ClinCon 2010

Hello to all of our loyal readers.  It's Adam here and I am sorry for the long periods of nothing to read.  It was that time of year again, and I was preparing for the ClinCon conference.  If you are unfamiliar with it, head over to their WEBSITE.

The reason this takes up so much of my time is because I am part of my agency's ALS competition team.  We compete in these scenario-based competitions.  It's somewhat of a game.  Imagine the worst possible call you could ever run, and multiply that by five.  That tends to be the types of scenarios the sadist that come up with the challenges think up.

This was my fourth year competing at ClinCon and my team had remained winless.  There are two days of competitions with some of the best teams in the country competing.  On the first day is the preliminary round, which every team competes in.  A team is made of three crew members, and one alternate whom usually holds the video camera.

Preliminary scenario

Bus crash:

• The first five minutes was a START Triage scenario which required each team to go through a number of cards that included patient type and vital signs.  Each card had a number and you had to assign a color (red, yellow, green, or black) to the corresponding numbers.  
• We are then rushed in, to what is deemed the yellow treatment area.  Within this area was a mother holding a baby, and a patient complaining of burning eyes. 
• A good sample history and assessment uncovers the cause of the burning eyes which is chlorine.  The patient also presented with wheezing.
• The baby was who was actually a green, was not suppose to be re-triaged, but kept with mom instead.
• The mother ends up having hypertension, and then postpartum eclampsia.  Her seizures would persist until Magnesium was administered.
• At about the ten minute mark, another patient presents.  He is nearly unresponsive, and shows signs of a cardiac contusion and cardiac tamponade.  

Treatments they were looking for:

• Rapid full-body assessments on every patient.
• Re-triage all patients red.
• Flush eyes of chlorine exposed patient
• Treat wheezing with bronchodilator 
• Once wheezing subsides rales present - treat with Lasix or CPAP
• Treat Eclampsia with Magnesium Sulfate
• Recognize pericardial tamponade 

Treatments we did:

• Got 100% of the assessments
• Flushed eyes of chlorine exposure
• Provided high-flow O2, then albuterol, the nebulized Sodium Bicarbonate.
• Recognized the low acuity of the baby and kept it with mom
• Treated mom with benzodiazepines then Mag.
• Recognized Beck's triad & electrical alternans (cardiac tamponade) and performed a pericardiocentesis.  

So we didn't do exactly everything that they were looking for.  Even though we completely resolved the tamponade, there were no points for the percardiocentesis because they said "no one does that".  Um, we do.  In fact, all arrest thought to be due to blunt force thoracic trauma receives three needles in their chest.  One of them in the heart.  

We were concerned that the other 40 teams would have done better and we wouldn't make it into the top five this year.  This concern subsided once we saw the results.  We got second over all and made it into the finals once again.  Even though, this is just a scenario-based competition and not a real sport, there is a lot of pride.  These teams that compete in these challenges take it very seriously and are impressively good.  We were thrilled to have done so well.  

The Finals

Political rally:

The bus that crashed in the preliminaries was to be headed to a political rally that set the scene for the finals.  The finals are performed in front of a live audience at the venue.  Prior to entering the scenario, each team was shown a video.  It is of the political rally, and portrayed a possible explosion.

• Three initial patients.
• A room filled with picket signs and full bottles labeled dihydrogen monoxide
• A single black box about the size of a shoe box was present in the middle of the room.
• First patient was in V-fib arrest, and had a dialysis shunt.  CPR was being poorly performed by a distractor.  

A distractor is any actor in the scenario that is not a patient.  Dihydrogen monoxide = water.

• Second is a patient with an avulsed eye from a possible explosion.
• Third patient presented with an open mandibular fracture and signs of traumatic asphyxia.
• At about 4 minutes, a fourth patient presented.  He was yelling and deaf.  He had signs of bilateral perforated tympanic membranes, or eardrums.  He was yelling that his neck hurt.
• At about five minutes three more patients walked in with burning eyes from being maced.  

Sounds easy right?  Well in twelve minutes it is a very stressful and high paced incident.  

Treatments they were looking for:

• Scene control
• Assessments for every patient
• V-fib arrest patient is to be defibrillated into a PEA
• After PEA is present they expected you to determine hyperkalemic cause and administer sodium bicarbonate and/pr calcium chloride.  
• The eye avulsion only required BLS care
• The traumatic asphyxia required a cricothyrotomy within five minutes.  
• Obtain SAMPLE history from deaf guy by writing it down
• Flush the eyes of the maced individuals
• DON'T OPEN THE BLACK BOX

If you opened the box, you became exposed to chlorine gas and had to flush your eyes before you could do anymore treatments.  I am not going to go into the details of how every team performed or what exactly we did.  All I am going to say is WE WON.  

That's right, Lee County EMS, my team, got first place this year.  So bragging rights are ours for the year, and then we will return for the competition once again.  There are many other similar competitions to this throughout the country and I will be on EMS Educast this month to talk about them a little more.  

So I am back and will be getting back to posting more often.  You may have noticed the new look of the site.  Tell me what you think.  I am hoping to make the move soon to FIRE-EMS Blogs.