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Archives for October 2011

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

- Rogue Medic

Ipecac for Tricyclic Antidepressant Overdose

Mon, 31 Oct 2011 18:28:37 -0400 by
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Maybe I should have titled this, How to Kill Patients Without Really Thinking, but I am sure I will have many other uses for that title.

In one high performance system, I found out quickly that I would never fit in. I was riding along with them to be signed off for authorization to work in the county as a medic, because that was the way things worked back then. A bunch the medics were sitting in the EMS room at the hospital, when in walked on of the new good ol’ EMS mythology boys.[1]

This new good ol’ EMS myth boy was bragging about how he had given ipecac to a patient. The medical director (who was also the county medical director) had ordered the medic to give ipecac to a patient who stated she had taken an overdose of a tricyclic antidepressant. I mentioned that ipecac is contraindicated for tricyclic OD (OverDose). He insisted that ipecac was not contraindicated. Another good ol’ EMS myth boy stated that the doctor would never have ordered it, if the treatment were contraindicated.

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Image credit.

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Having an EMS Field Guide – the old laminated paper version of the electronic EMS Field Guide advertised in EMS Blogs sidebar – I was able to quickly flip to the page that included ipecac and I read off the contraindications, which included tricyclic antidepressants. The most recent EMS Field Guide that I have also includes this, but the electronic version does not. It appears that they take it for granted that nobody uses ipecac anymore. I hope that they are correct, but I doubt it. These guides can be helpful for checking indications/contraindications/side effects/doses of a hundreds of medications we use on a regular basis.

I hope that nobody still uses ipecac in EMS, but do your protocols include ipecac?

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That medical director ordered ipecac. The medic had no idea that ipecac was contraindicated, since this was in a high performance EMS system that focuses on speed and stupidity, more of both, but did not focus on any criteria of performance that might improve outcomes.

The medical director told me, “I did not think that it was a serious overdose.”

In that case, the wise course of treatment would be benign neglect, not iatrogenic poisoning.

This decision that patient abuse was the best course of action was based on the report the medical director received over the phone/radio from a medic too clueless to think. Did the medic recognize that the doctor was ordering him to give a treatment to punish the patient? I don’t remember.

Why would a doctor trust a clueless person to give accurate, or even useful, information? This cycle of stupidity is repeated too many times.

How do these clowns ever graduate from paramedic school?

That is not really a question. The reason for such pathetic paramedics is our ridiculously low standards in EMS.

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Routinely improperly administered by caregivers[2]

Even the places I regularly criticize appear to recognize that ipecac is bad treatment and that EMS routinely makes things worse when we use ipecac.

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Footnotes:

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[1] good ol’ EMS mythology boys
Those more interested in coming up with excuses to avoid, or harm, patients, rather than help them. Those who think that a doorway diagnosis is in any way adequate. Those who do not understand why they do what they do, but remember that in medic school they were told that this is the only way to do things.
Further information

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[2] EMS Protocols
MIEMSS (Maryland Institute of Emergency Medical Services Systems)
2005 revision
p 71/163
PDF Download

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Filed Under: Heresy, Mythology, Pharmacology

Comment on Injury-adjusted Mortality of Patients Transported by Police Following Penetrating Trauma

Sun, 30 Oct 2011 18:37:00 -0400 by
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In the comments to Injury-adjusted Mortality of Patients Transported by Police Following Penetrating Trauma is the following from Anonymous –

I have been a medic for the phila fire dept for 13 years at a medic unit doing 8000 runs a year. There are many things that are not factored into this study.
1. Zero care being done during the transport in police vehicle

No formal policy outlines how care should be provided to injured patients transported by police, and in practice (based on our observations) individuals transported by police are typically rendered no care, including even direct pressure on bleeding extremity wounds.[1]

Clearly, the authors of the study did take this into account.

This would only make outcomes worse for patients transported by police. You are only making EMS look worse.

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2.police have no bsi issued and use none during transport of bloody pt

That would not affect the outcome for patients. Most police I know do carry gloves.

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3.delay of dispatch of EMS and lack of direct communication between police and EMS

Many of the problems with the way that EMS and police are handled at the political level and are not within the control of the authors. Assuming that the politicians do not change these policies, there is no reason to expect that the results would change.

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4.it is frequent practice for police to pull around an arriving medic unit

I prefer to have the police between me and the scene of a shooting/stabbing. Are you claiming that the police transport patients when EMS is already on scene?

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5. Police do get more OT transporting a trauma pt

How would that affect the patients’ outcomes?

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6. Transport of pt’s that should be left DOA to preserve a crime scene

This also not a good thing, but –

This would only make the outcomes look worse for those patients transported by police.

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7. Unsafe,reckless driving by police often leaves the pt wedged between the seats of the car upon arrival at the ED.

The same as above – this would only worsen the outcome for patients transported by police.

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8. ED staff being exposed due to trying extricate a bleeding mess that is wedged in the rear of a patrol car. ( the police aren’t getting the pt out once at the ED)

Once more, this is not good, but would only lead to worse outcomes for those transported by police.

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9. Delay of care and lack of treatment while trying to remove the pt from a patrol car

Ditto.

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10.Improper sanitation of the transporting police vehicle after the bloody transport

This is not good, but should not affect outcomes either way.

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Image credit.

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Medic units are often times available with good response times and the practice is still being done.

When 911 dispatches EMS is not within the control of the the authors of the study.

Is 911 avoiding dispatching EMS?

Is there a way to obtain documentation of this delay of dispatch?

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It is a poor, unsafe standard of care and should be stopped.

One alternative for systems that are short of paramedics (such as paramedics) might be a tiered system.

There are implications for dispatch policy, as well, in that proximity of the prehospital provider to the injury scene should outweigh the level of training when making decisions about dispatch for penetrating injury.[1]

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Believe me we do get our fair share of penetrating trauma but allowing this in any fashion is an insult to our profession.

I don’t care about insults to our profession.

A much bigger problem is people who harm out patients.

I don’t see how any of the information you provide points out any flaws in the study.

There are plenty of flaws in the system, but the point of this was to suggest an alternative for systems that are flawed.

We believe that these findings suggest that implementation of police transport for this patient population is safe and may help to decompress overwhelmed EMS systems or those without any significant EMS structure either in rural areas or in resource-poor countries.[1]

The flaws are flaws with the system, rather than flaws with the study.

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Footnotes:

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[1] Injury-adjusted Mortality of Patients Transported by Police Following Penetrating Trauma.
Band RA, Pryor JP, Gaieski DF, Dickinson ET, Cummings D, Carr BG.
Acad Emerg Med. 2010 Dec 16. doi: 10.1111/j.1553-2712.2010.00948.x. [Epub ahead of print]
PMID: 21166730 [PubMed – as supplied by publisher]

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Filed Under: Heresy, Research

Unintended Consequence, Banks, and Regulation – 2

Sat, 29 Oct 2011 06:30:33 -0400 by
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As with the regulators experience with unintended consequences,[1] the banks are facing some unintended consequences with their response of dramatically increased debit/credit card charges on smaller accounts.

Some banks have reconsidered,[2] but the banks already appear to have been hurt by their attempt to deal with a removal of the ability to pass on billions of dollars in fees.[3] Fees that were often not noticed by consumers. It will be interesting to see if this encourages more people to examine bank fees. Will more people realize that, in a time of historically low interest rates, 18%, 21% and higher credit card interest rates can be avoided by shopping around.

Credit Card Averages[4]
Product . . . . . . . . . . . . . . . . . . . . . Rate
Balance Transfer Cards . . . . . . . . 16.21%
Cash Back Cards . . . . . . . . . . . . . . 16.41%
Low Interest Cards . . . . . . . . . . . . 10.82%
Rewards Cards . . . . . . . . . . . . . . . 15.41%

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There is also a movement to have deposits move out of big banks.[5]

All of these people have made decisions, but how many have considered the unintended consequences. Sen. Durbin had his tunnel vision dramatically pointed out to him when the banks announced new fees. The banks face a similar fate due to the anger of customers. The credit unions may end up with a large number customers who may generate more costs than fees, resulting in fewer benefits for more creditworthy customers/members. Will these moves also lead more people to use cash, therefore decreasing the amount of taxes paid by those already underpaying taxes?[1]

In EMS, we are not any better at anticipating the consequences of our actions, but we move decisively with blissful ignorance, then claim that we cannot change, because the poorly considered actions are now a Standard Of Care. Are we any less harmful than the bankers or the regulators?

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Image credit.

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Footnotes:

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[1] Unintended Consequence, Banks, and Regulation
Rogue Medic
Article

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[2] Chase and Wells Fargo drop debit card fee tests; Bank of America set to adjust its plan
Washington Post
Article

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[3] Credit Unions Seeing Surge In New Accounts
By Chris Morran
October 25, 2011 3:30 PM
The Consumerist
Article

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[4] Credit Card Averages
bankrate.com
Sample

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[5] Will ‘Bank Transfer Day’ Hurt Big Banks?
October 28, 2011
Seeking Alpha
Avery Goodman
Article

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Filed Under: Ethics, Heresy, Risk Management

Video of Spinal Immobilization and Abandonment

Fri, 28 Oct 2011 06:30:58 -0400 by
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In the comments to Making Things Worse With Spinal Immobilization – 1 is this from Anonymous (the video is embedded in that post) –

Is there no duty to act?

By a private citizen?

Absolutely not.

I think that Finland has a law requiring citizens to come to the aid of people in emergencies, but even then, this patient is in the care of EMS, so the duty is to get out of the way.

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Is the videographer an EMT/Medic?

I did not see anything to identify the person either as EMS or as not EMS.

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He states the EMS crew response time indicating that he was there, aware of the incident but favoured taking the video over providing patient care.

The filming appears to have only begun after EMS arrived.

How do you know that he/she did not provide care right up until the point when EMS arrived and took over care?

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If the videographer is an EMT/Medic, abandonment comes to mind. Just a thought….

The patient is in the care of EMS, so how is there any possibility of patient abandonment?

The scare stories about having a duty to act when off duty are pure EMS Mythology. Even in New York City.

Should the videographer fight with the EMTs over who gets to provide better care?

Many times I have stopped and provided care to people until EMS arrived. You would have just as much reason to been accusing me of abandonment.

Just how much intervention do you require to not make accusations of patient abandonment?

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Considering abandonment from a different Big Apple perspective of patient care –

Does the use of overly restrictive protocols by NYC REMAC constitute abandonment?

I could make a much better case that the denial of care to patients unnecessary rationing of care by NYC REMAC is abandonment.

The same is true of any protocols that are used as a ceiling for limiting patient care, but that is a topic for another time.

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In a later comment, Anonymous imaginatively added this –

So all morals go out the window? Hope you don’t need CPR and a trained civilian has the same ideals. Perhaps the videographer will film “from here to eternity” starring yours truly. A sad day for sure. Don’t take this personnaly but when the world sinks to that level off concern for their fellow man, it’ time to get off. Glad you can live with your thoughts!

Filming EMS while they are working is not abandonment.

Look at the specifics.

Did the person leave the scene?

No. Still there filming.

Is the patient being deprived of care because of any neglect by the person filming?

No. The patient is in the care of EMS.

Is there any hint of abandonment?

No.

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Filed Under: Ethics, Heresy, Legal Medicine, Spinal Immobilization

The Living Will and Senate Testimony From Terry Read

Thu, 27 Oct 2011 14:50:04 -0400 by
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Terry Read sent me an email with a scan of his father’s living will and a link to the Texas Senate Hearings (the link is also in the comments to Terry Read Comments on the Death of His Father and the Living Will).

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Rogue Medic,

I say that I know what happened based on the fact that I was there and went through it.

My point is that this is a very emotional experience. People regularly make mistakes in describing events. For example, in the testimony given by you and by your mother, you contradict each other. Does that mean that one of you is telling lies?

No. It means that our observations depend on many different things, as do our memories.

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You are basing your comments on your speculations. So anything that I say certainly has more weight than what you say.

Yet, I can show that your statements are inconsistent, even though I was not there.

Eyewitness testimony is unreliable.

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As far as the San Antonio Fire Department not initially cooperating, why do you think this has been going on for so long?

Please provide some evidence to support your conclusion.

You claim that this took a long time. Compared to what?

You claim that the SAFD did not cooperate with someone. Whom did they not cooperate with and what evidence do you have that they did not cooperate?

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The investigation took a long time because the Fire Department was not answering the DSHS investigator.

Do you have any documentation to support that claim?

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Have you read HB 577. It says “
SECTION 1. Section 166.102(b), Health and Safety Code, is
amended to read as follows:
(b) When responding to a call for assistance, emergency
medical services personnel:
(1) shall honor only a properly executed or issued
out-of-hospital DNR order or prescribed DNR identification device
in accordance with this subchapter; and
(2) have no duty to review, examine, interpret, or
honor a person’s other written directive, including a written
directive in the form prescribed by Section 166.033.”

So Rogue Medic, treatment by the paramedics may still be terminated, but not by not by the Living Will.

That is not true.

EMS may still contact medical command, as they did in the case of your father, and follow medical command orders. Even the person reading the bill in the video states that specifically.

Resuscitators’ efforts can still be stopped if the patient’s personal physician is present and approves it. If the physician is not present, the medical director of EMS can make the decision.[1]

HB 577 does not state that EMS may not honor a living will.

It is offensive that you would prevent people with living wills from having their wishes followed just because of one unusual, but personal, case.

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The State EMS Director admitted the person on the other end of the phone may not be a doctor during the House Committee hearing in which I testified.

An out of context description of a comment is useless. What did the person say? What did the person mean? What was the context?

If a movie reviewer describes a movie as “A tremendous waste of time.” Advertisements for the movie could quote the reviewer as calling the movie “Tremendous.”

That would be tremendously out of context and not at all helpful. You misinterpret HB 577, but you expect me to accept your interpretation of something else? Why?

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Through the Open Records Act, I have requested minutes of the meeting, but have not gotten them yet. I am not sure how detailed the minutes are. But you are certainly welcome to make the same request. It was the House Public Health Committee Meeting for April 20, 2011 – for HB 577.

That would be nice.

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The lead paramedics stated it would be against the law to continue when I told the paramedics not to stop treatment. Then when I tried to get to my father, the paramedics ganged up on me, wrestled me down, and threatened to have me taken away in handcuffs.

Criminal law, civil law, EMS law, company policies, something else?

Plenty of people will tell you that treating a patient in violation of a doctor’s order is practicing medicine without a licence. I disagree with that interpretation of violation of a doctor’s orders, but that may have been what the paramedic meant, assuming the paramedic actually made that statement.

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As far as the Living Will, I can ask WOAI to post. But in the meantime, what would you like me to do, scan it and shoot it to you? Would you like me to photocopy it and mail it to you? If you provide a mailing address, I will do that. Would you like to meet in person and have me show it to you personally? If you do, I am sure we can arrange a meeting.

Below is the living will.

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This is a scan of Samuel Read’s living will sent to me by Terry Read. I have edited it to remove the Social Security Number and to convert it to JPEG format. Click on the image to make it larger.

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But I am a little curious. Will any of this satisfy you? Also, if you watch the story, what do you think that I was showing to Mireyea Villarreal? I was going over the Living Will with her.

How would I know what you were showing her?

Why would I jump to any conclusions about what you were showing her?

If they had the document, competent journalists should have provided at the very least the wording of the document, but that was not done. In the absence of evidence, the most reasonable conclusion is that the document does not support your claims.

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You seem to think I have been hiding something when I have not.

I have only been asking for evidence to support your claims and making the most reasonable conclusions about the evidence available.

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As far as a patient not wanting resuscitation, they still have the option of a DNR.

The rules affecting advance directives need to be dramatically rewritten.

What you mean to state is that they still have the option of an Out-Of-Hospital DNR.

If they have a standard DNR, which is not an Out-Of-Hospital DNR, the rules are the same as for a living will.

This is abusive and unfair to patients.

You are supporting abuse of patients with wishes different from your father’s.

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The link below will take you to the 82nd Legislatures Senate Committee on Health and Human Services Sessions. Our Testimony is on the May 17, 2011 session. HB 577 is the second bill being testified on. My mother and I begin testimony at about the 7:40 mark.

http://www.senate.state.tx.us/75r/senate/commit/c610/c610.htm

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You can hear my mother and myself both testify that the Living Will called for examination by two physicians, and my mother had power of attorney. None of those things happened. This is what we testified to before a Senate Committee. Do you think both my mother and I committed perjury?

You and your mother gave different descriptions of the events of that day. Not just slightly different, but contradictory. Does that mean that either, or both, of you committed perjury?

You still do not understand how unreliable eyewitness testimony is. You and your mother were eyewitnesses to the same event and provide descriptions that do not agree.

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Do you think that a copy of the Living Will was not supplied to Representative McClendon’s office in their investigation?

Should I assume that Rep. Ruth McClendon has any understanding of advance directives?

Absolutely not. Look at the wording of this bill. This is written so that lawyers will be involved. As I stated before, in Representative Ruth McClendon Trying to Eliminate Patient Rights in Texas,

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Also, do you think that the Living Will was not provided to the Department of State Health Services in their investigation?

Did the Department of State Health Services find any fault with SAFD?

Chief Grenato says paramedics on scene reviewed Sam Read’s living will with a medical expert over the phone; then decided to stop treatment. The state has reviewed this case and cleared the department of any wrong doing.[2]

The state has reviewed this case and cleared the department of any wrong doing.

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If my mother and I both committed perjury on what was in the Living Will, all of these parties would know it.

Why do you assume that anything that is not perjury is the truth?

You can make the statement that you have not perjured yourself, but that does not mean that what you stated is the truth, the whole truth, and nothing but the truth.

Truth and falsehood are not clear black and white issues. Otherwise, you and/or your mother have perjured yourselves by giving different testimony.

Since all of these parties did not come to the same conclusion, there must be more to this than you understand, which is what I have been stating from the beginning.

For example, let’s compare the testimony given by your mother, where you were not handcuffed and your testimony, where you were handcuffed.

They then threatened to handcuff him and take him away and stated that that would not bother him at all.[1]

and I tried to get to my father to continue treatment myself. They wrestled me down and had me taken away in handcuffs, so I had to give up at that point.[1]

Whom should I believe? Is this perjury? Did you just make a mistake?

The state has reviewed this case and cleared the department of any wrong doing.

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Also, note that the State EMS Director was not at the Senate Committee Meeting after having gotten questioned at the House Committee meeting.

OK, but what does that mean? Does it mean anything? Does it signify anything other than the person having limited time and many responsibilities?

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One more thing, I am almost 49 years old and have a 4 year old son that my wife and I prayed many years for. And like you, I have other interest as well. Do you think I would have devoted the tremendous amount of time, energy, and emotion to this effort, as I am still doing, if I did not know that the wrong thing had really happened? I have gained nothing from this financially. The only thing I have gained is recognition that the wrong thing happened. And even now, I am still dealing with people like yourself.

Terry Read

I repeat that you are very emotionally involved in what happened and that has affected your actions. I do not know what a daughter, prayer, or time have to do with this. People do plenty of things voluntarily, but that does not mean that they are right. You are comparing things that are completely unrelated.

If the paramedic contributed more of his energy, more of his free time, and spent more of his money contradicting you, would that make him more reliable than you? He was there. What if he has half a dozen children? Would that affect what is true?

On political issues, people on differing sides contribute a tremendous amount of time, energy, and emotion to this effort, but that does not mean that both sides are right, or that one side is right and the other side is wrong.

You ask me to read your mind. Mind reading is what scam artists do. I look at evidence.

Time, energy, and emotion do not determine the truth.

Your justifications only discourages trust in your judgment.

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Is it true that EMS personnel are not capable of interpreting a simple document?

Or is it that the lawyers write unnecessarily complicated documents to discourage others from interpreting these documents.

What if we educated EMS personnel (and nurses and doctors) about the application of advanced directives and simplified them. For example, my suggestion for a living will clearly state at the top of the page what minimum requirements need to be satisfied (based on those from Samuel Read’s living will). This is just one possible way of improving the communication of the patient’s wishes.

All of this could have been prevented by requiring that these documents be written much more clearly, not by arbitrarily assuming that more treatment is better.

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Click on the image to make it larger.

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If EMS is incapable of interpreting well written advance directives, then EMS clearly cannot provide complicated treatments to any patients. The most complicated EMS treatment algorithms are used for treating cardiac arrest.

Should we only provide treatment that is simple and easy?

Would patients be better off with less treatment, so that we don’t have to think? Mr. Read, in his testimony, states that more treatment is better.

That is not true. What we need is more appropriately applied treatment.

Defending the incompetence of the legislature in writing rules for advance directives is not good for patients.

We need to stop lowering our standards to accommodate those who least understand.

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Footnotes:

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[1] Video of May 17, 2011 testimony
Texas Senate
Page with link to video in Real Media format

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[2] EMS workers stop medical treatment after reading will in the field
Mireya Villarreal
July 27, 2011
WOAI
Article

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Filed Under: DNR, Ethics, Heresy, Legal Medicine

Community and International All in One – EMS Garage Episode 150 and Fentanyl

Wed, 26 Oct 2011 12:36:37 -0400 by
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This week’s EMS Garage covered several topics. Community and International All in One: EMS Garage Episode 150. Chris Montera, Gary Wingrove, Pat Songer, Russell Stine, and I discuss these topics –

International Roundtable of Community Paramedics and Community Paramedic – Community Paramedic is something that is inevitable. Many people do not like the idea, but there is no practical alternative. The main question is how to best set up a Community Paramedic program.

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International Paramedic – We need to stop using the infantile excuse of That’s not the way we do it here. This attitude kills patients. Imagine if everyone decided that they would freeze their thinking at some point in time and never make any progress beyond that point unless it came from their own people. That is the opposition to International Paramedic. We need to recognize that we have a lot to learn from the way the rest of the world implements EMS. We need to stop ignoring what others are doing and start learning from others. Go sign up at International Paramedic.

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Image credit.

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Ultrasound in EMS – “Machines made by Sono-Site Inc. will be put on 12 ambulances. The company provided the devices, which cost $60,000 to $70,000 each, and about $52,000 in training, Knapp said.” According to Pat Songer, his service is using different devices that only cost $6,000 to $6,700 each – less than 10% of the cost listed in the article. They have a lot of support from the hospital, which is very important. This has a lot of potential to improve care. We need to pay attention to the research and see what the advantages and disadvantages are. I am hesitant to suggest that this be used to encourage refusals, but triaging patients to community hospitals seems to be an area where this cuts costs and improves care.

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Legal Medicine – We assume that we know how not to be sued or how not to lose a law suit, but this is just another EMS myth.

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And fentanyl –

A little bit on fentanyl. I mentioned that the most important advantage in using fentanyl is that it wears off quickly. This means that a patient who receives enough fentanyl to tolerate an ambulance ride (a bouncy truck ride lying on top of the rear axle as it hits pot holes) should already have the fentanyl wearing off when we arrive at the ED (Emergency Department). Time from administration and total dose will affect how quickly it wears off.

Why is fentanyl wearing off quickly important?

If the patient has enough fentanyl on board to tolerate the ambulance ride, then lying in a much better padded hospital bed that does not bounce around may result in oversedation and the main complication we wish to avoid – respiratory depression. In the ED they can assign one nurse to take care of this patient until the patient is breathing more deeply or they can give naloxone (Narcan).

Unfortunately, in some EDs they will quickly whip out the naloxone and will not titrate it to the desired effect – adequate respirations. A standard dose of naloxone can result in complete reversal of the pain management and increase the pain to much more than it was when we began treating the pain. Not titrating naloxone results in reversal of all of the endorphin effects – all the things that a person is able to do on their own to manage their pain.

Not titrating naloxone is torture.

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Image credit. Ouch! Don’t be stingy with the fentanyl.

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We want to avoid putting the patient in the situation of having their pain relief reversed. In the ED, one on one observation of patients is not common. The patient is being transferred from EMS, which has several people observing the patient, to the ED, which has several patients per nurse. The ED is just not staffed to provide one on one observation without detracting from the care of other patients. Sometimes staff will over-react to respiratory depression and hurt the patient.

We should not be causing problems for the ED or for the patient by transferring a patient that the ED is not as prepared to treat than we are in EMS.

Not noticing dangerous respiratory depression in EMS is incompetence.

Not noticing dangerous respiratory depression in the ED may be just due to having divide attention among many patients at a time when things change.

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Go listen to all of these at EMS Garage.

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Filed Under: Assessment, EMS Garage, Fentanyl, Heresy

Making Things Worse With Spinal Immobilization – 1

Tue, 25 Oct 2011 12:59:04 -0400 by
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This video of spinal immobilization for leg pain was sent to me by Dan Crawford.

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[youtube]JpXerAwOapM[/youtube]

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This apparently begins 2 minutes after the motorcycle crash. Nice response time, but from there things only get worse. This guy looks as if he would rather go by taxi than by ambulance.

He has leg pain, so that does qualify as distracting pain for those who believe that spinal clearance criteria matter. So immobilizing him is following protocol.

That does not mean that there is any benefit to the patient.

Is there even any potential benefit to the patient?

That only depends on how imaginative you are in your What if the sky really is falling? scenarios. In the real world, there is no reason to believe that there is any benefit to this patient from being strapped to a board.

There is obvious harm.

Spinal clearance criteria assume that there is some benefit to immobilizing patients who actually have spinal injuries.

There is no good evidence to support this belief.

There is good evidence that the opposite is true.

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The OR for disability was higher for patients in the United States (all with spinal immobilization) after adjustment for the effect of all other independent variables (2.03; 95% CI 1.03-3.99; p = 0.04).[1]

RESULTS:
There was less neurologic disability in the unimmobilized Malaysian patients (OR 2.03; 95% CI 1.03-3.99; p = 0.04).[1]

For a person with a spinal injury, being immobilized doubles the likelihood of being disabled.

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Back to the video. The injured guy is complaining of leg pain. We should address any life threatening injury first, but there do not appear to be any life threatening injuries to address.

What about the possibility of disability if he moves his neck?

I’ve seen bobble-head dolls that move their necks less than this immobilized collared patient.

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Image credit.

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The cervical collar does nothing to decrease movement of his neck. If anything, the irritation from the collar probably causes the patient to move his neck more than he would otherwise. Cervical collar = more neck movement. EMS in action.

When strapping the patient to the board, what benefit is there from putting a strap over the injured leg? This only causes more pain and therefore more movement.

At 4:12 of the video is this exchange –

Patient – It hurts!

EMT – I know it hurts. It’s going to hurt more if you keep moving.

Ouch!

What he means is –

Stop complaining about me hurting you. I am only hurting you out of a misguided attempt to protect myself from you and the theoretical lawyers who will sue me for NOT harming you.

Our only defense is ignorance.

Maybe it should be IMS in action. Ignorant Medical Services.

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When medicine is a bureaucracy, we are better off on our own.

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Footnotes:

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[1] Out-of-hospital spinal immobilization: its effect on neurologic injury.
Hauswald M, Ong G, Tandberg D, Omar Z.
Acad Emerg Med. 1998 Mar;5(3):214-9.
PMID: 9523928 [PubMed – indexed for MEDLINE]

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Filed Under: Heresy, Irrational Government Oversight, Spinal Immobilization

The Fraud of “If It Saves Just One Life It’s Worth It”

Mon, 24 Oct 2011 16:00:53 -0400 by
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We have many people who claim that it is acceptable to do certain things with the excuse that – If It Saves Just One Life It’s Worth It.

Perhaps the best way to save lives is to kill anyone who uses this justification.

Will it save any lives?

We are supposed to stop considering risks and benefits. We are supposed to be afraid of being viewed as callous with the lives of others.

The reality is that whatever is being considered is probably going to kill more people than it will ever save – that is why they use scare tactics. If there were good reasons for what they want, they would not need scare tactics.

If It Saves Just One Life It’s Worth It.

Saving lives is good.

It’s For The Children.

Helping children is good.

The drug has a Black Box Warning! We can’t use that dangerous drug!

Black box warnings do point out possible problems with giving a medication.

All medications have side effects. Some of these side effects can result in death. Medications with lethal side effects include water and oxygen. These are medication, even though we use them every day without prescriptions. Too much oxygen can kill. Too much water can kill. Clearly, we need to protect people from these dangerous chemicals.

We need to prohibit exposure to water. We need to prohibit exposure to oxygen. If It Saves Just One Life It’s Worth It.

Would we save any lives? Of course not, but this isn’t about reality. This is about creating the appearance that opponents of whatever poorly considered idea are reckless and dangerous.

If It Saves Just One Life It’s Worth It means that the person does not know what he is discussing and that he does not want to know. Unintended consequences do not matter. Scare tactics are all that matter.

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Image credit.
The unbalanced perspective of If It Saves Just One Life It’s Worth It in a picture.

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Should this one theoretical life saved be more important than all of the damage done to everyone else?

Why do so few people consider that unintended consequences affect everything?

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If this post can save even one person from falling for the fraud of If It Saves Just One Life It’s Worth It, then this post was worth it. 😉

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Filed Under: Ethics, Fraud, Heresy
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