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EMSWORLD.com | JULY 2016 31 T he 18th annual EMS State of the Sciences Confer- ence—more commonly referred to as the Gather- ing of Eagles—convened in Dallas, TX, on February 19 and 20, 2016, hosted by Paul Pepe, MD, MPH. In a perennially packed house, one meaty presentation followed another, providing EMS practitioners with a steady stream of ingenious "beyond state-of-the-art" material revolving around ways to provide better EMS patient care and operations. In Part 1 of a multipart series, we highlight three presentations that focused on mass gathering and disas- ter management issues. Visit http://gatheringofeagles.us/ for 2016 conference presentations, from which the accompanying articles are drawn, and preview information for the 2017 Gathering of Eagles. Inside the Gathering of Eagles When top docs meet, the information comes fast and furious Limb-and-Lif e Decisions Are you ready to perform a feld amputation? I t had been 25 years since the Philadelphia Fire Department had last needed its physi- cian response team in the field, but when a train struck a pedestrian late one night last summer, it was time again. The 46-year-old victim was not killed but entrapped, his left leg mangled beneath a wheel. Freeing him would require its amputation. Such calls are rare, but the department can answer them with a plan that calls for bring- ing hospital-based physicians to the field when surgical extrications are required. On this night docs Megan Stobart-Gallagher, DO, and Melissa Kohn, MD, of Einstein Medical Center answered the call. The doctors crawled under the train and, using a surgical saw and Gigli saw, removed the foot at the ankle. "It was the right thing to do at the right time," Stobart-Gallagher later told the press, "and getting that patient out when we did probably saved his life." 1 'Move the Process Forward' A 1996 survey found just 13% of responding systems had performed an in-field extremity amputation in the previous five years, and 96% said they had no training for it. Only two of 143 systems even had a protocol. 2 That was 20 years ago, but there's no reason to think things have changed much since. "I don't think there's probably been much improvement," says Craig Manifold, DO, chair of ACEP's EMS Advisory Committee, who pre- sented on the subject with Philly Fire's EMS medical director, Crawford Mechem, MD, at February's Gathering of Eagles conference. "But we have seen improvements in protocol development, and now we have an EMS sub- specialty and are developing EMS fellows, so I think it's a perfect time to include it in training and move the process forward." As one aspect of that, EMS World will host a special amputation lab for medical directors at this year's EMS World Expo, October 3–7, in New Orleans. Visit EMSWorldExpo.com Leave a flap of skin to suture over the amputation site. PART 1 Paul Pepe FEATURED SPEAKER EMSWorldExpo.com