Severe pain + 2mg of Morphine = severe pain.

- Rogue Medic

Slaying the Immobilization Dragon – Free JEMS Podcast by Jon Politis

 

This is an apt metaphor for the way we handle spinal immobilization.

We will do anything, even sacrifice our children, ask us for anything!

Just don’t ask for evidence!

It appears that Jon Politis is going to be describing the abysmal state of evidence (all negative) that looks at the way EMS uses spinal immobilization.
 


Image credit.
 

The town had a pond, as large as a lake, where a plague-bearing dragon dwelled that envenomed all the countryside. To appease the dragon, the people of Silene used to feed it two sheep every day, and when the sheep failed, they fed it their children, chosen by lottery. It happened that the lot fell on the king’s daughter, who is in some versions of the story called Sadra.[8] The king, distraught with grief, told the people they could have all his gold and silver and half of his kingdom if his daughter were spared; the people refused. The daughter was sent out to the lake, dressed as a bride, to be fed to the dragon.[citation needed] [1]

 
 

George came along and rescued the damsel from the dragon, as Jon will probably be encouraging us to rescue our patients from our backboards.

Jon, not George, but why quibble?
 

Spinal immobilization is a hot-button topic in the prehospital setting. During this webcast, Jon Politis, MBA, NREMT-P, will delve into the latest science in order to slay the immobilization dragon and provide answers to the following questions:
Is spinal immobilization always necessary?
Are there “high-risk” mechanisms?
How much spinal movement is OK?
Sponsored by Hartwell Medical
[2]

 
 

Is this a ploy to defend spinal immobilization?

I come to bury Caesar, not to praise him.
 

Is this just a way to encourage EMS spinal clearance (limiting spinal immobilization to those most likely to be harmed by spinal immobilization)?

I do not know.
 

Will this change anything?

Immediately? Probably not.

This may become a part of the evidence used to convince EMS medical directors to ignore the PHTLS (PreHospital Trauma Life Support) dogma.

There is extensive commentary on spinal immobilization, the absence of evidence of benefit, and the abundant evidence of harm.
 

In the absence of evidence of benefit, we should be limiting treatment to research participants, since these patients are receiving an unexamined treatment.

These patients continue to be test pilots of spinal immobilization.

They are not receiving adequate information to make an informed consent, nor an informed refusal for this guinea pig treatment.

It is reasonable to assume that all treatments cause some harm, and spinal immobilization has well documented harms. We only assume that some benefit actually exists. There probably is no benefit, just as with the rest of our wishful thinking-based medicine.

All quacks seem to uses the same scam – But what if it works and we do not use it?

That kind of fraud would justify using anything that does not have good evidence of benefit – homeopathy or Reiki, but these frauds probably will not directly harm the patient. Spinal immobilization lacks that safety.

Why do we listen to such nonsense?

The stakes are high, and when the stakes are high, a lot of us turn out to be very superstitious.

We don’t know the truth and we do not want to know. We are not protecting our patients. We are harming our patients in order to protect our superstitions.

We are dangerous.
 

Slaying the Immobilization Dragon – Registration Page.

Footnotes:

[1] Slaying the Immobilization Dragon
DATE: May 2, 2013
TIME: 1 p.m. Eastern / 10 a.m. Pacific
COST: FREE

Registration Page.

Speaker:
Jon Politis, MPA, NREMT-P, is the retired chief of the Colonie EMS Department in upstate N.Y. An active EMT since 1971, he has been a career firefighter, state EMS training coordinator for Vermont and New York and a paramedic training program coordinator. He has served on the National Registry of EMTs board and on the Committee on Accreditation for the EMS Professions.

To access the live presentation, please click on the following link:
link.

[2] Saint George and the Dragon
Wikipedia
Article

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