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

- Rogue Medic

A Discussion on Evidence from EMS Expo

 
There were a lot of people in Las Vegas to discuss various approaches to patient care at EMS Expo.

Many do not think that research is relevant to EMS, or that research is not relevant when there is already a strong opinion that a treatment work and the evidence does not support the opinion.

It should not surprise anyone that I participated in some of these discussions into the wee hours.

Suppose a primitive culture believes that they have a treatment that works very well.

When a certain condition presents itself, the shaman uses a treatment that has been handed down from shaman to shaman.
 


Image credit.
 

Everybody knows the treatment works.

If the treatment is not used, the patient dies.

If the treatment is used, the patient lives.

We should ignore demands for evidence, because evidence-based medicine does not exist in this primitive culture.

Who are we to question the ways of this culture?

Isn’t it arrogant to try to impose our values on this culture?

It works for them, so shouldn’t we accept that?

Is this the right approach?

Why?

or –

Why not?

On 9/24/2013, I will post My Response to A Discussion on Evidence from EMS Expo, which is already written, just not posted yet.

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Comments

  1. “If the treatment is not used, the patient dies.
    If the treatment is used, the patient lives.”

    Sounds very much like, well, evidence 🙂

    • JB,

      “If the treatment is not used, the patient dies.
      If the treatment is used, the patient lives.”

      Sounds very much like, well, evidence 🙂

      Except that asking for the evidence is considered to be culturally insensitive.

      How dare we not trust the word of people who were not even there?

      This is just like EMS intubation success.

      Of course I get every tube on the first attempt!

      First attempt? Only attempt!

      Then someone actually keeps track of what happens during intubation – as in evidence, not baseless claim.

      Now the success rate is different.

      100% is no longer 100% and truth is cultural.

      Now is it evidence?

      No.

      It is only evidence if we do not ask for evidence.

      It is a baseless claim.

      Evidence requires standards of observation, measurement, documentation, . . . .

      None of those are present, so this is not evidence.

      This is anecdote.

      Anecdote can also be my cousin’s sister’s mother knows somebody three towns over, who once heard a story about someone who knew somebody who had a vague recollection about something – and they are certain that every detail is true.

      Anecdote is information that is unreliable, because it is obtained in a way that is not controlled, so inaccuracies and errors are presented as truth – and truth might not even appear anywhere in the story.

      Anecdote is just a story of unknown veracity.

      .

  2. I think I remember talking with someone about something very similar. I believe we cut the discussion off sometime around 6am.

    I had a blast, although it probably didn’t appear that way at the time.

    Did we ever reach an agreement on that subject? I can’t remember, not that that it’s important..

    • DiverMedic,

      I think I remember talking with someone about something very similar. I believe we cut the discussion off sometime around 6am.

      We did, but you were not the only one I had this kind of conversation with. I think it was closer to 4, but it was still painful the next day.

      I had a blast, although it probably didn’t appear that way at the time.

      Me, too.

      Did we ever reach an agreement on that subject? I can’t remember, not that that it’s important..

      There were several similar conversations, so things I mention that were not in our conversation are not hallucinations, but taken from conversations with other people.

      I don’t think we did, but I do think the subject is important.

      We have too many treatments that do not have valid evidence of benefit.

      Without evidence of benefit, we should assume the treatment is harmful.

      If the treatment actually works, we should be able to provide evidence that it works.

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