Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Evidence Based Medicine and Law – Star of Life Law

This is a follow-up to the discussion of MOI (Mechanism Of Injury) begun on Ambulance Driver’s column for EMS1.com – The Cult of Mechanism, which was given a brief introduction at Ambulance Driver’s blog, then hijacked over to here for some commentary, but mainly remaining at AD’s place. Then out of nowhere it is re-hijacked by Star of Life Law. Has he no ethics about this secondary hijacking? Well, he is a lawyer.

What does this lawyer do with his post?

He writes about legal stuff. So predictable. However, a lot of the discussion was about what may land EMS in court, or our patient in the ICU/cemetery. The court room can be scary. Pete Reid writes Star of Life Law and promises to address the legal aspects of EMS on his blog. Of course he starts by picking on the guy with the big yellow head.

From the way we are quoted, it almost seems as if AD and I do not agree on the value of MOI. We do not agree on everything. For example, AD does get a bit carried away when it comes to bacon.

Neither of us seem to have much respect for the abused tool that is MOI. A tool that is held out to the EMS community as a stay out of court free card.

Will you get in trouble for basing your treatment on MOI?

If your medical director knows what the value of MOI is, then Yes. You will probably be questioned on the reason for treatments that are not based on a patient assessment.

Is there a reason to be treating a person based on what does not appear to have injured the patient?

Not really. MOI is a clue. I thought about wording this differently, so that I could write that those basing treatment on MOI don’t have a clue. That would be misrepresenting MOI. MOI is a clue about the patient’s condition, but it is a very weak clue.

What are the MOI criteria?

First let’s look at all of the ACS (American College of Surgeons) trauma triage criteria.

Physiologic criteria:
Systolic blood pressure 29 breaths/min

Anatomic criteria:
Flail chest
≥2 proximal long bone fractures
Penetrating injury (nonextremity)

“Other” criteria:
Age 55 years
Known cardiac or respiratory disease

Mechanism criteria:
Crash speed >20 mph
≥30-inch vehicle deformity
Rearward displacement of front axle
Death of a same-vehicle occupant
Ejection of patient from the vehicle
Opposite-side intrusion >24 inches
Same-side vehicle intrusion >18 inches
Vehicle rollover[1]

The funny thing about these criteria is that you cannot find them on the ACS web site. At least I cannot. I have spent hours searching the site on different occasions. Apparently these are some sort of secret.

This is all I am going to write today. There is a lot about the trauma triage criteria, their application/misapplication, and other stuff to discuss. read what others have written. Welcome Star of Life Law to the EMS blogging community.

Footnotes:

^ 1 Evidence for and impact of selective reporting of trauma triage mechanism criteria.
Burstein JL, Henry MC, Alicandro JM, McFadden K, Thode HC Jr, Hollander JE.
Acad Emerg Med. 1996 Nov;3(11):1011-5.
PMID: 8922006 [PubMed – indexed for MEDLINE]

These criteria are from a 1996 study, so they are probably not the most recent, but they do provide a lot to write about.

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