In Part I, I started to look at the kind of trouble that an Ambulance Chaser would be up to.
Waveform capnography was one of the recommendations that the AHA (American Heart Association) has not effectively stressed.
What else does Ambulance Chaser state has been neglected by the AHA?
What about dual defibrillation? Therapeutic hypothermia initiated during the arrest? Mechanical CPR devices?
Was there good evidence that these treatments improved survival before the 2010 guidelines were written?
Is there good evidence now?
We have enough problems with wishful thinking-based treatments already. We should not be adding to the problem. These treatments should only be used as part of well controlled studies.
The “everyone gets a card” mentality means that the current courses have become another example of the “everyone gets a trophy” mentality that permeates our country right now.
We have a problem with people who do not understand science claiming that their politics, feelings, opinions, et cetera are as good as valid science.
We are plagued with climate change denialists, vaccine denialists, evolution denialists, moon landing denialists, 9/11 truthers, and other conspiracy theorists who want their wishful thinking participation trophies.
We have been lowering the standards in America so that every conspiracy theorist can get a preach the controversy participation trophy.
These are not controversies.
Would we let these conspiracy theorists fly a plane we are traveling on, fix our vehicles, grow our food, or do other things that do not require advanced science education?
No, but we put our heads in the sand and pretend that their ignorance is as good as the valid research of the best scientists we have.
Here’s your participation trophy.
In fact, if I was a medical director, the only card courses I’d require would be Advanced Medical Life Support (AMLS) and PreHospital Trauma Life Support (PHTLS). Those are courses designed for EMS providers and based on assessment, not blind parroting of rote, already dated protocols.
PHTLS (PreHospital Trauma Life Support) still encourages the use of backboards and discourages research to find out if there is any decreased disability with use of backboards, any increased disability with use of backboards, or if the benefits and harms are roughly even.
We don’t know and we don’t want to know, because as long as we cannot prove that there is increased disability, we can have our wishful thinking participation trophies.
This is dangerously irresponsible, but it is what happens when wishful thinking becomes more important than valid evidence.
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.
We are irresponsibly assuming that backboards are beneficial, as we did with blood-letting (how many did doctors bleed to death?), prophylactic post-heart attack antiarrhythmics (estimated 60,000 dead), dumping fluids into patients with uncontrolled hemorrhage (how many did EMS kill?), . . . .
Assuming that something is beneficial may be OK – as long we are the only ones assuming the risk.
We are not the ones assuming the risk. Our patients are the ones injured by our hubris.
We appear to have abandoned ethics in favor of wishful thinking.
It’s time EMS progresses beyond rote memorization and embraces assessment-based interventions and sound science. Kudos to those EMS medical directors and EMS systems who’ve moved their protocols to accept the current science — and who don’t let the possession of a “card” define competency or currency in resuscitation science.
The whole purpose of merit badge cards is to relieve the medical director of responsibility for oversight of competence.
How was I to know the medic was incompetent? He had a
license to kill merit badge to kill and that is all anybody can require.
I wash my hands of any responsibility for actual oversight.
Plausible deniability is the reason for merit badge requirements.
We are trying to hide from responsibility by adhering to low standards.