There are plenty who … claim to be competent at intubation even though their last intubation was months ago on the third attempt and if the patient had not already been dead – that would have finished the patient off …

- Rogue Medic

What am I thankful for this Thanksgiving?


The violent crime rate continues to drop. In America the violent crime rate is less than half of what it was in 1992.

Not just the violent crime rate, but also the total number of violent crimes continues to drop. According to the FBI, 1,932,274 violent crimes were reported in 1992, but that number had decreased to 1,165,383 in 2014 – a decrease of 766,891.

There were 40% fewer violent crimes reported in 2014 than in 1992.

During the same time the US population has increased by over 60 million people. This is nowhere near perfect, but the trend has been a pretty steady decrease in the total number of violent crimes and the violent crime rate since 1992.

I became a paramedic in 1992, so the cause and effect should be obvious to everyone.

US Violent Crime rate - 1960 - 2014

The data are from the FBI.[1],[2]

While the violent crime rate is not as low as it was in 1960, the murder rate was the lowest in 2013 and 2014.

US Murder Rate - 1960 - 2014

The data are from the same FBI sources.[1],[2]

If you think that those were the good old days, half a century ago life expectancy and quality of life were much worse than they are now. They was even worse a century ago. They were even worse the century before that. And so on, back to the agricultural revolution about 10,000 years ago.

Happy Thanksgiving!


[1] Uniform Crime Reporting Statistics
National or State Level
Web page.

National or state offense totals are based on data from all reporting agencies and estimates for unreported areas.

The 168 murder and nonnegligent homicides that occurred as a result of the bombing of the Alfred P. Murrah Federal Building in Oklahoma City in 1995 are included in the national estimate.

The 2,823 murder and nonnegligent homicides that occurred as a result of the events of September 11, 2001, are not included in the national estimates.

The 2012 data is not from this source. It is from the revised data in the table in footnote [2] below. The violent crime rate was revised up from 386.9 per 100,000 population to 387.8 (an increase of 0.9). The total number of violent crimes was revised up from 1,214,464 to 1,217,057 (an increase of 2,593 reported violent crimes).

[2] Crime in the United States, 2014
Table 1
Crime in the United States
by Volume and Rate per 100,000 Inhabitants, 1995–2014
Web page.


Happy Friday the 13th – New and Improved with Space Debris


This is not your regular scary old Friday the 13th. This one is new and improved with Death from the Skies! Not the great book by Phil Plait, just the fear and anxiety of the What if . . . ?

This debris will not cause any harm to anyone, but the whole idea of superstition is to fear the unknown and come up with other superstitions to provide a feeling of control over the unknown. But look at the bones name!


It’s got to mean something!

It couldn’t just be a coincidence!

Those phrases are the basis of a lot of superstition and conspiracy theories.

For example, psychics aren’t going to be completely wrong all of the time, so they claim that their vague prediction, that is almost right if you ignore most of what really happened, is proof of their abilities, when it is only to be expected that nobody will be completely wrong all of the time unless they make very few predictions. Psychics make a lot of predictions in order to be able to say they got something right. Nostradamus was given credit for this for centuries, but he is just another one who makes vague predictions that cannot all be completely wrong.

Sylvia Browne is one of the most famous people to take advantage of this. She gets everything wrong, but spins it so that those who want to believe can ignore reality and continue to believe pay her millions of dollars.

Is a bunch of WTF debris on Friday the 13th something to worry about? No.

Our lack of understanding of probability is what we should really worry about. People do lie with statistics, but people lie much more often with words. How often do people claim that we should not understand English, because people lie with English? Why should we choose willful ignorance of probability and statistics, when the same argument would be ridiculed if it were made for something we like?


Comments on Pennsylvania Eliminating Backboards for Potential Spinal Injuries

There were several comments to Pennsylvania Eliminating Backboards for Potential Spinal Injuries that indicate that I was probably not clear enough in my explanation of the protocol change in Pennsylvania. Backboards are not being completely eliminated, but the requirements to extricate/transport patients on backboards has been eliminated.

The use of backboards as extrication devices should be rare if we do what is best for the patients. The use of the backboard during transport should be the kind of thing that causes hospital staff to come look at the ancient artifact, like DeLee suction, rotating tourniquets, or knives for blood letting.

DeLee Suction.

Blood letting.

Would there ever be a situation where DeLee suction rotating tourniquets blood letting backboarding is best for the patient?

The backboard requires more manipulation than other extrication methods, since it requires manipulation to get the patient onto the backboard at the scene and again requires manipulation to get the patient off of the backboard onto either the EMS stretcher or the hospital stretcher. Hospitals are not leaving patients with unstable spinal injuries on backboards. So the backboard is probably going to be the least commonly used extrication device.

There is no evidence that use of a backboard is safe.

There is no reason to believe that placing a patient on an extrication device that is so uncomfortable that it encourages movement, such as the backboard, is safe.

There is no evidence that manipulation of a patient with an unstable spinal injury onto a backboard is safe.

The scoop is only going to require some manipulation to get the patient onto the scoop, but the scoop could be separated and then slid together under the patient, separated to remove from under the patient on the stretcher, so that will probably result in the least manipulation of the spine and be the most commonly used extrication device

A sheet may not provide adequate support for the head of an unconscious patient, but a backboard only provides support after we manipulate the patient’s head onto the board.

There is no evidence that scoops, or sheets, or vacuum mattresses, improve outcomes, but they should result in less manipulation of any spinal injury. The whole hypothesis of backboarding is to limit/prevent movement of the spine, but backboards do not do appear to limit or prevent movement of the spine.

We keep making excuses for harming our patients.

Where is the evidence that backboards are effective?

Where is the evidence that backboards are safe?

In the absence of valid evidence of safety and efficacy, we have little justification for applying backboards to patients.


Pennsylvania Eliminating Backboards for Potential Spinal Injuries

Medical directors should already have every EMS provider in Pennsylvania following the new Statewide BLS Protocols, but the procrastinators have until July 1, 2015 to get everyone to aggressively avoid using backboards.

We should not be manipulating the potentially injured spines of patients to get them onto backboards for no known benefit, while possibly causing permanent disabilities or other significant harms.

Excessive motion of the spine may worsen spine fractures or spinal cord injuries (especially in patients with altered consciousness who can’t restrict their own spinal motion), but immobilization on a long spine board may also cause pain, agitation, respiratory compromise, and pressure ulcers. Patients with the following symptoms or mechanisms of injury should be assessed to determine whether restriction of spinal motion is required:[1]



What are the full steps to be performed for someone suspected of having an unstable spinal injury?

Restrict Spinal Motion

Apply Rigid Cervical Collar[1]


We are beginning to realize that collars are probably also not be such a great idea,[2] but this is only one step to decrease the harm we cause for no apparent benefit.

If ambulatory,

Allow patient to move to stretcher mattress with minimal spinal motion3 [1]


This is just recognizing that people have been walking to stretchers without sudden onset of paralysis, so manipulating the patient’s spine onto a flat board for no known benefit was never a good idea. It was just dogma, that went unquestioned for too long.

If nonambulatory,

Use backboard, scoop/orthopedic stretcher, vacuum mattress, or other device to move patient to stretcher with minimal spinal motion4,5 [1]


We could use a sheet, since manipulating the patient onto a backboard, or other device, may result in much more movement of the spine than sliding a sheet under the patient and using the sheet to lift the patient.

Use CID may be used to further restrict spinal motion[1]


The typo is not important, but we can consider putting some sort of blocks next to the patient’s head to keep the head of an unconscious patient from flopping around.

Transport on stretcher mattress without backboard if patient ambulatory or if scoop/orthopedic stretcher can be removed with minimal patient motion.[1]


Again, the use of a sheet to move the patient may be the preferred method, since the use of the sheet may produce the least manipulation of the spine. We are trying to minimize the manipulation of the spine, not trying to defend some dogma that there is only one right way of doing things, regardless of outcomes. The patients’ outcomes are what matter, not adherence to the protocol at the expense of the patients.

The protocol clearly does not limit us to using backboards, scoops, orthopedic stretchers, or vacuum mattresses.

Using a sheet to move the patient, so that it does not produce more manipulation that would be produced by using these other devices appears to be encouraged, if not required. We are supposed to use the method that is least likely to harm the patient, which probably makes a backboard the least acceptable method.

This protocol also applies to assessment of patients before inter-facility transfer for injuries from a traumatic mechanism unless a medical command physician agrees that the patient may be transported without restriction of spinal motion.[1]


Any suggestion that a patient is going to be manipulated back onto a backboard should result in a firm, No, thank you.

I am not a lawyer, but I wouldn’t be surprised to see law suits against EMS agencies/providers who continue to cause harm with backboards, when there are less harmful alternatives available and no protocol/standard of care to defend this abuse of patients by placing them on backboards.


Pennsylvania is the largest state (not all states have statewide protocols, so this is often only at the agency level) to do this and joins a growing list of EMS agencies that are putting patients ahead of superstition –

Agencies/EMS Systems Minimizing Backboard use –

Let me know if I should add your agency to this list.

Alameda County

Albuquerque-Bernalillo County Medical Control Board

Bend Fire and Rescue
Bend, OR

Bernalillo County Fire Department

CentraCare Health
Monticello, MN

Chaffee County EMS

Connecticut, State of

Durham County EMS

Eagle County Ambulance District

HealthEast Medical Transportation
St. Paul, MN

Johnson County EMS

Kenosha Fire Department
Kenosha, WI

Macomb County EMS Med Control Authority
Macomb County, MI

Maryland, State of

MedicWest Ambulance

Milwaukee EMS

North Memorial Ambulance & Aircare
Minneapolis, MN

Palm Beach County Fire Rescue

Pennsylvania, Commonwealth of

Pewaukee Fire Dept
Pewaukee, WI

Rio Rancho Fire Department

SERTAC (Southeast Regional Trauma Advisory Council)

Wichita-Sedgwick County EMS System

Xenia Fire Department
Xenia, OH

Outside of the US –

NHS (National Health Service)
England (UK?)

St. John Ambulance
New Zealand


Queensland, Australia


[1] Spinal Care
2015 Pennsylvania Statewide BLS Protocols
261 – BLS – Adult/Peds
pp 59 – 61
Protocols in PDF Download Format.

[2] Why EMS Should Limit the Use of Rigid Cervical Collars
Bryan Bledsoe, DO, FACEP, FAAEM, EMT-P and Dale Carrison, DO, FACEP
Monday, January 26, 2015


Happy Darwin Day 2015


Charles Darwin is one of the greatest scientists of all time. We should celebrate the tremendous work that he has done, but it is considered politically incorrect to point out that evolution is real and that we use science to learn about reality.

To celebrate Darwin Day, Ken Ham has decided to do even more to embarrass himself. You remember him. He is the guy who debated Bill Nye.


What would it take to change your mind?
Bill Nye – Evidence.
Ken Ham – Nothing.

Nothing? If God were to tell Ken Ham that evolution is true, that would not change Ken Ham’s mind, because his mind is made up? Or is Ken Ham telling us that he does not believe that God exists?

Ken Ham claims to understand science, but the scientists he employs are required to sign a statement that what Ken Ham believes sets a limit their science. Ken Ham is celebrating today as Darwin was wrong Day.[1]

The 66 books of the Bible are the written Word of God. The Bible is divinely inspired and inerrant throughout. Its assertions are factually true in all the original autographs. It is the supreme authority in everything it teaches. Its authority is not limited to spiritual, religious, or redemptive themes but includes its assertions in such fields as history and science.[2]


Ken Ham tells us that only his interpretation of the Bible is the truth. Science encourages us to look everywhere for the truth.

If you do not sign a Statement of Faith, you cannot work for Ken Ham. You only have to read the Bible to see that even the description of Creation has irreconcilable contradictions if Genesis is to be interpreted as science, rather than metaphor.

24 Then God said, “Let the earth bring forth living creatures after [ag]their kind: cattle and creeping things and beasts of the earth after [ah]their kind”; and it was so. 25 God made the beasts of the earth after [ai]their kind, and the cattle after [aj]their kind, and everything that creeps on the ground after its kind; and God saw that it was good.

26 Then God said, “Let Us make man in Our image, according to Our likeness; and let them rule over the fish of the sea and over the birds of the [ak]sky and over the cattle and over all the earth, and over every creeping thing that creeps on the earth.” 27 God created man in His own image, in the image of God He created him; male and female He created them.[3]


God made Adam and Eve after making the animals.

18 Then the Lord God said, “It is not good for the man to be alone; I will make him a helper [a]suitable for him.” 19 Out of the ground the Lord God formed every beast of the field and every bird of the [b]sky, and brought them to the man to see what he would call them; and whatever the man called a living creature, that was its name.[4]


God made Adam and Eve before making the animals.

It doesn’t matter which came first, if this is a metaphor, but if this is supposed to be literally true and accurate, then it does matter which came first.

Is your God incapable of telling the difference between before and after? Ken Ham’s God can’t seem to tell the difference. Ken Ham seems to prefer to mock his God.

Is your God limited by the restrictions Ken Ham arrogantly places on God?

Is your God capable of using metaphors?

Are there other places where your God uses metaphors in the Bible?



[1] #DarwinWasWrongDay
AiG (Answers in Genesis)
Ken Ham’s Twitter hashtag encouraging rejection of evolution
Page at AiG

[2] Statement of Faith
AiG (Answers in Genesis)
Section 2: Basics
Updated: December 12, 2012
Accessed on February 12, 2015
Page at AiG

[3] Genesis 1:24-27
New American Standard Bible (NASB)
Bible Gateway (a Christian site)

Pick up a printed Bible. Look at whatever version of the Bible you like. You can look up one verse at a time to compare among versions.

[4] Genesis 2:18-19
New American Standard Bible (NASB)
Bible Gateway (a Christian site)


Should ACLS Recommend the Unknown Based on Weak Evidence?

The AHA (American Heart Association) and ILCOR (International Liaison Committee on Resuscitation) will be meeting tomorrow to finalize the recommendations for the 2015 ACLS (Advanced Cardiac Life Support) guidelines. Here is the comment I submitted on the proposed recommendation for epinephrine (Adrenaline in Commonwealth countries) in cardiac arrest.

I have not received any information about where to submit SEERS comments, so I am sending this to you. Please forward it to whomever is supposed to receive comments.

Vasopressors for cardiac arrest (1. Epi v Placebo)

Consensus on Science:
For all four long term (critical) and short term (important) outcomes, we found one underpowered trial that provided low quality evidence comparing SDE to placebo (Jacobs, 2001, 1138).


As a trial that is stated to be underpowered (through no fault of Dr. Jacobs),[2] is there any valid reason the Jacobs study should be considered to be superior to observational studies?

Among 534 subjects, there was uncertain benefit or harm of SDE over placebo for the critical outcomes of survival to discharge [RR 2.12, 95% CI 0.75-6.02, p=0.16] and good neurological outcome defined as CPC of 1-2 [RR 1.73, 95% CI 0.59-5.11, p=0.32].[1]


We do not have good evidence to tell us if this is harmful or beneficial and we do not have any way of determining which patients will be harmed or helped by administration of epinephrine.


However, patients who received SDE had higher rates of the two important outcomes of survival to admission [RR 1.95, 95% CI, 1.34-2.84, p=0.0004] and ROSC in the prehospital setting [RR 2.80, 95% CI 1.78-4.41, p<0.00001] compared to those who received placebo.[1]


Are these surrogate endpoints important?

How do we know?

If these surrogate endpoints are important, why is there no valid evidence to support this claim?

We have a history of being misled by surrogate endpoints. We used to bleed patients and that produced a number of clear benefits in surrogate endpoints.

Physicians observed of old, and continued to observe for many centuries, the following facts concerning blood-letting.

1. It gave relief to pain. . . . .

2. It diminished swelling. . . . .

3. It diminished local redness or congestion. . . . .

4. For a short time after bleeding, either local or general, abnormal heat was sensibly diminished.

5. After bleeding, spasms ceased, . . . .

6. If the blood could be made to run, patients were roused up suddenly from the apparent death of coma. (This was puzzling to those who regarded spasm and paralysis as opposite states; but it showed the catholic applicability of the remedy.)

7. Natural (wrongly termed ” accidental”) hacmorrhages were observed sometimes to end disease. . . . .

8. . . . venesection would cause hamorrhages to cease.[3]


We don’t do that any more, because medicine is not supposed to just create a superficial improvement.

We should not be making any recommendation to treat based on such weak evidence.

The evidence for the routine use of adrenaline is perceived to be at equipoise within the international community of resuscitation scientists requiring re-evaluation19 as suggested by this comprehensive systematic review and meta-analysis. There is a need for well-designed, placebo-controlled, and adequately powered RCTs to evaluate the efficacy of adrenaline and to determine its optimal dosing.11,16,54 The question as to the efficacy of adrenaline for OHCA remains unanswered.[4]


Since the question as to the efficacy of adrenaline for OHCA remains unanswered, we should avoid substituting a bad answer for We don’t know.

Maybe we should bring back the indeterminate class for these unanswerable questions.

Treatment Recommendation
Given the observed benefit in short term outcomes, we suggest Standard Dose Epinephrine be administered to patients in cardiac arrest.(weak recommendation, low quality)


The benefit is considered important, but that is just an expert opinion, which is the lowest level of evidence.

A weak recommendation to give a treatment of unknown benefit and unknown harm, based on evidence that is admitted to be of low quality, should not set the standard of care. Even if the guidelines are explicitly stated to not be standards of care, they are adopted as standards of care by the emergency medicine community and by the EMS community.

We don’t know enough to make a recommendation about epinephrine, or most other treatments, in cardiac arrest.

We do not need to keep making the same recommendation just because we have made it before. We can leave it up to the treating physician or to the medical director writing the protocols for EMS.

See also – Proposed 2015 ACLS Epinephrine Recommendation – Vasopressors for cardiac arrest (1. Epi v Placebo)


[1] Vasopressors for cardiac arrest (1. Epi v Placebo)
ILCOR Scientific Evidence Evaluation and Review System
Questions Open for Public Comment
Closing Date – February 28, 2015
Question page

[2] Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial
Jacobs IG, Finn JC, Jelinek GA, Oxer HF, Thompson PL.
Resuscitation. 2011 Sep;82(9):1138-43. Epub 2011 Jul 2.
PMID: 21745533 [PubMed – in process]

Free Full Text PDF Download of In Press Uncorrected Proof from


This study was designed as a multicentre trial involving five ambulance services in Australia and New Zealand and was accordingly powered to detect clinically important treatment effects. Despite having obtained approvals for the study from Institutional Ethics Committees, Crown Law and Guardianship Boards, the concerns of being involved in a trial in which the unproven “standard of care” was being withheld prevented four of the five ambulance services from participating.


In addition adverse press reports questioning the ethics of conducting this trial, which subsequently led to the involvement of politicians, further heightened these concerns. Despite the clearly demonstrated existence of clinical equipoise for adrenaline in cardiac arrest it remained impossible to change the decision not to participate.


[3] Blood-Letting
Br Med J.
1871 March 18; 1(533): 283–291.
PMCID: PMC2260507

[4] Adrenaline for out-of-hospital cardiac arrest resuscitation: a systematic review and meta-analysis of randomized controlled trials.
Lin S, Callaway CW, Shah PS, Wagner JD, Beyene J, Ziegler CP, Morrison LJ.
Resuscitation. 2014 Jun;85(6):732-40. doi: 10.1016/j.resuscitation.2014.03.008. Epub 2014 Mar 15.
PMID: 24642404 [PubMed – in process]


FDA takes steps to improve reliability of automated external defibrillators


Why improve the reliability of AEDs (Automated External Defibrillators)?

AEDs are important, much more important than the epinephrine I wrote about yesterday, because AEDs actually work – at least when the AEDs work as they are supposed to.

AEDs fail much more often than they should.

From January 2005 through September 2014, the FDA received approximately 72,000 medical device reports associated with the failure of these devices. Since 2005, manufacturers have conducted 111 recalls, affecting more than two million AEDs. The problems associated with many of these recalls and reports included design and manufacturing issues, such as inadequate control of components purchased from other suppliers.[1]


72,000 reports over ten years. In the US, there are about 300,00 cardiac arrests a year where treatment is considered and an AED might be applied. Out of those, how many times is an AED applied? 1/3?

If I use that ballpark number guess, then 72,000 out of 1,000,000 is 0.72%. The reporting of problems that are identified during equipment checks and maintenance should also decrease the rate of failure in the treatment of real patients. Maybe I decrease that guess at a failure rate during cardiac arrest treatment/assessment to 0.5% or 0.1%?

A decrease to 0.1% is one out of every 1,000 uses. Is that a tolerable level of failure for a device that has only two tasks, but has to remain ready to perform those tasks at all times? The two tasks are to differentiate between ventricular fibrillation/ventricular tachycardia and any other cardiac rhythm and to deliver a shock to the patient after ventricular fibrillation or ventricular tachycardia has been identified.

Image credit.

There are only a few moving parts and the designs may vary from what I describe. The wire that is manually attached to the defibrillator pads. The lids that is opened, turns on the AED, and triggers the voice prompts. The buttons that are pressed to turn on the AEDs not turned on by opening the lid, to analyze the rhythm, and to deliver the shock.

Would Do we accept a similar failure rate from an ambulance, which has many more moving parts?

Do we accept similar failure rates from our personal vehicles, which have many more moving parts?

Do we accept similar failure rates from aircraft, which has many more moving parts?

Yes and no.

We deal with the failures in these vehicles by building in redundancies and paying attention to maintenance, but the result is that the failures rarely cause death, or the lack of resuscitation that could have occurred with a properly functioning AED.

For example, NASA management claimed that they had an isty-bitsy teeny-weeny failure rate. They were shown to be wrong in a very dramatic, and deadly, fashion. Twice.

If a reasonable launch schedule is to be maintained, engineering often cannot be done fast enough to keep up with the expectations of originally conservative certification criteria designed to guarantee a very safe vehicle. In these situations, subtly, and often with apparently logical arguments, the criteria are altered so that flights may still be certified in time. They therefore fly in a relatively unsafe condition, with a chance of failure of the order of a percent (it is difficult to be more accurate).

Official management, on the other hand, claims to believe the probability of failure is a thousand times less. One reason for this may be an attempt to assure the government of NASA perfection and success in order to ensure the supply of funds. The other may be that they sincerely believed it to be true, demonstrating an almost incredible lack of communication between themselves and their working engineers.

. . . .

For a successful technology, reality must take precedence over public relations, for nature cannot be fooled.[2]


We need to understand what the actual failure rates are. We also need to work on the failure rate that comes from operator error.

The reason people are able to lie to us with statistics (statistics do not lie, but statistics can be used by liars) is that we choose to remain ignorant of the appropriate use of statistics. We ask to be lied to.

What is an acceptable failure rate? It isn’t zero, because a zero failure rate is a lie.


[1] FDA takes steps to improve reliability of automated external defibrillators
January 28, 2015
Food and Drug Administration
FDA News Release

[2] Volume 2: Appendix F – Personal Observations on Reliability of Shuttle
Report of the Presidential Commission on the Space Shuttle Challenger Accident (Also known as The Rogers Commission Report)
by R. P. Feynman
NASA report


The Most Misleading Medical News of 2014


The media are horrible at reporting medical stories, or any other science stories. They regularly report that some recent study shows a cure for cancer, as if cancer is just one illness. What were the media worst at covering this year?


They said Ebola was easy to catch, that illegal immigrants may be carrying the virus across the southern border, that it was all part of a government or corporate conspiracy.[1]


Image credit.

The part of that quote that affects EMS is the claim that ebola is easy to catch.

Ebola does require isolation precautions – and we are not good at using, or understanding, isolation precautions. Just watch your coworkers putting everything on. Even worse, watch them take them off. Much worse, watch yourself in a mirror.

We are far from good at using isolation precautions.

Ebola spreads through direct contact with bodily fluids such as blood, vomit and diarrhea. Coughing and sneezing are not symptoms.

Airborne viruses, meanwhile, have the ability to travel large distances propelled by a sneeze or cough. In those cases, people breathe in virus particles without even realizing it. Scientists say there is no evidence Ebola works like that.[1]


Back in August Dr. Anthony Fauci described how we should expect this outbreak to progress. Looking back, we should have ignored the news media and reread this article.

Although the regional threat of Ebola in West Africa looms large, the chance that the virus will establish a foothold in the United States or another high-resource country remains extremely small. Although global air transit could, and most likely will, allow an infected, asymptomatic person to board a plane and unknowingly carry Ebola virus to a higher-income country, containment should be readily achievable.[2]


Dr. Fauci predicted that in August (print edition September 18). His prediction was more accurate than the media reported it as it happened a month later (a week later than the print edition).

Perhaps we should pay as much attention to what Dr. Fauci wrote about our optimism in favor of inadequately studied treatments.

Among the therapies in development is a “cocktail” of humanized-mouse antibodies (“ZMapp”), which has shown promise in nonhuman primates. ZMapp was administered to two U.S. citizens who were recently evacuated from Liberia to Atlanta, and both patients have had clinical improvement. However, it is not clear whether ZMapp led to the recovery, and with only two cases, conclusions regarding its efficacy should be withheld.[2]


Perspective is important and we should apply it more often.

For example –

1. Restricting travel from Ebola-outbreak countries to the United States is the best way to prevent the spread of Ebola to our shores.


There is no evidence that restricting travel will prevent spread of Ebola to the U.S. Exposed and infected persons might reach our country undetected and thereby escape essential public health monitoring, which could worsen transmission risk. The key to controlling this epidemic is to stop Ebola at its source in West Africa.[3]


If we won’t take the risk of caring for these patients, we should not interfere with those who do understand appropriate treatment and do treat these patients.


[1] 2014 Lie of the Year: Exaggerations about Ebola
Tampa Bay Times
By Angie Drobnic Holan, Aaron Sharockman
Monday, December 15th, 2014 at 3:08 p.m.

PolitiFact editors choose the Lie of the Year, in part, based on how broadly a myth or falsehood infiltrates conventional thinking. In 2013, it was the promise made by President Barack Obama and other Democrats that “If you like your health care plan, you can keep it.”


[2] Ebola–underscoring the global disparities in health care resources.
Fauci AS.
N Engl J Med. 2014 Sep 18;371(12):1084-6. doi: 10.1056/NEJMp1409494. Epub 2014 Aug 13. No abstract available.
PMID: 25119491 [PubMed – indexed for MEDLINE]

Free Full Text from New England Journal of Medicine.

[3] Ten Key “Facts” About Ebola: True or False?
Kristi L. Koenig, MD, FACEP, FIFEM
November 7, 2014
JournalWatch Emergency Medicine from NEJM