Do you like articles that inveigh against EMTs/paramedics and EBM (Evidence-Based Medicine)?
Here are some samples from a rant by my friend Mike.
Here is the bottom line, at the top of the page, they have too little education, do not understand science, and are too simple minded.
Apparently, an EMT irritated him. I have occasionally been a source of irritation for Mike.
EMS does have too little education, but the problem is less about the quantity, than it is about the quality. If EMS education were more evidence-based that would improve the quality, but it would not make Mike happy.
People do not understand science. Things appear to be improving in both EMS and medicine. This article is an ironic example of the problems with medicine, with understanding science, and with the use of evidence.
There is really only one example of the use of valid evidence –
Maybe you were even one of those services that “forced” your local hospital to institute the now questionable practice of hypothermia based on “science?” More sad news, you were duped.
Mike does not explain how he came to the conclusion that the
science pathophysiology was wrong. Was it a lucky guess?
You should do yourself a favor and go read some of the many websites on science based medicine compared to “evidence based medicine.”
Mike follows this recommendation with a list of some of the potential problems with research. We do need to better understand research, but a lack of perfection affects everything, so imperfection is not a reasonable criticism of EBM or SBM (Science-Based Medicine).
I have yet to see an EMS provider pick up a study they like and try to reproduce it.
How would having each individual reproduce each study, be relevant to anything? If I do not study something myself, I cannot use the research?
Later he exaggerates the problems with EMS research. Was he mocking himself here? Is he mocking himself there? Both? 😳
What is important in interpreting medical research, is that we are able to read a study in a way that we can identify flaws in the study, see if the researchers found ways to control for as many variables as possible, recognize possible biases, et cetera.
I did not set up any studies to reproduce the therapeutic hypothermia studies, because the information is in the paper. When the information is not there, that is a flaw. I did explain that prehospital therapeutic hypothermia with IV fluid is an example of why it is wrong to extrapolate from pathophysiology about untested treatments.
If it was possible to create and publish a study that showed what to do or what was best for patients in every conceivable situation, why would we need healthcare providers at all?
There is a website that creates quotes like this for the wisdom of Deepak Chopra. It generates random fictional quotes that sound like what Chopra would say (e.g. – “Interdependence belongs to the flow of bliss”). See what you get. Maybe I should create a quote generator for Mike.
Would any reasonable person suggest that it is possible to create and publish a study that showed what to do or what was best for patients in every conceivable situation?
Why does Mike?
That’s right, no double blind random placebo controlled studies on the validity of CPR. No prospective treatment studies on unconscious people who cannot be advised on and consent to the risks. No deviating from “the standards” or “commonly accepted” modalities of care. Sometimes you can get a waiver, but it is easier to walk on water and part seas.
The therapeutic hypothermia patients were conscious and gave consent to participate in the study?
Think about that and how much Mike understands what he is writing about.
Consciousness was a reason for exclusion from these studies. Why doesn’t Mike know this?
Pick up any study with human patients. It will explain how the ethical consent was handled for the patients in that study.
Nazi Germany is the closest anyone has come to unbiased human experimentation.
The Nazis were obtaining consent?
There is nothing wrong with using logical fallacies for satire. Did Mike intend his manifesto as satire or as spectacular irony? 😳
Most EMS providers simply don’t have the education, time, or resources to check that sort of stuff. They read a study, and assume this evidence has been met.
That may apply to most doctors, too. It isn’t the right way to approach research, but it is a criticism of the reader, not the evidence.
Then Mike valiantly lashes out at some more straw men.
What can EMS, and doctors, do to better understand research?
Read some of the many analyses of evidence that are available for free on the internet. I frequently write about the problems with research, but I do not make the mistake of claiming that EMS research is useless.
Many others write about EMS and emergency medicine research. I described some of the best sites a year ago.
Read some of these –
For an accurate description of SBM, read the site that originated the concept –
 Targeted temperature management at 33°C versus 36°C after cardiac arrest.
Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, Pellis T, Stammet P, Wanscher M, Wise MP, Åneman A, Al-Subaie N, Boesgaard S, Bro-Jeppesen J, Brunetti I, Bugge JF, Hingston CD, Juffermans NP, Koopmans M, Køber L, Langørgen J, Lilja G, Møller JE, Rundgren M, Rylander C, Smid O, Werer C, Winkel P, Friberg H; TTM Trial Investigators.
N Engl J Med. 2013 Dec 5;369(23):2197-206. doi: 10.1056/NEJMoa1310519. Epub 2013 Nov 17.
PMID:24237006[PubMed – indexed for MEDLINE]
 Effect of Prehospital Induction of Mild Hypothermia on Survival and Neurological Status Among Adults With Cardiac Arrest: A Randomized Clinical Trial.
Kim F, Nichol G, Maynard C, Hallstrom A, Kudenchuk PJ, Rea T, Copass MK, Carlbom D, Deem S, Longstreth WT Jr, Olsufka M, Cobb LA.
JAMA. 2013 Nov 17. doi: 10.1001/jama.2013.282173. [Epub ahead of print]
PMID: 24240712 [PubMed – as supplied by publisher]
 Induction of prehospital therapeutic hypothermia after resuscitation from nonventricular fibrillation cardiac arrest*.
Bernard SA, Smith K, Cameron P, Masci K, Taylor DM, Cooper DJ, Kelly AM, Silvester W; Rapid Infusion of Cold Hartmanns Investigators.
Crit Care Med. 2012 Mar;40(3):747-53. doi: 10.1097/CCM.0b013e3182377038.
PMID: 22020244 [PubMed – indexed for MEDLINE]
 Induction of therapeutic hypothermia by paramedics after resuscitation from out-of-hospital ventricular fibrillation cardiac arrest: a randomized controlled trial.
Bernard SA, Smith K, Cameron P, Masci K, Taylor DM, Cooper DJ, Kelly AM, Silvester W; Rapid Infusion of Cold Hartmanns (RICH) Investigators.
Circulation. 2010 Aug 17;122(7):737-42. doi: 10.1161/CIRCULATIONAHA.109.906859. Epub 2010 Aug 2.
PMID: 20679551 [PubMed – indexed for MEDLINE]
It has been said by some that the thoughts and tweets of Deepak Chopra are indistinguishable from a set of profound sounding words put together in a random order, particularly the tweets tagged with “#cosmisconciousness”. This site aims to test that claim! Each “quote” is generated from a list of words that can be found in Deepak Chopra’s Twitter stream randomly stuck together in a sentence.
 Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials.
Smith GC, Pell JP.
BMJ. 2003 Dec 20;327(7429):1459-61. Review.
PMID: 14684649 [PubMed – indexed for MEDLINE]