Archives for March 2010

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

- Rogue Medic

What kind of punishment do you get for NOT disobeying dispatch?

There is a video in the article. It cannot be embeded.

Tony Weinmann, president of the Fraternal Association of Professional Paramedics, said Monday that the city notified two paramedics of pending discipline in connection with Curtis Mitchell’s death.[1]

These paramedics have received notice that they will be disciplined, in spite of being cleared of responsibility in 2 separate investigations. They have not been told what kind of discipline, although it has been leaked to the press that at least one will be fired. At the time this story was published, this morning, one of the paramedics was still at work on the street.

She was still not aware of what kind of punitive action will be taken by the city for being cleared by 2 independent investigations. If she is investigated a third time and cleared, maybe Mayor Luke Ravenstahl and Public Safety Director Michael Huss will have to execute her.

Pittsburgh Public Safety Director Mike Huss would not confirm reports of discipline, but he said the city has completed its investigation and is planning a news conference at 1:30 p.m.[1]

It is now 3:00 PM and still there is no new report of the form of punishment.

His longtime partner, Sharon Edge, told WTAE Channel 4 Action News that she didn’t think the two paramedics should lose their jobs.

“I think they used them as a scapegoat. I don’t want them to get fired because that wouldn’t be right, and Curtis wouldn’t have wanted that,” said Edge.[1]

2 independent investigations and the person most affected by the death of her common law husband. The same conclusion. The medics are not at fault in causing the death of Curtis Mitchell.

Scapegoats.

The paramedics’ union criticized city leaders on Saturday, saying, “It is quite obvious prior to this incident that the city was ill-prepared for this snow disaster. The administrators in charge of the public’s safety did not put the employees of the city of Pittsburgh in a position to carry out their responsibilities in an effective manner.”[1]

Now, if I were the skeptical type, I might suspect that this is an attempt by the people responsible for the handling of emergencies in the City of Pittsburgh to deflect blame onto someone else. Secret higher standards for the people actually doing the work, but lower standards for those in charge. Why so many secrets?

Would that be an unreasonable suspicion?

We all had ample time to prepare.

– Cecil County Director of Emergency Services Richard Brooks.[2]

Cecil County does not handle emergencies the same way that Pittsburgh handles emergencies.

I have also written about this here –

City may discipline EMS workers – Public Safety Director Michael Huss – 02/18/10

Where Was Public Safety Director Michael Huss during the Death of Curtis Mitchell? – 02/20/10

Public Safety Director Michael Huss and Others Continue to Blame the Medics for the Snow – 02/22/10

The Need for Evidence Before Assessing Guilt – 02/24/10

Anonymous Comments on the Death of Curtis Mitchell – 03/02/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part I – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part II – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part III – 03/22/10

What kind of punishment do you get for NOT disobeying dispatch? – 03/23/10

The Scapegoats Will Be Punished – 03/23/10

Pittsburgh – Punishment, not Planning – 03/24/10

Josie Dimon was the Scapegoat of Public Safety Director Michael Huss in the Death of Curtis Mitchell – 02/16/11

Michael Huss – Pittsburgh EMS Only Needs Someone Good With a Shovel – 02/16/11

Links updated 02/16/11.

Footnotes:

[1] Paramedics To Be Disciplined For Man’s Death After Snowstorm – Curtis Mitchell Died, Despite Repeated Calls To Pittsburgh 911
ThePittsburghChannel.com
Posted: 3:54 pm EDT March 22, 2010
Updated: 11:02 am EDT March 23, 2010
Article

[2] From Mitigation Journal

EMS Under the Bus in Pittsburgh – 02/28/10

And in the Mitigation Journal podcast –

MJ156: Winter Storms: Interview with Mr. Richard Brooks, Director Cecil County MD, Emergency Services – 02/23/10

From the MedicCast

Snow Storm 2010 Response and Episode 208 of the MedicCast – 02/28/10

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Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part I


I have not been on any of the podcasts covering the Pittsburgh EMS response in the snow and ice, when Curtis Mitchell died. I just listened to the EMS Garage podcast that covered this as a part of the episode.

It seems that the less you know about what happened, the more you blame the medics. The topic seemed to be dominated by comments stating, the news said, or the news didn’t say.

Do we trust the news to get the story right?

Few people seem to be surprised at how little information was released.

Originally, the information released was that a couple of medics responded 3 times, but those medics refused to get out of their truck because they were lazy.

We now know that there were 6 different medics. The medics did not refuse to get out of the truck. The medics were canceled by dispatch. It appears that the crews were then reassigned to other patients, because they were running non-stop all day. Calls were waiting for ambulances to become available.

Running non-stop transporting patients in the snow and ice is somehow lazy?

This is to be expected during disaster conditions. This does not seem to be the experience of the critics, even though they claim to have extensive disaster experience.

These medics transported a lot of other patients.

How did the patients get to the hospital, if the medics did not get out of the truck?

How did the patients get to the hospital if these medics were lazy?

In this case, it appears that the media were fed misleading information by Public Safety Director Michael Huss. The man responsible for public safety essentially pointed his finger at the medics and squealed, They did it! They did it! They did it!

OK, squealed may not technically correct. That doesn’t mean that it is any less fair than anything Public Safety Director Michael Huss said. He is responsible for public safety, but apparently only when the sun is shining, but not too much sun.

Two mistakes, that many people have repeated –

The medics never got out of the truck.

And –

The medics never tried.

Does anyone have any evidence to support either statement?

Does anybody really think that this is true?

Why does anyone believe this?

Insanity?

Immaturity?

Gullibility?

Mass hallucination?

I believe that the reason is a lack of critical judgment.

Did any news report make either statement? If the medics did not get out of the truck, and no help was sent, who dug the ambulances out of the snow?

Public Safety Director Michael Huss did say something about the medics needing to get out of the truck, but is there any reason to believe that the words of Mr. Huss are at all credible?

The comments of Public Safety Director Michael Huss were what originally caught my attention. The comments remind me of a child trying to explain that he does not know what happened to the missing chocolate chip cookies, even though he is covered with melted chocolate.

Maybe the child is not guilty, but am I going to start looking for some mysterious stranger or maybe a cookie monster?

Still, this is the explanation that was repeated on the podcast. There was some dissent on the show, but the uninformed critics of the medics did seem to dominate the discussion. I like the EMS Garage. Chris Montera does a great job of encouraging discussion on important topics. This was a segment that will encourage people to blame the wrong people. This will encourage people to ignore disaster planning, because the medics can just get out of the truck and walk. The only way this is disaster planning, is by turning something that is not a disaster into a true disaster. Then management will blame the lowest people on the totem pole.

In a different podcast, covered on both Mitigation Journal and the MedicCast, there is a different approach to the topic. That is in Part II. Then there is Part III.

Podcasting on the death of Curtis Mitchell:

From Mitigation Journal

EMS Under the Bus in Pittsburgh – 02/28/10

And in the Mitigation Journal podcast –

MJ156: Winter Storms: Interview with Mr. Richard Brooks, Director Cecil County MD, Emergency Services – 02/23/10

From the MedicCast

Snow Storm 2010 Response and Episode 208 of the MedicCast – 02/28/10

From the EMS Garage

Up to My Pips: EMS Garage Episode 75 – 03/02/10

Writing on the death of Curtis Mitchell:

From Too Old To Work, Too Young To Retire

Trouble Right Here In Three River City – 02/19/10

Comment From Someone In Pittsburgh – 02/20/10

More From Pittsburgh – 02/23/10

Update On The Pittsburgh Story – 02/28/10

And Then I Realized… – 03/01/10

Fertilizer – 03/22/10

Human Sacrifice – 3/24/10

The Tapes Don’t Lie, But People Do – 3/29/10

The Drama Continues In Pittsburgh – 5/12/10

Let The Scapegoating Begin – 01/06/11

Common Sense Prevails – 02/15/11

From David Konig

EMS Blog Rounds Edition 32 – 03/09/10

Why You Need A Social Media Presence: The Case Of Pittsburgh EMS – 02/22/10

Yes Mary, It Is A Transportation System – 02/19/10

From 9-ECHO-1

Pittsburgh…my take on it – 02/23/10

Still Don’t Make It Right… – 03/20/10

From A Day In The Life Of An Ambulance Driver

As usual the truth is somewhere between the extremes – 02/20/10

From Pittsburgh Legal Back Talk

The Power of Saying “I’m Sorry”. – 02/21/10

Medic’s Perspective on Mitchell Case. – 02/22/10

The Need for Evidence Before Assessing Guilt. – 02/23/10

The View from Foggy Goggle. – 02/25/10

I have also written about this here –

City may discipline EMS workers – Public Safety Director Michael Huss – 02/18/10

Where Was Public Safety Director Michael Huss during the Death of Curtis Mitchell? – 02/20/10

Public Safety Director Michael Huss and Others Continue to Blame the Medics for the Snow – 02/22/10

The Need for Evidence Before Assessing Guilt – 02/24/10

Anonymous Comments on the Death of Curtis Mitchell – 03/02/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part I – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part II – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part III – 03/22/10

What kind of punishment do you get for NOT disobeying dispatch? – 03/23/10

The Scapegoats Will Be Punished – 03/23/10

Pittsburgh – Punishment, not Planning – 03/24/10

Josie Dimon was the Scapegoat of Public Safety Director Michael Huss in the Death of Curtis Mitchell – 02/16/11

Michael Huss – Pittsburgh EMS Only Needs Someone Good With a Shovel – 02/16/11

Links updated 02/16/11.

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Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part III


Why the flurry of posts on the death of Curtis Mitchell?

The Pennsylvania Department of Health has exonerated the paramedics of any wrongdoing, but that ruling seems to carry little weight with city officials.[1]

Just a few quotes to highlight the problems in Pittsburgh

Mr. Huss (public Safety Director Michael Huss) said they should have walked to Mr. Mitchell’s home to retrieve him. “It’s that simple,” he said.[2]

On Friday, (Mayor) Ravenstahl reiterated that the city has its own rules.

“When you look at the state’s requirements that nothing was done wrong, we feel differently,” said Ravenstahl. “But one thing that’s important to understand is that we have higher standards — in terms of what we expect from our paramedics here in Pittsburgh — than what the state requires.”

Ravenstahl, along with other city officials involved in the case, has not revealed what those standards are.

“We’ll disclose that at the time when we make an announcement. It’s not [public disclosure] at this time. We will make it available,” said Public Safety Director Michael Huss.[3]

Double secret probation?

[youtube]Y0cF2piwjYQ[/youtube]

Apparently, Mayor Ravenstahl thinks he can shield his friend from any blame for poor planning, by blaming the paramedics, who were following lawful directions from dispatch. The medics were not as tactful as they should have been, but that was addressed by the medical director before the first press conference.[4]

This would be suspicious, if someone were attempting to get rid of Pittsburgh EMS and have the fire department take over EMS. Has anyone asked what the fire department was doing during this storm? Was their behavior better than the behavior of EMS? Public Safety Director Michael Huss is a retired fire chief. Maybe he knows.

We’re successful because our business, be it fire department, EMS, combination, career, volunteer, emergency management, emergency operation, or in my case emergency services – We have got to be flexible, forward thinking, out of the box type people. That’s when we’ll do the best job.

When people come at you with something that you did not predict, and you can sit back for a few minutes and go, “There’s a way we can deal with this,” and make it work, then refine it for the next time. That’s how we’re going to have success.

– Cecil County Director of Emergency Services Richard Brooks.[5], [6]

That kind of thinking doesn’t seem to be possible in Pittsburgh.

For links to other writing/podcasting on the subject, see Part I or Part II.

Footnotes:

[1] Investigation Clears EMS Workers In Snowstorm Death – Mayor Says City Has ‘Higher Standards’
ThePittsburghChannel.
Posted: 4:58 am EDT March 19, 2010
Updated: 5:34 pm EDT March 20, 2010
Article

[2] City may discipline EMS workers – Man died at home despite repeated calls to 911 during snowstorm
Thursday, February 18, 2010
By Sadie Gurman,
Pittsburgh Post-Gazette
Article

[3] Investigation Clears EMS Workers In Snowstorm Death – Mayor Says City Has ‘Higher Standards’
ThePittsburghChannel.
Posted: 4:58 am EDT March 19, 2010
Updated: 5:34 pm EDT March 20, 2010
Article

[4] Medical Call Review for 5161 Chaplain Way 2/6/2010
Ron Roth, MD Final 2/15/10
Medical Director, City of Pittsburgh, Department of Public Safety
Medical Director, Allegheny County Emergency Operations Center
Free Full Text

[5] MJ156: Winter Storms: Interview with Mr. Richard Brooks, Director Cecil County MD, Emergency Services
Mitigation Journal
Podcast

In the Mitigation Journal blog on the same topic –
EMS Under the Bus in Pittsburgh – 02/28/10

[6] Snow Storm 2010 Response and Episode 208 of the MedicCast
MedicCast
Podcast

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Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part II


As opposed to what I wrote about in Part I, there is a more thoughtful, more thorough approach to disaster planning covered on both Mitigation Journal and the MedicCast.

Cecil County (Maryland) Director of Emergency Services Richard Brooks is interviewed.

This is a podcast that is very important to listen to.

There are many important topics that people do not understand. For example, if there is the possibility of a disaster, how much preparation is appropriate? When the disaster does not happen, there will be many critics, so some places avoid preparation.

Better not spend too much. That will look bad, if the storm is not as bad as forecast. If the worst happens, we can just blame the medics.

That is an important contrast between Pittsburgh and Cecil County. It is true that Pittsburgh has a lot of financial problems that other places do not have, but this should have encouraged them to call for help earlier. The National Guard has 4 wheel drive vehicles. Pittsburgh needed 4 wheel drive vehicles. The National guard has snow plows. Pittsburgh needed snow plows. The decision to call early should have been easy.

When 911 calls are put on hold for 10 hours, you might want to consider that you are dealing with a disaster. Maybe avoiding dealing with a disaster is their style.

When you have 911 calls on hold for 10 hours, you need to admit that you are overwhelmed. You need to use your brains, rather than having crews wandering around in the snow, doing things that should be done by equipment. The Luddite approach leads to deaths.

Public Safety Director Michael Huss clearly does not believe in using critical judgment. His response was for the medics to tie themselves up on one call for hours by getting out of the truck and walking to the patient. Then possibly endangering the patient by having 2 people try to drag him through the snow and ice. Mayor Ravenstahl seems to be defending his buddy.[1]

We all had ample time to prepare.

– Cecil County Director of Emergency Services Richard Brooks.

In the interview, Richard Brooks describes using critical judgment and encouraging his people to use critical judgment. He describes it as thinking outside the box. I do not like the phrase for a bunch of reasons. One is that it has become overused by so many people. Richard Brooks uses it appropriately.

Michael Huss doesn’t seem to want medics to appropriately use equipment. He seems to want them to just use their legs. If they do that, he seems to think that the lack of preparedness will not be noticed.

Why?

He knows what happened, so he thinks that he knows how to avoid it in the cheapest way possible. He is wrong. Monday morning quarterbacks usually are.

Public Safety Director Michael Huss encourages us to think as Luddites. Technology is evil. Destroy all tools. And blame the medics.

We’re successful because our business, be it fire department, EMS, combination, career, volunteer, emergency management, emergency operation, or in my case emergency services – We have got to be flexible, forward thinking, out of the box type people. That’s when we’ll do the best job.

When people come at you with something that you did not predict, and you can sit back for a few minutes and go, “There’s a way we can deal with this,” and make it work, then refine it for the next time. That’s how we’re going to have success.

– Cecil County Director of Emergency Services Richard Brooks.

That is not the bureaucratic response. The bureaucratic response is to sacrifice low ranking personnel to protect the jobs of their bosses (the ones who really caused the problem).

Cecil County will not have to deal with explaining a preventable death to the media, because they will be prepared for disasters. When their preparation does not lead to an easy solution, they will start trying other things.

How much thought is required to decide to send a 4 wheel drive truck to pick up a patient, rather than have the medics re-enact the Iditarod? If we use the right tools, we are able to help more people. If we use critical judgment, we are able to help more people. If we use the Luddite solution, we endanger everyone.

I am very critical of people who discourage the use of critical judgment.

I think that the only way that the statements of Public Safety Director Michael Huss make sense, is if we abandon the use of critical judgment. We would need to engage in a willing suspension of disbelief.[2]

Reasonable people only engage in a willing suspension of disbelief to enjoy fiction. Fiction, that otherwise would be seen as unbelievable.

Public Safety Director Michael Huss does not even provide good unbelievable fiction.

The official report from the medical director is not fiction.[3]

There is more in Part III

Podcasting on the death of Curtis Mitchell:

From Mitigation Journal

EMS Under the Bus in Pittsburgh – 02/28/10

And in the Mitigation Journal podcast –

MJ156: Winter Storms: Interview with Mr. Richard Brooks, Director Cecil County MD, Emergency Services – 02/23/10

From the MedicCast

Snow Storm 2010 Response and Episode 208 of the MedicCast – 02/28/10

From the EMS Garage

Up to My Pips: EMS Garage Episode 75 – 03/02/10

Writing on the death of Curtis Mitchell:

From Too Old To Work, Too Young To Retire

Trouble Right Here In Three River City – 02/19/10

Comment From Someone In Pittsburgh – 02/20/10

More From Pittsburgh – 02/23/10

Update On The Pittsburgh Story – 02/28/10

And Then I Realized… – 03/01/10

Fertilizer – 03/22/10

Human Sacrifice – 3/24/10

The Tapes Don’t Lie, But People Do – 3/29/10

The Drama Continues In Pittsburgh – 5/12/10

Let The Scapegoating Begin – 01/06/11

Common Sense Prevails – 02/15/11

From David Konig

EMS Blog Rounds Edition 32 – 03/09/10

Why You Need A Social Media Presence: The Case Of Pittsburgh EMS – 02/22/10

Yes Mary, It Is A Transportation System – 02/19/10

From 9-ECHO-1

Pittsburgh…my take on it – 02/23/10

Still Don’t Make It Right… – 03/20/10

From A Day In The Life Of An Ambulance Driver

As usual the truth is somewhere between the extremes – 02/20/10

From Pittsburgh Legal Back Talk

The Power of Saying “I’m Sorry”. – 02/21/10

Medic’s Perspective on Mitchell Case. – 02/22/10

The Need for Evidence Before Assessing Guilt. – 02/23/10

The View from Foggy Goggle. – 02/25/10

I have also written about this here –

City may discipline EMS workers – Public Safety Director Michael Huss – 02/18/10

Where Was Public Safety Director Michael Huss during the Death of Curtis Mitchell? – 02/20/10

Public Safety Director Michael Huss and Others Continue to Blame the Medics for the Snow – 02/22/10

The Need for Evidence Before Assessing Guilt – 02/24/10

Anonymous Comments on the Death of Curtis Mitchell – 03/02/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part I – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part II – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part III – 03/22/10

What kind of punishment do you get for NOT disobeying dispatch? – 03/23/10

The Scapegoats Will Be Punished – 03/23/10

Pittsburgh – Punishment, not Planning – 03/24/10

Josie Dimon was the Scapegoat of Public Safety Director Michael Huss in the Death of Curtis Mitchell – 02/16/11

Michael Huss – Pittsburgh EMS Only Needs Someone Good With a Shovel – 02/16/11

Links updated 02/16/11.

Footnotes:

[1] Investigation Clears EMS Workers In Snowstorm Death – Mayor Says City Has ‘Higher Standards’
ThePittsburghChannel.
Posted: 4:58 am EDT March 19, 2010
Updated: 5:34 pm EDT March 20, 2010
Article

[2] Suspension of disbelief
Wikipedia
Article

[3] Medical Call Review for 5161 Chaplain Way 2/6/2010
Ron Roth, MD Final 2/15/10
Medical Director, City of Pittsburgh, Department of Public Safety
Medical Director, Allegheny County Emergency Operations Center
Free Full Text

.

Education Problems, Autism, and Vaccines

Monday I wrote about the problems that can result from national standards. We do need to raise our education standards. An excellent example can be seen in the faulty logic used by those claiming that vaccines cause autism.

Hypothesis: Vaccines cause autism.

Experiment: Compare the rate of autism in groups with differences in vaccination methods. There are many ways this can be done, depending on the way the vaccine is hypothesized to cause autism.

However, the people claiming that vaccines cause autism do not accept the research that has been done. They claim that it is obvious that vaccines are dangerous and no amount of science will change their minds.

Vaccines contain thimerosal. Thimerosal is mercury. Mercury causes brain damage. The brain damage caused by mercury is exactly the same as autism. Mercury is one of the most toxic substances on the planet, so we have to stop poisoning children with it.

Clearly, this is a problem. We have a substance so dangerous that it must produce close to 100% brain damage. It is good that these public spirited people have raised this alarm.

Wait!

Using faulty logic, we can prove almost anything. Here is one example.

Zeno’s paradoxes provide several. Here is just one.

In a race, the quickest runner can never overtake the slowest, since the pursuer must first reach the point whence the pursued started, so that the slower must always hold a lead.[1]

Once the pursuer reaches the spot where the slower runner was, the process repeats infinitely. Since distances can be made ever smaller – there is no distance so infinitesimal, that is not made up of an infinite number of even smaller infinitesimal distances. Therefore, the faster runner can never catch up to a slower runner, who has just a tiny head start.

Using a different paradox, Zeno proves that the runner cannot even first reach the point whence the pursued started.

That which is in locomotion must arrive at the half-way stage before it arrives at the goal.[2]

The same endlessly repeating problem of infinitely divisible space is the explanation.

However, we know that these are not impossibilities. It is only by proposing an explanation that sounds reasonable, that these become confusing.

The way we find out the truth is simple. We test the claim.

Anyone capable of walking can walk across a room. There is no need to break the motion up into smaller and smaller parts. The motion is continuous.

Similarly, the problem of thimerosal only appears insurmountable. The only way to determine the accuracy of the claim is to test it.

The single study, that has supported any connection between thimerosal and autism, had such fatal flaws that it was retracted by the journal that published it. In 2004, most of the authors of the study had their names removed from the study, when they became aware of the fraud involved. The study was funded by lawyers hoping to win a big settlement from drug companies. All the lawyers needed was a study that showed this connection. About half a million dollars later, Andrew Wakefield was able to produce just such a study.

One problem with the explanation that thimerosal is such a toxic substance is that the occurrence of autism is supposed to happen so quickly after the vaccination, that the connection is inescapable. Some parents describe the onset of autism symptoms resembling somebody turning off a switch.

This study investigated if the discontinuation of thimerosal-containing vaccines paralleled a decrease in the occurrence of autism. The incidence of autism remained fairly constant during the period of use of thimerosal in Denmark, and the rise in incidence beginning in 1991 continued even in the group of children born after the discontinuation of thimerosal. The amount of thimerosal used in vaccines changed during the study period with less amount of thimerosal administered in the period 1970–1992. Moreover, the thimerosal-containing vaccine was gradually phased out meaning that the incidence rates should decline gradually if thimerosal has any impact on the development of autism. However, an increase (rather than a decrease) in the incidence rates of autism was observed.[3]

So much for throwing a switch.

Using the logic of the anti-vaccinationists, this must be evidence that thimerosal protects against autism.

There are many reasons for using this chart. The chart is from the same study as the paragraph that is above it, so it was handy. It is dramatic. It makes it easy to see that there is no connection between when thimerosal was in the vaccines (up until the vertical line) and autism (begins to increase just as the thimerosal is removed). There are other studies that show the same information. The evidence is clear.

There is no reason to believe that vaccines cause autism.

Then there is the comment that is supposed to silence disagreement. If you don’t have an autistic child, you cannot understand anything about autism. Unless you agree with the anti-vaccinationists. It doesn’t matter if you know what you are talking about, if you agree with them.

Therefore, if I want to know what is the best treatment for something, I should ignore doctors and ask a parent of a child with the condition. Using this logic, the most knowledgeable parent would be one with a child sick for the longest time with that disease. If being a parent of a sick child confers expertise, then the longer that illness continues, the greater the expertise conferred by this faulty logic.

If my child is sick, I am not going to look for parents with the same condition. These parents may have a lot of useful information about many things. However, the abilities to understand assessment, diagnosis, and treatment are not infections transmitted from the children to the parents.

The doctor to go to is also not the one treating children who do not get better. The anti-vaccinationists might conclude that the greatest expert is a parent who had at least one child die from the illness. They are persuaded by emotion, not reason.

There is a further problem with, I refuse to listen to anyone who does not have an autistic child. These parents even ostracize other parents of autistic children unless those parents agree with the emotional claims of the anti-vaccinationists about thimerosal. Catch-22 has nothing on them.

What about the mercury?

Thimerosal is C9H9HgNaO2S or sodium ethylmercurithiosalicylate. Mercury is Hg. Thimerosal is not mercury, but a compound that contains mercury. Being in a compound changes the characteristics and the effects of elements.

An example that people in EMS should understand is chlorine (Cl). This is so toxic, that it was used as a poison gas. Mix it with sodium (Na), which is also extremely toxic, and you have sodium chloride. Sodium chloride (NaCl) is known as common table salt. Sodium chloride is also the ingredient in normal saline, which we inject into the veins of just about every patient with a serious medical condition.

According to the anti-vaccinationists, No amount of mercury is safe. Based on what? Using the same criteria (Because I say so!), no amount of sodium or chlorine would be safe in the body. After all, they are toxic.*

The video below is less than 10 minutes long, but does a great job of explaining ways in which science keeps us from attributing too much to anecdotes, such as this. He was a normal little boy, until he received the vaccine. Autism is diagnosed at the time that children receive vaccinations. This is true, even for children who do not receive vaccinations. Since the vaccines do not cause autism, the only thing avoiding vaccination does is to endanger children.

The explanations that sound good, but are not supported by research are examples of narrative fallacy. I have written more than a little bit about narrative fallacy, because it is important. Using this devotion to reasonable sounding explanations, even though research demonstrates that these explanations are wrong, is a problem. Fortunately, in medicine there is more of an understanding of science. If that were not the case, we might be still bleeding patients to get rid of bad humors.

Narrative Fallacy –

Narrative Fallacy I

How did this happen? – Research

Narrative Fallacy II

CAST and Narrative Fallacy

C A S T and Narrative Fallacy comment from Shaggy

Some Research Podcasting Comments

Shaggy Comments on Some Research Podcasting Comments.

Spine Immobilization in Penetrating Trauma: More Harm Than Good?

EMS EdUCast – Journal Club 2: Episode 43

Education Problems, Autism, and Vaccines

Footnotes:

^ * This does ignore the obvious problem that both hyponatremia and hypocalcemia are fatal conditions, even though sodium and calcium are toxic. If only there were some kind of medical expert to explain cutting edge toxicology. Somebody like Paracelsus.

^ 1 Zeno’s paradoxes
Wikipedia
Achilles and the tortoise
Article

^ 2 Zeno’s paradoxes
Wikipedia
The dichotomy paradox
Article

^ 3 Thimerosal and the occurrence of autism: negative ecological evidence from Danish population-based data.
Madsen KM, Lauritsen MB, Pedersen CB, Thorsen P, Plesner AM, Andersen PH, Mortensen PB.
Pediatrics. 2003 Sep;112(3 Pt 1):604-6.
PMID: 12949291 [PubMed – indexed for MEDLINE]

Pediatrics has the free full text and free PDF available at their site.
Free Full Text                 Free PDF

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National Standards for Education

In today’s news there is a story about mandatory voluntary national standards for education. These are not EMS standards/protocols, but the issues are not significantly different. I will specifically address EMS standards/protocols in other posts, but the parallels should be pretty clear.

The Patrick administration will not adopt national academic standards if they are lower than those established in Massachusetts, long championed as having among the most rigorous expectations, according to the state’s education secretary.[1]

That is a sensible response, but maybe we need to consider it from the opposite direction. Is any other response sensible?

There is an advantage to being able to move from state to state and have a child transfer directly into the same grade. As a parent, I have moved across state lines several times. In my case, this advantage would have been minimal. The advantage does not seem to justify a national standard, unless that national standard produces very little harm in its unintended consequences.

“We are trying to sound the alarm,’’ said Jim Stergios, the institute’s (The Pioneer Institute, a conservative-leaning public policy research organization in Boston) executive director. “Massachusetts has the highest standards in the nation. Why would you want to change course?’’[1]

That is the big problem with the idea of national standards. National standards seem to place more value on uniformity, than on quality.

As with EMS, there are plenty of advantages to national standards. There is a big drawback when statewide standards, or nationwide standards, are proposed. Promises of benefits are the focus, but when the everybody standards are enacted, a mindless devotion to uniformity replaces many of the benefits.

Rather than have the standards raise up the places with lower quality, there is a backpedaling on raising the standards. The new goal is to prevent the standards from becoming a hardship for those who might benefit the most from standards.

The result is often a set of standards that makes improvement for the places of low quality optional. After all, it would somehow be elitist to insist that poor educators significantly improve their quality.

Here is an important point on standards from the article.

While adopting the standards would be voluntary, the Obama administration has said that it intends to withhold millions of dollars in grants for low-income students in states that refuse to join the effort — regardless of the quality of their existing standards.[1]

We’re here to offer you some protection. There are some dangerous people in the neighborhood. We would really hate to see anything bad happen to your nice store. Of course, this is completely voluntary.

What kind of miscreant would possibly decline an offer to join the effort?

Or decline to volunteer?

I avoid the left wing/right wing political parties because I could hurt myself from laughing too hard. This is just another example. The left wing trying to improve schools by cutting off funding for low-income students. Are they trying to put The Onion out of business?

You will lower your standards, so that you are just like all of the other states. Otherwise we will deprive you of your share of education funding for low income students. We will cut your budget until you lower your standards. Of course, this is completely voluntary.

The administration also says states that embrace the standards will have a better chance of receiving potentially hundreds of millions of dollars in its “Race to the Top’’ competition, which rewards education innovation. Massachusetts has applied for $250 million from that program.[1]

A quarter of a billion dollars of bribery incentive. This does not even include the grants for low-income students being threatened redistributed to more worthy causes. Causes more worthy than keeping the poorest children from growing up too ignorant for anything more than jobs as political appointees.

Of course, it would be ignorant, vulgar, and completely unfair to label these tactics as anything other than helpful.

One member — Sandra Stotsky, a former associate education commissioner who oversaw the development of the state’s standards — ridiculed the national benchmarks, saying they rely too heavily on broad “empty skills’’ and lack rich academic content at each grade level.[1]

Empty skills. As in skills testing devoid of any context? It is as if she is referring to the National Registry of EMTs examination. If uniformity were the quintessence of education, NR would produce excellent beginner medics, since NR places uniformity above all else.

It is unclear whether states would have to adopt the national standards word for word or whether they could augment them with existing ones so long as the state standards were higher. Adopting new standards is unappealing in lean economic times because it can require the wholesale replacement of textbooks and additional training for teachers.[1]

Don’t worry. These will always be flexible standards. We would never change a policy after everyone is committed to using this standard.

Trust us.

We’re from the government.

We’re here to help.

Trust us.

Then there are the educators, the ones supposed to be familiar with reading comprehension. Such a person is Glenn Koocher, executive director of the Massachusetts Association of School Committees. Maybe not an educator, but a spokesperson for administrators of educators?

“The rest of the nation will finally march to the same beat as Massachusetts,’’ Koocher said.[1]

Inflexible standards will force everyone to march to the same beat, but it is unlikely to be the same beat that Massachusetts is currently marching to. All A is B may not be the same as All B is A.

If the standards are completely inflexible, it is not clear that Massachusetts will agree to the offer to voluntarily use the national standards. That offer is beneficent, and clearly without the possibility of any ulterior motive. Depending on how much Massachusetts has come to rely on these federal grants might profit from the generosity of those redirecting low-income education funds, Massachusetts may feel compelled to cooperate with these voluntary tactics.

Glenn Koocher may not be rejoicing once Massachusetts is marching to the same beat as the rest of the nation. Glenn Koocher may even develop a better understanding of syllogism, although I wouldn’t count on it.

Metaphor-wise,Huh? Harrison Bergeron[2] is essential to any discussion of standards that are potential ceilings.

Footnotes:

^ 1 State firm on school quality. Will reject US standards if they don’t measure up.
By James Vaznis
Globe Staff / March 15, 2010
The Boston Globe
Page 1
Page 2

^ 2 Harrison Bergeron
Wikipedia
Harrison Bergeron is a short and excellent story in the collection Welcome to the Monkey House by Kurt Vonnegut. It has been turned into a film, but the story is much better in print. This is one story that should be mandatory reading in all schools. Kurt Vonnegut has created perhaps the most horrifying, most banal dystopia.
Article

^ Huh? The Apartment
I blame Billy Wilder (and/or I. A. L. Diamond) for this not-so-new neologism method.
1, 2, 3 and 4, 5, 6 and 7 and 8.

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Protocol Problems

 
David Konig writes a must read response to a question Twittered by Steve Whitehead.

When is it OK to deviate from your established written protocols?

While I do not use Twitter, I can answer this in less than 140 characters.
 

Deviation from protocol is not just acceptable, but mandatory, when the protocol is wrong for the patient.
 

The answer to the question does not identify the problem.

The problem is that the patient is not now, nor ever has been, the priority in patient care. That needs to change.

At one end, there are too many of us who are afraid to say when the protocol is wrong for the patient, or to do what is right for the patient, when it is obvious – when we are faced with a real patient.

At the other end, we have QA/QI/CYA people and medical directors more interested in whether protocol observance has been documented, than whether there is actually appropriate care being delivered to patients.

I have received more criticism for doing the right thing than I have received praise for doing the right thing.

I have received more criticism for doing the right thing than I have received criticism for any of the wrong things I have done.

In EMS, as in everything else, we seem to want to live as if the following quote is some sort of rule to live by.
 

Worldly wisdom teaches that it is better for reputation to fail conventionally than to succeed unconventionally.John Maynard Keynes.[1]

 

This is a rule to kill by.

We would rather kill a patient by following the protocol, than do what is right for the patient, if it means deviating from the protocol.

Too many of us are putting going along to get along ahead of patient care.

Maybe we need to encourage the malpractice attorneys to go after bad care, rather than protocol deviation, or gold standard deviation.

We need to get rid of the people who think that critical judgment is a bad thing.

We need to get rid of the people who think that critical judgment can be replaced by protocols.

We spend too much time worrying about appearances, while we kill our patients.
 

Elsewhere, this problem is described this way. There are a lot of officers who will risk their lives for their country, but there are damned few who will risk their careers.
 

Footnotes:
 

[1] There is an interesting discussion of the quote in Independent Cacophony.
 

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Homeopathy vs Science – a Metaphor

What could it mean?

At Homeopathy vs Science – a Metaphor, there is an imagined discussion among a scientist, a homeopath, and a user of homeopathy about the explanation of the illusion.

Also, there are some good comments in the post Homeopathy vs. science? at Respectful Insolence.

Of course, this is not limited to being a metaphor of homeopathy, but works for all anti-science.

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