In the comments to No More Comments on Popular Science is this from Duke Powell –
Rogue Medic says Epinephrine is no good.
I have been critical of epinephrine because we are routinely giving epinephrine in cardiac arrest, but we do not have any evidence that epinephrine improves any outcome that matters. ROSC (Return Of Spontaneous Circulation) is not an outcome that matters. Epinephrine does improve ROSC, but there is no increase in people leaving the hospital with good brain function (the outcome that matters and surviving for more time is better). There is evidence of harm. The evidence of harm is not great, but the evidence of benefit does not exist.
More ROSC, but fewer survivors. That is not a benefit.
I do not claim that epinephrine is good, bad, or neutral. I point out that there is probably a subset of cardiac arrest patients who do benefit from epinephrine, but we have no way of knowing who those patients are.
I describe the lack of evidence of benefit and explain that standards of care should be supported by valid evidence of improved outcomes.
He says backboards are no good.
There is also no valid evidence of improved outcomes with backboards for unstable spinal fractures.
Where is the evidence that using backboards on patients with unstable spinal fractures results in fewer disabled patients (the outcome that matters)? There is evidence of harm. The evidence of harm is not great, but the evidence of benefit does not exist.
Rogue Medic disagrees about a lot of things that scientists have said are “best practices” for EMS.
I disagree with using treatments that are not based on valid science.
I disagree even more strongly with standards of care that are not based on valid science.
In most instances this medic with over 40 years experience agrees with Mr Rogue Medic. Not because of the science, but because of my experience.
That is not a very good reason for disagreeing with standards of care. It is a good reason for asking questions of the people who would know about the evidence, but even a 40 year career is just a series of anecdotal experiences. What kind of control has been used to minimize the effects of bias?
What has been done to make sure that confirmation bias does not limit recollection to those anecdotes that support individual bias?
But disagree with him on global warming? He calls you a science denier and says you can’t think for yourself.
I described some of the reasons you appear to be a science denialist above. That is science denialism on the topic of EMS.
You would get the same responses to EMS science denialism if you understood climate change. There are people who are willing to agree with science when it agrees with their prejudices, but are science denialists when science does not confirm their prejudices.
The problem is with the people, not with science.
Science does not care about prejudices.
Science just tells us what is real.
Science is not perfect.
Because science is not perfect, it depends on confirmation by different methods and by replication (preferably more than once). And most of all, science depends on rigorous attempts at objectivity, because everyone has biases.
Science does not exist to confirm biases.
Fact of the matter is, I am thinking for myself in terms of climate change. I’m not the guy following the crowd. Just as you are not the guy following the crowd with EMS best practice.
I am the guy basing decisions on science.
You appear to be the guy claiming that science does not matter. You appear to be the guy basing decisions on politics.
It isn’t the decision that matters, but the way we get there. Political decisions should be made based on valid science, rather than denying science or trying to make science fit political goals.
BTW, make sure your furnace is working, things are about to get colder, starting tomorrow.
Now you are discussing weather.
You do not appear to know the difference between weather and climate, but you seem to think that you know enough to tell scientists that they are wrong.
Thank you for reinforcing my point.
 Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest.
Hagihara A, Hasegawa M, Abe T, Nagata T, Wakata Y, Miyazaki S.
JAMA. 2012 Mar 21;307(11):1161-8. doi: 10.1001/jama.2012.294.
PMID: 22436956 [PubMed - indexed for MEDLINE]
 Prehospital Intravenous Fluid Administration is Associated With Higher Mortality in Trauma Patients – Part I, Part II, and Part III
 Prehospital Intravenous Fluid Administration is Associated With Higher Mortality in Trauma Patients: A National Trauma Data Bank Analysis.
Haut ER, Kalish BT, Cotton BA, Efron DT, Haider AH, Stevens KA, Kieninger AN, Cornwell EE 3rd, Chang DC.
Ann Surg. 2010 Dec 20. [Epub ahead of print]
PMID: 21178760 [PubMed - as supplied by publisher]