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

The RAD-57 – Still Unsafe?

ResearchBlogging.org
 

Brandon Oto of EMS Basics and Degrees of Clarity organized The First EMS What-if-We’re-Wrong-a-Thon. I did not participate, because I was taking a break from blogging at the time. Brandon is doing it again, so I decided to look for something I wrote that I have been wrong about to contribute. I thought about Masimo. I had been very critical of Dr. Michael O’Reilly (then Executive Vice President of Masimo Corporation) for being an advocate of bad science. He has since been hired away by Apple.[1] He should be less dangerous with a telephone than he was with the RAD-57. At the time, he wrote –
 

Masimo stands by its products’ performance and knows that when SpCO-enabled devices are used according to their directions for use, they provide accurate SpCO measurements that provide significant clinical utility, helping clinicians detect carbon monoxide poisoning in patients otherwise not suspected of having it and rule out carbon monoxide poisoning in patients with suspected carbon monoxide poisoning.[2]

 

The problem is that there is no evidence that the RAD-57 is safe or effective at ruling out carbon monoxide poisoning in anyone.

There is evidence that the RAD-57 will fail, if used to try to rule out carbon monoxide poisoning. One study showed that the RAD-57 will miss half of the people with elevated carbon monoxide levels.
 

The RAD device correctly identified 11 of 23 patients with laboratory values greater than or equal to 15% carboxyhemoglobin (sensitivity 48%; 95% CI 27% to 69%).[3]

 

What if I was wrong?

Is there any evidence that the RAD-57 is able to rule out covert, but life threatening carbon monoxide poisoning?[4]
 


 
 

Was I wrong?

While there have been several studies of the RAD-57, I could not find any evidence that the RAD-57 is safe or effective at ruling out carbon monoxide poisoning.

There does not appear to be any research on the use of the RAD-57 to screen firefighters to rule out carbon monoxide poisoning, even though advertising shows using the RAD-57 to screen firefighters.

Was I wrong? No. That is why this is not a part of The First EMS What-if-We’re-Wrong-a-Thon.

However, I did find some interesting carbon monoxide poisoning papers –

One shows that we may be causing harm by aggressively providing oxygen. This is not enough of a reason to stop providing oxygen, but if this hypothesis is supported by further research, we will need to change treatment.
 

While CO’s affinity for hemoglobin remains undisputed, new research suggests that its role in nitric oxide release, reactive oxygen species formation, and its direct action on ion channels is much more significant. In the course of understanding the multifaceted character of this simple molecule it becomes apparent that current oxygen based therapies meant to displace CO from hemoglobin may be insufficient and possibly harmful.[5]

 

Another shows that the addition of catalytic converters seems to have dramatically decreased the car exhaust suicide rate and the level of carbon monoxide in survivors of these suicide attempts.
 

RESULTS:
Since 1985, the CDR for suicidal motor vehicle-related CO poisoning has decreased in parallel with CO emissions (R2 = 0.985). Non-fatal motor vehicle-related intentional CO poisoning cases decreased 63% over 33 years (p = 0.0017). COHb levels decreased 35% in these patients (p < 0.0001).
[6]

 

CO is Carbon monOxide.
CDR is Crude Death Rate.
COHb is CarbOxyHemoglobin.

There are still some papers that show that we do not understand what the RAD-57 can’t do –
 

The fact that all the Paramedic Rescue Squads were equipped with medical triage sets and were able to conduct non-invasive measurements of carboxyhemoglobin made it possible to introduce effective procedures in the cases of suspected carbon monoxide poisoning and abandon costly and complicated organisational procedures when they proved to be unnecessary.[1]

 

No. The Magic 8 Ball did not indicate a problem, but that does not mean that it is safe to rule out carbon monoxide poisoning with a Magic 8 Ball. The Magic 8 Ball RAD-57 is not accurate enough to rule out carbon monoxide poisoning.

The RAD-57 is only appropriate for sending more people to the hospital. While the extra cost of these false positives is a problem and will cause people to mock Masimo, this may save some lives or just prevent more serious consequences of carbon monoxide poisoning.

If you use the RAD-57 to determine that someone does not need to go to the hospital, get a lot of very good insurance, because eventually one of those patients will have a heart attack, or a stroke, or die and carbon monoxide will be part of the reason for the bad outcome. Your advice will have contributed.

If you send a firefighter back into a fire because you think you have ruled out carbon monoxide poisoning, eventually you will be the cause of death or disability of firefighters. Don’t do it.
 

CONCLUSIONS:
While the Rad-57 pulse oximeter functioned within the manufacturer’s specifications, clinicians using the Rad-57 should expect some SpCO readings to be significantly higher or lower than COHb measurements, and should not use SpCO to direct triage or patient management. An elevated S(pCO) could broaden the diagnosis of CO poisoning in patients with non-specific symptoms. However, a negative SpCO level in patients suspected of having CO poisoning should never rule out CO poisoning, and should always be confirmed by COHb.
[7]

 

Highlighting in bold is mine.

SpCO is Masimo’s registered trademark for their noninvasive indirect measurement of carbon monoxide using the RAD-57.

Was I wrong? I will find something else to write about, because there is even more evidence that the RAD-57 should not be used to try to rule out carbon monoxide poisoning now than when I originally criticized Masimo.
 

Also read the article by Dr. Brooks Walsh on the RAD-57 and screening for carbon monoxide poisoning in fire fighters – Checking firefighters for carbon monoxide – recent studies, persistent concerns.
 

Here is the rest of what I have written about the Dr. O’Reilly, Masimo, and the RAD-57

The RAD-57 Pulse Co-Oximeter – Does It Work – Part I
Fri, 12 Nov 2010

The RAD-57 Pulse Co-Oximeter – Does It Work – Part II
Wed, 17 Nov 2010

How Not to Respond to Negative Research
Fri, 26 Nov 2010

How Not to Respond to Negative Research – Addendum
Fri, 26 Nov 2010

How TO Respond to Negative Research
Sun, 05 Dec 2010

Bad Advice on Masimo’s RAD-57 – Part I
Fri, 18 Feb 2011

Bad Advice on Masimo’s RAD-57 – Part II
Mon, 21 Feb 2011

Bad Advice on Masimo’s RAD-57 – Part III
Thu, 24 Feb 2011

Bad Advice on Masimo’s RAD-57 – Part IV
Mon, 28 Feb 2011

Performance of the RAD-57 With a Lower Limit – Better?
Wed, 18 May 2011

Accuracy of Noninvasive Multiwave Pulse Oximetry Compared With Carboxyhemoglobin From Blood Gas Analysis in Unselected Emergency Department Patients
Tue, 21 Feb 2012

Mass sociogenic illness initially reported as carbon monoxide poisoning
Wed, 22 Feb 2012

Psychic vs. RAD-57
Thu, 23 Feb 2012

Footnotes:

[1] Apple makes yet another medical field hire for unknown project
By AppleInsider Staff
Thursday, January 30, 2014, 04:04 pm PT (07:04 pm ET)
AppleInsider
Article

[2] Performance of the Rad-57 pulse co-oximeter compared with standard laboratory carboxyhemoglobin measurement.
O’Reilly M.
Ann Emerg Med. 2010 Oct;56(4):442-4; author reply 444-5. No abstract available.
PMID: 20868919 [PubMed – indexed for MEDLINE]

Free Full Text of letter and author reply from Ann Emerg Med.

[3] Performance of the RAD-57 pulse CO-oximeter compared with standard laboratory carboxyhemoglobin measurement.
Touger M, Birnbaum A, Wang J, Chou K, Pearson D, Bijur P.
Ann Emerg Med. 2010 Oct;56(4):382-8. Epub 2010 Jun 3.
PMID: 20605259 [PubMed – indexed for MEDLINE]

Free Full Text Article from Ann Emerg Med.

[4] Accuracy of Noninvasive Multiwave Pulse Oximetry Compared With Carboxyhemoglobin From Blood Gas Analysis in Unselected Emergency Department Patients
Rogue Medic
Tue, 21 Feb 2012
Article

[5] A modern literature review of carbon monoxide poisoning theories, therapies, and potential targets for therapy advancement.
Roderique JD, Josef CS, Feldman MJ, Spiess BD.
Toxicology. 2015 Aug 6;334:45-58. doi: 10.1016/j.tox.2015.05.004. Epub 2015 May 18. Review.
PMID: 25997893

[6] Suicidal carbon monoxide poisoning has decreased with controls on automobile emissions.
Hampson NB, Holm JR.
Undersea Hyperb Med. 2015 Mar-Apr;42(2):159-64.
PMID: 26094291

[7] False positive rate of carbon monoxide saturation by pulse oximetry of emergency department patients.
Weaver LK, Churchill SK, Deru K, Cooney D.
Respir Care. 2013 Feb;58(2):232-40. doi: 10.4187/respcare.01744.
PMID: 22782305

Free Full Text from Respir Care.

Weaver, L., Churchill, S., Deru, K., & Cooney, D. (2012). False Positive Rate of Carbon Monoxide Saturation by Pulse Oximetry of Emergency Department Patients Respiratory Care DOI: 10.4187/respcare.01744

Hampson NB, & Holm JR (2015). Suicidal carbon monoxide poisoning has decreased with controls on automobile emissions. Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc, 42 (2), 159-64 PMID: 26094291

Roderique, J., Josef, C., Feldman, M., & Spiess, B. (2015). A modern literature review of carbon monoxide poisoning theories, therapies, and potential targets for therapy advancement. Toxicology, 334, 45-58 DOI: 10.1016/j.tox.2015.05.004

Touger, M., Birnbaum, A., Wang, J., Chou, K., Pearson, D., & Bijur, P. (2010). Performance of the RAD-57 Pulse Co-Oximeter Compared With Standard Laboratory Carboxyhemoglobin Measurement Annals of Emergency Medicine, 56 (4), 382-388 DOI: 10.1016/j.annemergmed.2010.03.041

O’Reilly, M. (2010). Performance of the Rad-57 Pulse Co-Oximeter Compared With Standard Laboratory Carboxyhemoglobin Measurement Annals of Emergency Medicine, 56 (4), 442-444 DOI: 10.1016/j.annemergmed.2010.08.016

.

Deja vu all over again in segregation

 

I was just a little kid when Alabama Governor George Wallace gave his famous inauguration speech announcing segregation now, segregation tomorrow, and segregation forever.[1] I had hoped that we, in America, had matured and improved our morality in the last half century.
 


 

Alabama Supreme Court Chief Justice Roy Moore wants to prove that segregation, and other immoral acts, still get votes in Alabama.[2] The Alabama Supreme Court is elected and today the Chief Justice demonstrated that he will continue to pander to the immorality of voters. He was removed from office in 2003 for idolatry, but the voters support idolatry – as long as it is their version of the golden calf. Because tradition has arbitrarily limited the rights of some Americans, some Americans think that immoral tradition should continue.

These defenders of immorality claim that they are defending Biblical marriage. With so many forms of God-endorsed Biblical marriage, why do they defend only one form? Why not the polygamy that God approved of in the Bible? Why not the selling of a daughter into sexual slavery that God approved of in the Bible? Why do they leave out the parts of the Bible that they find embarrassing?
 

7 “If a man sells his daughter as a female slave, she is not to [a]go free as the male slaves [b]do. 8 If she is [c]displeasing in the eyes of her master [d]who designated her for himself, then he shall let her be redeemed. He does not have authority to sell her to a foreign people because of his [e]unfairness to her. 9 If he designates her for his son, he shall deal with her according to the custom of daughters. 10 If he takes to himself another woman, he may not reduce her [f]food, her clothing, or her conjugal rights. 11 If he will not do these three things for her, then she shall go out for nothing, without payment of money. Exodus 21:7-11[3]

 

What about all of the other forms of Biblical marriage that the God of the Bible endorses?
 

biblical marriages
Image credit.
 

Fortunately, we live in America, so these examples of Biblical immorality are prohibited.

Justifications of slavery are rooted in the Bible and an economic system that is so obscene that it is used as a metaphor for other, less bad economic systems, such as communism and Nazism. We had to defend America against a rebellion by those who wanted to expand slavery. It took half a million deaths in a war to end this Biblical immorality.
 

Justifications of laws prohibiting contraception are rooted in the Bible. Struck down by the American Supreme Court in Griswold v. Connecticut in 1965.[4]
 

Justifications of laws prohibiting interracial marriage are rooted in the Bible. Struck down by the American Supreme Court in Loving v. Virginia in 1967.[5]
 

Justifications of laws prohibiting marriage equality are rooted in the Bible. Struck down by the American Supreme Court in Obergefell v. Hodges in 2015.[6]
 

To paraphrase what has been written elsewhere, The fact that I can no longer sell my daughter as a sex slave means that we have already redefined marriage. It is just one of many parts of eternal and unchanging laws of the God of the Bible that are illegal in civilized countries.

On the other hand, maybe these Christians are right. Maybe we should return to Biblical marriage. I don’t make much money as a paramedic and my daughter got her looks from her mother. The bidding starts at . . . well, make me an offer. It is the moral thing to do, according to the Bible.

When will we stop listening to Bible thumpers promoting immorality in the name of their interpretation of their Bible?

The American Constitution is in conflict with the Bible, because the Founding Fathers were more interested in fair play than in promoting persecution by the religious. The Founding Fathers could have limited the vote (and political office) to Protestants, but they explicitly forbade such discrimination.[7]

So many of these segregationists claim to disapprove of big government, but demand a big government to enforce their rules of watered down sharia. Hypocrisy seems to be required to defend such blatant immorality.

Footnotes:

[1] George Wallace’s 1963 Inaugural Address
Wikipedia
Article

[2] The Quixotic Adventures of Roy Moore – Alabama’s chief justice issued an order on Wednesday to keep the state’s same-sex marriage ban intact despite the Supreme Court’s landmark ruling last year.
The Atlantic
Matt Ford
5:15 PM ET
Article
 

Alabama Supreme Court Chief Justice Roy Moore issued an administrative order Wednesday that effectively banned same-sex marriages in the state, less than seven months after the U.S. Supreme Court ruled that same-sex marriage bans violated the Constitution.

 

[3] Exodus 21:7-11
New American Standard Bible (NASB)
Bible Gateway – A Christian site that allows you to use any other version if you like.
God
Link to these holy words of the God of the Bible

[4] Griswold v. Connecticut
U.S. Supreme Court
Decided: June 7, 1965
FindLaw
Transcript

[5] Loving v. Virginia
U.S. Supreme Court
Decided: June 12, 1967
Cornell University Law School
Transcript

[6] Obergefell v. Hodges
U.S. Supreme Court
Decided: June 26 2015
SCOTUSblog
Transcript

[7] Article VI Section 3
U.S. Constitution
Transcript
 

The Senators and Representatives before mentioned, and the Members of the several State Legislatures, and all executive and judicial Officers, both of the United States and of the several States, shall be bound by Oath or Affirmation, to support this Constitution; but no religious Test shall ever be required as a Qualification to any Office or public Trust under the United States.

 

Highlighting is mine.
 

.

Why is progress so slow in resuscitation research?

ResearchBlogging.org
 

Why is progress so slow in resuscitation research? A lot of money and time went in to finding out which type of blood-letting ventilation works best – ignoring the absence of valid evidence that ventilation is better than no ventilation. Why not gamble with our patients?

In response to The Fatal Flaw in Trial of Continuous or Interrupted Chest Compressions during CPR,[1],[2] Kenny commented that –
 

there are many things in your blog that are not correct.[1]

 

I asked for specifics and received the following from Anonymous (maybe Kenny and maybe not) –
 

That the study design ASSUMES we don’t want to know if ventilation is useful or not.[1]

 

Ventilation study implied facepalm
 

Assumes is not many things, but the comments may be from different people and there may be so many things, that Kenny is still documenting all of the examples. Perhaps the following is more specific wording that will satisfy defenders of the study –

    The study design strongly suggests that

        in the attempted resuscitation of adult patients

            with cardiac causes of cardiac arrest

                which is almost all cardiac arrest patients

                    active ventilation does not need evidence,

                        but selecting the favorite flavor of ventilation

                            does need expensive high quality evidence

                                just in case someone ever produces valid evidence

                                    that these patients are not harmed by ventilations

                                        and that these patients receive some benefit from ventilations.
 

That is a lot to assume believe without appropriate evidence.

Based on the available evidence, what are the odds that ventilations are not harmful and are beneficial?
 

Does anyone have any good argument to give ventilations as much as a 50% chance?
 

What about a 40% chance that ventilations will survive a valid study?

How about a 30% chance?

20%?

Is there any justifiable reason to be so optimistic?

If there isn’t any justifiable reason to be optimistic, then we are only making assumptions when we take shortcuts to eliminate the essential research in order to study something that is traditional, rather than based on valid evidence.
 

Do the authors understand that there isn’t valid evidence of any benefit/lack of harm from active ventilations?

Do the authors care that there is not valid evidence of any benefit/lack of harm from active ventilations?

If I have overlooked a third possibility, somebody should let me know. If there is valid evidence, somebody should provide it.

Footnotes:

[1] The Fatal Flaw in Trial of Continuous or Interrupted Chest Compressions during CPR
Wed, 25 Nov 2015 10:15:20
by Rogue Medic
Article

[2] Trial of Continuous or Interrupted Chest Compressions during CPR.
Nichol G, Leroux B, Wang H, Callaway CW, Sopko G, Weisfeldt M, Stiell I, Morrison LJ, Aufderheide TP, Cheskes S, Christenson J, Kudenchuk P, Vaillancourt C, Rea TD, Idris AH, Colella R, Isaacs M, Straight R, Stephens S, Richardson J, Condle J, Schmicker RH, Egan D, May S, Ornato JP; ROC Investigators.
N Engl J Med. 2015 Nov 9. [Epub ahead of print]
PMID: 26550795

Free Full Text from NEJM.

Nichol, G., Leroux, B., Wang, H., Callaway, C., Sopko, G., Weisfeldt, M., Stiell, I., Morrison, L., Aufderheide, T., Cheskes, S., Christenson, J., Kudenchuk, P., Vaillancourt, C., Rea, T., Idris, A., Colella, R., Isaacs, M., Straight, R., Stephens, S., Richardson, J., Condle, J., Schmicker, R., Egan, D., May, S., & Ornato, J. (2015). Trial of Continuous or Interrupted Chest Compressions during CPR New England Journal of Medicine DOI: 10.1056/NEJMoa1509139

.

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!

Footnotes:

[1] Uniform Crime Reporting Statistics
National or State Level
FBI
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
FBI
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!

WT1190F

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
CA
 

Albuquerque-Bernalillo County Medical Control Board
NM
 

Bend Fire and Rescue
Bend, OR
 

Bernalillo County Fire Department
NM
 

CentraCare Health
Monticello, MN
 

Chaffee County EMS
CO
 

Connecticut, State of
CT
 

Durham County EMS
NC
 

Eagle County Ambulance District
CO
 

HealthEast Medical Transportation
St. Paul, MN
 

Johnson County EMS
KS
 

Kenosha Fire Department
Kenosha, WI
 

Macomb County EMS Med Control Authority
Macomb County, MI
 

Maryland, State of
MD
 

MedicWest Ambulance
NV
 

Milwaukee EMS
WI
 

North Memorial Ambulance & Aircare
Minneapolis, MN
 

Palm Beach County Fire Rescue
FL
 

Pennsylvania, Commonwealth of
PA
 

Pewaukee Fire Dept
Pewaukee, WI
 

Rio Rancho Fire Department
NM
 

SERTAC (Southeast Regional Trauma Advisory Council)
WI
 

Wichita-Sedgwick County EMS System
KS
 

Xenia Fire Department
Xenia, OH
 
 

Outside of the US –
 

NHS (National Health Service)
England (UK?)
 

St. John Ambulance
New Zealand
 

Norway
 

QAS
Queensland, Australia
 
 

Footnotes:

[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
JEMS
Article

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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?
 


 

Footnotes:

[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)
Passage

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)
Passage

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