Smacc Price

[Jovanna Ponder]

TheFOAMed community is unique. Anyone who uses it regularly or contributes to it knows that. For most of us the knowledge we gain through social media and free sources drives our practice heavily. The format and environment helps us to stay motivated and always wanting to learn more. This passion that we have is what drives us to attend SMACC in the first place.

A full day of education from some of the smartest, most motivated prehospital providers in the world. One of my favorite talks, an empassioned rant really, was from Per Bredmose (@VikingOne_). He spoke about the difficult situation of intervening when care is not appropriate or not aggressive enough. It really embodied the SMACC and FOAMed mantra of patient advocacy.

Monday night was also quite notable. During the trip I became quite involved with the EMS Wolfpack (@EMSWolfpack) and EMS Pocus (@emspocus, ). The two groups collaborated to throw a pub night. We rented out an entire bar, The Trinity Inn, for a night of informal point-of-care ultrasound education, socialization, and alcohol consumption. We had no idea what to expect, nor did we know what was coming.

It started off with a few people learning the basics of POCUS (echo, RUSH, vascular access). But, before we knew it, the bar was full. It was impossible to even walk through it. In addition, Jim DuCanto (@jducanto) was there with his SALAD vomiting airway mannequin. This is probably the only documented instance of SALAD being performed in a bar; we are very proud of this. People were learning difficult airway techniques all throughout the night until the bar kicked us out.

However, the learning that was done was not the most remarkable point of the night. We had providers of all levels, from every continent, and from all specialities of critical care attend. People networked and collaborated with each other in a format that I believe is unique to SMACC. As was spoken about in SMACCforce, there was a true flattening of the heirarchy where paramedics were engaging physicians, and vice versa, in relevant and important conversation. The night was an overwhelming success and next year we will need a bigger pub.

Tuesday was the first day of the main conference. There were so many incredible talks that it would take me days to summarize them so I will focus on the ones that impacted me the most. The conference started with an incredible opening with a light show and the new smaccDUB soundtrack. This was followed by the John Hinds plenary, a series of speakers with topics designed to commemorate John.

The rest of day one consisted of concurrent sessions. First I attended the Oxygen and Stress session where we learned from geniuses, including John Myburgh (@JAMyburgh) and self-proclaimed sex god Mervyn Singer that supplemental oxygen is probably a bad thing in most cases and patients do well without it.

The second half of the day was the How I Do It session. Providers spoke on specific practices they use regularly. Casey Parker (@broomedocs) discussed the importance of using evidence based values such as pretest probability when performing tests. In general many of the tests done in the emergency department are not helpful and difficult to interpret. Per Bredmose spoke on his use of inhaled nitric oxide in Norwegian helicopter critical care. Their use focuses primarily on bridging ARDS patients to ECMO but also in any cause of pulmonary hypertension such as pulmonary embolism. The day concluded with a panel discussing how medical knowledge and new data should be disseminated. There was argument about peer-review, journal bias, and the high cost to access new studies. The broad consensus was that we need a centralized, open access location to put all new data which has a publicly viewable peer-review process.

Day two started with a plenary called Slaying Sacred Cows. This was a series of four incredible talks which truly all deserve individual recognition. Resa Lewis (@ultrasoundREL) spoke inspirationally about women as leaders. She taught lessons that are designed to help both men and women succeed as leaders in medicine.

Ross is a pediatric surgeon in the UK and he described some of the times during his practice that he has been most scared. This included operating on a 600 gram neonate with NEC. A patient this size has a blood volume of about 60 mL and they tend to bleed. He said that fear is the emotion that ends careers of excellent providers. The most important factor in dealing with fear is support from colleagues. In the right environment, fear can be overcome. This talk took such courage to give to a room of 2,000+. It is a must hear for everyone once it is released.

The next was from Reuben Strayer (@emupdates) who spoke about treatment of agitation. The most important part of the talk was this: we want droperidol back in the U.S.! It is a safe and effective drug for the significantly disruptive patient. If the patient is combative, or a threat to themselves or others, IM ketamine is the agent of choice.

The last talk of the morning plenary was from the amazing Liz Crowe (@LizCrowe2). She spoke about love in critical care and how it really impacts patient outcomes and provider health. As expected the talk was full of laughs and sexual enuendo. Remember your patients, patient families, and colleagues all need love.

Haney Mallemat (@CriticalCareNow) intrigued the audience by proposing a modern approach to PEA arrest. Not all are the same and underlying causes must be identified and treated if ROSC is to occur. PEA is really an umbrella term, much like SVT. Ultrasound should be used to distiguish between pulselessness with rhythm and echo motion (PREM) and pulselessness with rhythm and echo standstill (PRES).

The afternoon of day two featured three different forums, of which I attended Bare Knuckle EM. There were four sessions which included an EM literature update. It turns out bacon can be used to treat epistaxis! Who knew? ( ) Actual relevant topics were also discussed. The three following sessions were pro/con debates about important topics in EM. The topics were: EM is a failed paradigm, POCUS is a problem, and thrombolysis in submassive PE. Check these when they are released. The day concluded with SONIC BOOM, an entertaining and educational display of POCUS techniques.

The last day started off interestingly. The auditorium was about 1/4 full as a result of gala activities the night before. It gradually filled throughout the morning. The plenary talks were themed Beyond the Ivory Towers. The first two talks were from Kath Maitland (@KathMaitland) and Nikki Blackwell. They both discussed topics regarding their work in Africa providing care for critically ill patients with few resources. Kath focused on oxygen and its potential overuse.

In critical care, pre-hospital and in-hospital, providers carry a massive burden. Clinical responsibility paired with emotional trauma often leads to the downfall of incredible people. Ashley gave an emotional and honest talk with essentially no slides. I encourage everyone to listen to this when it is released.

Brining Sexy Back was the theme of my morning session. Weingart spoke about post-intubation sedation and analgesia. Remember: analgesia always and FIRST. The most notable talk though was from Alex Psirides (@psirides) on Why Your Hospital is Broken.

My last concurrent of the conference was A is for Airway. Four great talks here. Reuben Strayer presented a somewhat novel approach to laryngoscopy designed to make providers slow down and not rush. Listen to the lecture and see what its all about.

Karl Storz Endoscopy-America, Inc., El Segundo, California, has been awarded a maximum $371,796,082 modification (P00032) exercising the third one-year option period of a five-year base contract (SPM2D1-12-D-8213) with three one-year option periods offering Integrated Operating Room (IOR) components, system options & accessories, upgrades, training, maintenance services, and turnkey installation. This is a fixed-price with economic-price-adjustment, indefinite-delivery/indefinite-quantity contract. This is a fixed-price with economic-price-adjustment, indefinite-delivery/indefinite-quantity contract. Location of performance is California, with an April 26, 2020, performance completion date. Using customers are Army, Navy, Air Force, Marine Corps and federal civilian agencies. Type of appropriation is fiscal 2019 through 2020 defense working capital funds. The contracting activity is the Defense Logistics Agency Troop Support, Philadelphia, Pennsylvania.

American Purchasing Services, LLC, doing business as American Medical Depot, Miramar, Florida, has been awarded a maximum $294,502,746 modification (P00047) exercising the third one-year option period of a five-year base contract (SPM2D1-12-D-8211) with three one-year option periods for Integrated Operating Room (IOR) components, system options & accessories, upgrades, training, maintenance services, and turnkey installation. This is a fixed-price with economic-price-adjustment, indefinite-delivery/indefinite-quantity contract. Location of performance is Florida, with an April 24, 2020, performance completion date. Using customers are Army, Navy, Air Force, Marine Corps and federal civilian agencies. Type of appropriation is fiscal 2019 through 2020 defense working capital funds. The contracting activity is the Defense Logistics Agency Troop Support, Philadelphia, Pennsylvania.

PCX Aerostructures, LLC, Newington, Connecticut, has been awarded an $8,040,900 firm-fixed-price contract for pitch housing assemblies. This was a competitive acquisition with two responses received. This is a one-time buy with no option periods. Location of performance is Connecticut, with a Dec. 30, 2020, performance completion date. Using military service is Army. Type of appropriation is fiscal 2019 Army working capital funds. The contracting activity is the Defense Logistics Agency Aviation, Redstone Arsenal, Alabama (SPRRA1-19-C-0023).

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