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Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Belly flops with cliches, proves he’s a Satirist (You have a dirty mind if you’re thinking what I think you’re thinking this means)

Fri, 04 Oct 2013 09:00:25 -0400 by
 

What happens when EMS becomes so distorted that it is embarrassing?

Things get silly.
 

Image credit.
 

By silly, I mean the satire starts off simply, but then becomes a multi-layered satire that deserves its own Wikipedia page. There is no page, yet, or is there?

Kelly Grayson started us off with an article about EMS cliches.
 

From the blank stares I got from all assembled, I realized that none of them had ever seen Bull Durham. So while I educated them in the Tao of Crash Davis, I started thinking about the clichés we spout in EMS. Every cliché has at its root a central truth; that’s how they get to be clichés in the first place.

But nothing is so good as a well-placed cliché as a substitute for real wisdom and knowledge. Just insert one of these babies into a social media comment thread and watch the “Likes” pile up!

. . .

If you learn to use these simple EMS clichés, I guarantee that you will develop a reputation as a paramedic sage in no time. Especially to people who don’t know better.[1]

 

You’re going to have to read the full article yourself. Polonius would have been skewered several acts earlier if Kelly had been there, but this gets better.

Then Happy Medic turns up the satire by responding to Kelly.

 

8. “We cheat death.” We do, daily! I have a T-shirt with the Grim Reaper being slapped in the face by a bad ass medic with sunglasses and everything. You are so narrow minded you can’t see how we bring the dead back everyday. Epi works Kelly![2]

 

Go read the rest, too.
 

Ridicule is the only weapon which can be used against unintelligible propositions. Ideas must be distinct before reason can act upon them; – Thomas Jefferson.
 

Finally, Tor eckman takes it to Eleventy!!11!!! in the comments.
 

I also teach them to think and look for clues on scene, like just last week I got to see the lights come on in this “newb” Paramedic when he wasn’t going to spinal a patient in a MVC until I had him walk down the bank and look at the car, after seeing the mechanism he came back up, told the patient that he was lucky he wasnt paralyzed for walking up the bank. We did a standing take-down right then and there. By the time we got to the hospital the pt had pretty bad back pain, can you imagine if we hadn’t put him on the backboard? lawsuit. So go ahead and make fun of the noobs, I’ll take them and teach them.[3]

 

I think that someone should Call the Cops for all of this abuse of the witless, because the giggles just keep on coming.
 

Maybe this is an example of Poe’s law (a legitimate comment from some person who is so blind to their bias that they do not notice the self-parody)?[4],[5]

Maybe, but Tor eckman[6] is a character from Seinfeld. Tor eckman is a ridiculous alternative medicine practitioner, much like our ridiculous EMS providers who do not understand what it means for a treatment to improve outcomes.

Go spend some time reading the comments on social sites and you will see that this might not be satire, but somebody should take credit for it if it is satire – and somebody should be ridiculed for it if it is not satire.

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Footnotes:

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[1] The stupid EMS cliche usage guide – Using phrases like ‘We cheat death’ is so much easier than actually thinking
September 30, 2013
The Ambulance Driver’s Perspective
by Kelly Grayson
EMS1.com
Article

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[2] Kelly Grayson belly flops with cliches, proves he’s a Noob
Happy Medic
October 3, 2013
Article

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[3] Tor eckman’s comment
Kelly Grayson belly flops with cliches, proves he’s a Noob
Happy Medic
October 3, 2013
Comment

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[4] Poe’s law
Wikipedia
Article
 

Without a blatant display of humor, it is impossible to create a parody of extremism or fundamentalism that someone won’t mistake for the real thing.

 

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[5] Poe’s law
Conservapedia
Article

The site’s description of Poe’s law appears to qualify as a parody of extremism or fundamentalism that someone won’t mistake for the real thing. Or is it the real thing that someone will mistake for parody?

Will Andrew Schlafly wait until his mother is dead before he admits that he was just trying to please his mother, just not as violently as Norman Bates? Or is he the real thing that someone will mistake for parody?

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[6] The Heart Attack
Wikipedia
Seinfeld
Article

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Filed Under: Blasphemy, Education, Heresy, Humor

Nobel Peace Prize and President Obama

Sat, 10 Oct 2009 22:17:58 -0400 by
My first thought, on seeing the news that President Obama had won the Nobel Peace Prize, was that SNL (Saturday Night Live) had decided to turn the parody level up to 11. If CNN is going to take SNL seriously, then SNL will make it practically impossible for CNN. There will always be room for CNN to demonstrate greater incompetence, but not much.

I wrote about the commotion about a SNL parody of the ineffectiveness of the President thus far in his rookie year Does CNN have Any Credibility Left? The awarding of the Nobel Peace Prize appears to have been based on the CNN investigative analysis of SNL.

I went to the news source. It seemed legitimate. I checked others. This story is true.

He is the titular head of a country that is involved in 2 declared wars. There is probably more potential for this number of wars to increase, rather than to decrease. Although President Obama did not start these wars, he does not appear to be ending them.

There was the suggestion that the award was rushed to throw support behind the potential for President Obama to produce change. After all, it isn’t as if they could have waited a year, or two, or three, to see if this politician actually accomplishes something more than a world tour. That might give some justification for this award. Should we change the name to the Rookie of the Year Peace Prize – Any novice leader, who has not started a war in the first couple of weeks of office can win.

If he is so inclined, he may nuke Iran. I’ll bet that would make the prize committee proud.

This makes you wonder who else was being considered? The North Korean Elvis impersonator, Kim Jong-il?

Martin Luther King did not just talk about having a dream. Apparently, these days just having the dream is good enough.

President Obama’s number one accomplishment. He became the borrower on the largest sub-prime loan in the history of like forever.

Should we rename this the Sally Field Prize? This is just Europe saying, . . . you’ve wanted more than anything to have our respect. The first time we didn’t feel it, but this time we feel it, and we can’t deny the fact that we like you, right now, we like you! this is like Europe telling President Obama that he has been favorited on Facebook.

A lot of marriages start, because the woman sees potential in the man. A lot of these marriages end in divorce, because the man does not use the potential the way the woman thinks it should be used. Maybe Europe should have asked for a pre-nup.

Maybe it is as some have suggested, the Not George Bush Prize. A prize awarded in the first year of every presidency that immediately follows the second term of a second George Bush. If you think that you have ever won something that had high standards, try winning this one.

President Obama has a lot of potential, but so does Sarah Palin. She might even be able to do something interesting for the talent part of the competition. Maybe it was the beer he shared to help make peace between Henry Louis Gates and James Crowley. That might be foreshadowing the way to peace with the Islamic terrorists. Hey guys. Let’s sit down like a bunch of adults and discuss this over some beer and hot dogs. Yeah. That’s the ticket. A Beer and Hot Dogs Summit.

Maybe the Nobel Peace Prize should have its name changed to the John Winger Prize.

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Filed Under: Heresy, Humor, Politics Tagged With: ,

Does CNN have Any Credibility Left?

Tue, 06 Oct 2009 01:39:52 -0400 by
Apparently, Jon Stewart is now writing material for CNN. The network that I have criticized for their incompetent reporting of medical topics, has decided to branch out into comedy.

Wolf Blitzer, who either has a great poker face, or really believes what he is saying, claims that SNL (Saturday Night Live) has not been completely accurate in their portayal of President Obama. Wait! Let me check my calendar. Maybe I had a Rip van Winkle episode, here. No, I did not sleep until April Fool’s Day, nor is it mischief night. This is just CNN demonstrating that the future of journalism is definitely not on their network.

Next, CNN investigates professional wrestling to see if WWE is as scripted as reality TV.

Jon Stewart did a great job of reporting on the way CNBC covered financial news during the financial crash of a year ago. Jon Stewart had me laughing and had me impressed with his understanding of finance. CNN? Not so much.

This just in – CNN has unearthed an incredible story. Amos ‘n’ Andy were white. They were wearing makeup. Stop the presses!

I should send in a resume. Their hiring standards are incredibly low. I, Hildy Johnson, have experience covering executions. Nah, too obvious.

Just kidding. This is CNN. Nothing is obvious to them.

In the video, there is a guy assessing the accuracy of the facts presented in the comedy skit. He makes a big deal of claiming, that even though everything else is accurate, you can’t tell the difference between Afghanistan and Maybery. I guess, I just misunderstood why George Will was writing that it is Time to Get Out of Afghanistan. I thought that George Will was saying that things are really bad – that we do not have any more chance of winning than the Soviets did a couple of decades ago, or the British over a century ago. Silly me – I was reading. CNN does not appear to be competing for an audience that reads.

Maybe we should ship CNN over to Afghanistan. The jihadists will be laughing so hard at these journalists that they won’t be able to shoot straight.

I wrote about CNN’s medical coverage of a brain dead baby. This was a year and a half ago. They still have not changed the video. I wrote to the station and I wrote to Dr. Sanjay Gupta. You know Ask Dr. Gupta, their medical expert. He is somebody who should be able to look at this and say, That is completely wrong. Change it. After all, Dr. Gupta is a neurosurgeon. For those of you who get your medical information from CNN and might not understand the big word, a neurosurgeon is a brain surgeon.

I am still waiting. The video is still there with the same completely wrong information. Maybe Dr. Gupta is still looking for his medical dictionary.

I almost feel guilty for picking on such obvious idiots. Then I rememeber that they are getting paid for their incompetence. I guess Wolf Blitzer got into journalism, because the basket weaving class was too difficult. If Dr. Gupta is your surgeon, don’t bother writing, Other Side on the part of your head he is not supposed to operate on. That may be too complex. Maybe draw a skull and crossbones. Better yet just run away.

Maybe he did his residency with Mitchell and Webb.

CNN is Selling Snake Oil – All You Have to Do is Believe.

Atomic Nerds take some shots at CNN, as well. LOOK OUT, MR. PRESIDENT! MOCKERY! H/T The Smallest Minority – CNN Fact-Checks SNL.

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Filed Under: Brain-Dead, CNN, Heresy, Humor, Journalism, Politics Tagged With: , , , ,

Slightly More Than A Homeopathic Dose Of Ridicule

Fri, 03 Jul 2009 12:13:34 -0400 by
A&E = Accident and Emergency (In the US it is the ED, or Emergency Department).

I can anticipate the criticism.

Homeopathy’s not that ridiculous.

You are correct.

Homeopathy is more ridiculous than that. These are comedians. They can’t actually kill people to make a point. Homeopathy kills.

You are making a big deal about nothing.

Precisely.

Nobody is suggesting that Homeopathy be used in the ED.

Of course not. It doesn’t work outside of the ED, why would anyone expect it to work in the ED. Even the homeopaths do not expect it to work in the ED.

I never heard of Mitchell and Webb. I guess I’m going to have to check out some more of their stuff. Watch this a few times to pick up on all of the stuff you miss the first time through. The signs are great.

From Respectful Insolence. He has another video over there, too.

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Filed Under: Heresy, Humor Tagged With: ,

Weird Nursing Karaoke – A Beverage Free Zone

Sat, 30 Aug 2008 19:05:00 -0400 by
With my fondness for modifying the words of famous quotes or famous songs, I don’t know how I could have not noticed this Weird Al Yancovic of Emergency Medicine. Tex is an ED nurse. A transplant from Texas to North Carolina, he has a way of expressing himself that is hilarious. Do not consume beverages while watching. If you are expecting the chorus to be the same every time and think it might be safe to take a sip, I warned you.

One of his favorite people in the medical world is Dr. Deborah Peel. Not that she does anything medical – unless you count mass diagnosis and prescription of people she never met. I have written about her several times. He also mentions where a lot of the Deborah Peel stuff all started – WhiteCoatRants. He sings about her below to the tune of Helen Wheels, by Paul McCartney’s band Wings.

He has a lot of YouTubes at texicannc’s Channel. His blog is Weird Nursing Tales – excellent stuff! Hook him up with LawDog singing Dirty Deeds Done Dirt Cheap in a Pink Gorilla Suit and we could solve most of the problems facing law enforcement and medicine.

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By Rogue Medic
Filed Under: Dr. Deborah Peel, Heresy, Humor

Reporters – not just for target practice

Sat, 29 Mar 2008 00:41:00 -0400 by
Suppositories kill deadliest malaria parasites fast

Some headlines just make you smile.

How do they get the suppository in the parasite?

Oh! . . . . Never mind.

Suppositories derived from sweet wormwood kill the deadliest malaria parasites quickly and offer a stop-gap treatment for people in remote areas until they can reach a hospital, researchers said on Friday.

“stop-gap treatment” 🙂

Wormwood is the source of absinthe, which is now legal again – sort of.

It is sad that the understanding of statistics seems to escape most people:

The disease kills a child every 30 seconds

As if they are lined up and taken to an abattoir at a scheduled time.

It should read that: “On average, the disease kills a child every 30 seconds.” This clown is paid to write this poorly, but I did get a giggle out of the unintentional(?) humor.

By Rogue Medic
Filed Under: Heresy, Humor, Math

Public Perception of Pain Management

Sun, 16 Mar 2008 05:15:00 -0400 by

From the movie Juno comes this interesting line about pain management:

Doctors are sadists who like to play God and watch lesser people scream.

This received one of the biggest laughs of the movie. One thing about comedy is that there needs to be some truth for it to be funny – stretched to the extreme, maybe, but some truth to it.

Why do so many people believe this about doctors?

Is there any evidence to support this apparently widespread belief?

There are medical command physicians who seem to approach prehospital pain management from the Nancy Reagan perspective – Just say No!

Why?

Is there any evidence that opioids or sedatives are dangerous in the hands of trained medics?

A study in Prehospital Emergency Care (the journal of the National Association of EMS Physicians, National Association of State EMS Officials, National Association of EMS Educators, and National Association of EMTs) strongly suggested that opioids, at least, are safely used by appropriately trained medics.

Pridemark paramedics have administered IV fentanyl under standing order protocols since November 2001. The Pridemark pain management program is very aggressive and field crews receive regular continuing education related to pain management and procedural sedation. The pain management protocol states that an initial dose of 1-2 µg/kg fentanyl can be administered for pain with repeat doses at 1 µg/kg, titrated as needed. The protocol does not limit dosing intervals or maximum total dosing and the contraindications for administration include known hypersensitivity, hypotension, respiratory depression, and myasthenia gravis. The only standing order limitation during the study period was that fentanyl administration for abdominal pain required base contact.[1]

Absolutely no requirement to contact OLMC (On Line Medical Command), except for permission to treat abdominal pain.

That seems very risky!

How can medics possibly make reasonable decisions about the proper amount of medication to use?

Fentanyl is a very powerful drug. In some emergency departments the emergency physicians are not permitted to use fentanyl, since the anesthesia department has convinced the directors of the hospital that it is only safe in the hands of anesthesiologists. Certainly, there is no bias possible in that determination.

If fentanyl is not safe when used by attending emergency physicians, how can it possibly be safe in the hands of lowly paramedics?

How can simple paramedics safely administer this powerful drug on almost unlimited standing orders?

I wish that I worked as a lawyer in that crazy system – or as a mortician!

Well, let’s skip down to the results and find out the death toll.

Wait – we need to find out more about the patients first.

There were 2,315 patients who received IV fentanyl in the field; 186 patients were excluded because they received other medications such as other narcotics, sedatives, or nitrates (see Methods), thus leaving 2,129 patients who received IV fentanyl alone.

The average total fentanyl administration was 118 µg (standard deviation [SD] = 67), with a range of 5400 µg. Similarly, for the subgroup of patients who had their ED charts reviewed, the average total fentanyl administration was 118 µg (SD = 67),
The average dose was 118 micrograms?[1]

Are they trying to tell us that paramedics are starting with small doses, reassessing patients, and giving further doses only when necessary?

That just reeks of responsibility.

I don’t believe it.

Bring on the dead bodies, the malpractice, the horror!

Of the 2,315 patients who received fentanyl in the field, 66 patients had a vital sign abnormality. Of those 66 patients, three were excluded because they received a sedative in addition to the fentanyl. There were 46 patients who were excluded because their vital sign abnormalities occurred before the administration of fentanyl.[1]

66 vital sign abnormalities! Almost 3%. That sounds like something to worry about.

Of the 46 patients who had a vital sign abnormality before the administration of fentanyl, 38 patients’ vital signs improved after the administration of fentanyl, eight patients’ vital signs remained the same, and none worsened.[1]

I guess we can’t really blame the fentanyl for the problems if they happened before the fentanyl, but almost all of them improved after the fentanyl – and none of them got worse.

The medicine helped the patient, that is an interesting concept.

Bring on the less than 1% of problems left.

There have to be some serious problems and a few cadavers in there!

The retrospective chart review of 2,129 patients who were administered fentanyl citrate in the field for pain management revealed that only six patients (0.3%) had a field vital sign abnormality possibly attributed to the narcotic administration. No patients required a reversal or recovery intervention during transport.[1]

No problems outside of the hospital?

Just wait, in the hospital they will have problems!

Of the subgroup of 611 patients who had their ED charts reviewed,[1]

They only reviewed 611 ED charts out of 2,129 field administrations that were reviewed.

They must have been trying to cover something up!

Review of all 2,129 ED charts, instead of only the charts of those patients transported to a single facility, might have revealed more patients with complications. However, the sample subgroup was necessary because 2,129 patients were transported to 19 different hospitals and would have required IRB and HIPAA clearance from 19 individual facilities.[1]

Gosh, that makes sense, out of 19 hospitals they chose one that received 29% of the patients.

A nice busy hospital. They won’t put up with any of this EMS mayhem.

Let’s go back and see the carnage that must have overwhelmed the hospital!

Of the subgroup of 611 patients who had their ED charts reviewed, only seven patients (1.1%) had a vital sign abnormality that could be attributed to the field narcotic administration. The higher rate of vital sign abnormalities in the ED (1.1%) compared with the field rate (0.3%) was anticipated given the short transport times compared with the drug’s duration of action. Only one patient (0.2%) required a reversal intervention in the ED.[1]

Now we are getting some place! A victim!

That patient was an 81-year-old woman with a possible hip fracture who received two doses of 100 µg of fentanyl and developed respiratory depression, which prompted the administration of 0.4 mg of naloxone with an immediate reversal of the adverse effect.[1]

Well, maybe somebody died later – or had other serious complications!

No patient required admission for any complications of pain management, and there were no deaths. These findings demonstrate that fentanyl administration in the field is a safe method for pain management.[1]

But what about the scare tactics that are regularly employed to discourage us from using pain medicines?

Hah! I know what they missed.

They used so little that it didn’t cause any problems, but it also didn’t provide any benefit to the patients.

Where’s the benefit?

The pre-and post-pain-management verbal rating scale scores for all patients who received fentanyl were also evaluated. These data showed evidence of a statistically significant change in verbal rating scale scores after pain management. Clinically, this illustrates an improvement in pain from a categorization of severe to mild and thus supports the effectiveness of fentanyl administration.[1]

From severe pain to mild pain.

What more could you ask for?

Now that we have looked at the results it looks as if they behaved responsibly.

I would even say that they make a good case that it could be copied elsewhere.

Perhaps everywhere.

Why pretend that this study is too small to provide meaningful data; or that the methods were so limited that the results are irrelevant; or that this means it is OK, but only with tight OLMC requirements?

What this really tells us is that not only is there no good reason to limit standing orders (maybe for abdominal pain, which required OLMC in this study), but that there is a significant difference that can be made in patient care.

Why do we have medics treating patients with unsupportable limitations on what they can do without OLMC permission?

If the medics are not capable of providing this level of care, why does the medical director allow such dangerous medics to treat patients?

Why are we denying appropriate care to patients?

Why are we providing less-than-adequate care to patients?

There is no good reason.

Footnote:

[1] Safety and effectiveness of fentanyl administration for prehospital pain management.
Kanowitz A, Dunn TM, Kanowitz EM, Dunn WW, Vanbuskirk K.
Prehosp Emerg Care. 2006 Jan-Mar;10(1):1-7.
PMID: 16418084 [PubMed – indexed for MEDLINE]

I also write about pain maqnagement here:

Pain Management – What is too much?

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By Rogue Medic
Filed Under: Ethics, Fentanyl, Heresy, Humor, Morphine, OLMC Requirements, Opioid, Pain Management, Physician Oversight, Research, Sedation

Bizzaro Ambulance Driver?

Fri, 14 Mar 2008 17:04:00 -0400 by
What has happened to Ambulance Driver? Clearly, his post claiming that the Virginia Tech shooting is humorous is just the beginning of a long spiral to Risperdal-dom.

How can he find humor in something that was so painful for the families of those shot?

Let’s read this bit of comedy straight from the horse’s keyboard:

I just noticed on the program that one of the speakers will be James Hyatt, Executive Vice President and C.O.O. of Virginia Tech University.

The title of his presentation? Campus Security and Emergency Preparedness.

The program doesn’t say whether it’s supposed to be informative or humorous, but in any case, it oughta be a short lecture.

Hmm. I’m missing something here.

Where is the inappropriate humor at the expense of the victims?

Where is the lack of compassion?

Where is the Bizzaro Ambulance Driver?

The shooting was a tragedy. Nobody, and certainly not AD, has suggested otherwise. The suggestion of humor appears to be only related to the choice of speaker. Is he the closing ceremony speaker? I could not find information on line about this conference, so I don’t know.

It does make you wonder what they were thinking when inviting the “Executive Vice President and C.O.O. of Virginia Tech University” to speak about this.

With an EMS conference you want to make the topics relevant to EMS. How does this speaker relate to EMS? I don’t think many executive vice presidents and chief operating officers of EMS companies relate to EMS – and that’s part of their job.

If there is a desire to hear about the incident, then the local EMS personnel, those who were in various incident command positions, or dispatchers commenting on dealing with the confusion would be worth listening to.

If this were a conference of school administrators, then Mr. Hyatt might be an appropriate speaker. It isn’t, or has AD been telling us lies about where he is going? Is he leaving EMS for the exciting life of university administration?

Mr. Hyatt may have something worthwhile to say, but in my opinion, the bad taste is that Mr. Hyatt was invited to speak on this topic. I may be wrong. I hope AD has the opportunity to stay long enough to listen to Mr. Hyatt’s speech. It should give him material for a third post that can answer a lot of questions.

No, AD has not lost it.

Perhaps, instead, I should write:

Yes, Virginia, there is an Ambulance Driver.

Although with the success of his diet he is going to have to use pillows to dress up as Santa from now on (or as Barney).

By Rogue Medic
Filed Under: Ambulance Driver, Heresy, Humor, Virginia Tech