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

- Rogue Medic

What is the Future for EMS?


Happy Medic has begun a series of looking at how we will look back at EMS from 2066 – a hundred years after the EMS White Paper that much of EMS is based on.

Paramedic – A look back at the first 100 years.

Part 1 looks at Chemical reversal of death. Will we still be using drugs to attempt to resuscitate?

Predictions of the future often focus on technology, technology that rarely develops as we expect. However, medicine is very reliant on technology. In EMS, some people seem to have no idea how to take a pulse. That is what their pulse oximeter is for. While a pulse oximeter can provide information that palpating a pulse cannot, a pulse oximeter cannot provide all of the information that can be obtained by palpating a pulse.

We make a mistake when we assume that all we can see is all there is, and this is a common mistake in medicine.

Will we still be making some of the same mistakes?


Will we look back on some of what we do now as primitive and ignorant?


He writes –

It is worrisome that it took something drastic for Paramedics to look at their own practices for efficacy instead of demanding proof before using it that it would do no harm.

I do not think that we will eliminate medications from resuscitation, but I do not expect that we will be using the same medications in 2066 that we are currently using.

Part 2 looks at Cervical Spinal Restriction.


Why on earth would a Paramedic, even an early one, strap a healthy curved spine to a flat board?


That is funny, because I had a trauma specialist explaining to me that the use of spinal immobilization, which has only been demonstrated to be harmful, is something that should not be questioned, because –

1. If a bone is broken, we have to splint it.

2. All bones are to be treated the same – the humerus, which is not articulated and does not contain the spinal cord is identical to the spine.

3. This is too important to find out if it is harmful, because we just know it works.

PHTLS (PreHospital Trauma Life Support) is looking for evidence for possible changes to their next set of guidelines

This is the kind of logic that has been behind abandoned medical procedures for centuries –

Perhaps it has not been demonstrated safe but it has never been demonstrated unsafe either. Better stay with the known than go to the unknown. If you want to develop a research project, please go ahead and do it. But without proof that they are bad, we cannot just assume that they are bad.


Perversely, without any proof that they are good, or even safe, we are strapping millions of people to rigid boards.

When will we be smart enough to limit our interventions to those that really help?

When will we abandon treatment based on weak hypotheses?

Why do we make patients fit our equipment, rather than make equipment that does not harm our patients?

What does it take for an interventionist to put patients ahead of dogma?


At Street Watch: Notes of a Paramedic, there is a description of the continuing fall from grace of “spinal immobilization” – Another Nail in the Board. Go read it.

At Mill Hill Ave Command, there is a review of a recent study of the methods of extrication from vehicles and the amount of movement of the cervical spine – In order to protect the c-spine, should we stop helping?. Go read it.

At First Few Moments, Kyle David Bates, Russell Stine, Bob Lutz, Dr. Laurie Romig, Kelly Grayson and I discuss the lack of evidence of any benefit from spinal immobilization and the evidence of harm in A Change of the Dogma: If it helps only one? Episode 36.



  1. So. Here’s the question that has come to my mind now. Say you’re in an MVC off duty. You now have neck pain and would like to be transported. You have no deficits. Would you allow yourself to be “immobilized”? I have a feeling I know the basic answer but I look forward to your detailed answer as to why/why not.

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