in the literature. The availability of E-Cigarettes and vaping are leading to creative experimentation resulting in emergency department visits and death in some cases. It is important for emergency department nurses to have the knowledge to identify and care for patients who present with varying symptoms and vague histories that place them at risk for further injury.

Accidental exposures have become common place in pediatrics as drugs become more readily available for medicinal purposes and exotic animals become domestic pets. This interactive presentation will use case studies to discuss the inherent dangers that pediatric patients encounter daily. Case studies will be presented and include the following:

List the differential diagnoses associated with pediatric accidental exposures to readily available substances:

• Meningitis• Epilepsy/seizures• Aspiration• Sudden Unexpected Infant Death (SUID)
• Altered Mental Status• SMA• Enterovirus• Sepsis
Discuss the substances associated with pediatric accidental exposures
• THC• Fentanyl• Pet Terrapins• Marijuana
• Opioids • E-Cigarettes

Diagnosis and Management of the Septic Patient
Shayne Keddy

1.5 Hours Medical

The sepsis patient has provided many obstacles to the healthcare provider. More and more evidence points towards the time critical nature of sepsis. This increases the pressure on the prehospital and emergency department provider to quickly identify the septic patient and implement goal-oriented resuscitation strategies. In this course, we will discuss the most up-to-date, evidence-based strategies for identifying and managing the various presentations of sepsis.

By the end of this course, providers will be able to:

  1. Understand the pathology of sepsis
  2. Understand the risk factors associated with sepsis
  3. Utilize screening criteria for quickly identifying the septic patient
  4. Risk stratify those patients likely to develop septic shock
  5. Interpret lab values associated with sepsis diagnosis
  6. Implement an organized resuscitation strategy
  7. Understand the use of fluids and vasoactive agents in sepsis
  8. Demonstrate understanding of the common antimicrobial agents

1500 - 1615 -- Closing General Session

Creating a Culture of Civility: Challenges, Chaos and Recommendations -- Jason Dush

1.5 Hours Operations

Tired of dealing with people who BMW (bitch, moan and whine) and bully all the time? They suck our energy from us and pluck our last nerve. Labeled as "it is just their personality" they keep getting away with their behavior. In a time when team work, good communication, and solid interpersonal relationships are critical for creating a stress free environment that meets the public's needs, we can no longer afford to allow this behavior to continue. This session will look at how to deal with them and what to do when they accept no responsibility for their behavior and its impact on others. This session is helpful for anyone who is tired of working with "them" and would love some new insight.