We are there for the good of the patient, not for the good of the protocol, not for the good of the medical director, and not for the good of the company.

- Rogue Medic

Is ‘Narcan by Everyone’ a Good Idea?


Image credit.
 

My friend Jonathan Blatman asks the following question about naloxone (Narcan) on Facebook –
 

I’ve heard that PA (Pennsylvania) is looking to follow down the “Narcan for everyone” route, in allowing PD and BLS folks to give intranasal naloxone.[1]

 

The problem is not that basic EMTs, or first responders, or police are stupid people.

The problem is that all people are stupid people.

Doctors, nurses, and paramedics do not understand naloxone, so we need to improve the understanding of pharmacology among doctors, nurses, and paramedics, before we increase the ranks of ignorant people inappropriately administering the drug.

Naloxone itself is very safe.

A quack once challenged me to take 1,000 times the dose of any medicine I chose, while he would do the same with some natural product. I accepted and chose naloxone, with the condition that he first take 1,000 time the daily recommended dose of one of something he considered completely safe and natural – water.

The quack had it pointed out to him that this dose of all natural water would be deadly. The quack backed out. Whether naloxone’s standard dose is 0.4 mg (it should not be more than this) or the dose more popular in areas with frequent fentanyl overdoses (2.0 mg) does not matter. Naloxone has been demonstrated to be relatively safe at massive doses.
 

Adult Patients
In one small study, volunteers who received 24 mg/70 kg did not demonstrate toxicity.
In another study, 36 patients with acute stroke received a loading dose of 4 mg/kg (10 mg/m2/min) of naloxone hydrochloride injection followed immediately by 2 mg/kg/hr for 24 hours. Twenty-three patients experienced adverse events associated with naloxone use, and naloxone was discontinued in seven patients because of adverse effects. The most serious adverse events were: seizures (2 patients), severe hypertension (1), and hypotension and/or bradycardia (3).
[2]

 

400 mg (0.4 mg dose x 1,000) or 2,000 mg (2.0 mg x 1,000) would be higher than the doses tested in these patients, but would still be much safer than 1,000 times the recommended daily dose of water, even though water is safe and essential for life. It does not matter if there is fluoride in the water for it to be lethal, but we should fluoridate water, because only conspiracy theorists think that fluoride is dangerous in drinking water.
 


Download YouTube Video | YouTube to MP3: Vixy | Replay Media Catcher
 

We engage in magical thinking about the drugs we give.

The problem is not with the drug. The problem is with the actions of the people giving the drug – us.

We still have a big push for giving fibrinolytics (tPA – tissue Plasminogen Activator) to patients with acute ischemic stroke, even though most of the improvement may be due to the transience of stroke symptoms in some stroke patients (TIS – Transient Ischemic Attack). Fibrinolytics do not appear to be beneficial for acute ischemic stroke and there is no reason to give them for a TIA.

There is weak beneficial evidence in only two out of eleven studies (only 18% of studies) – and increases in death in most studies of fibrinolytics for acute ischemic stroke.[3] The problem is not with the drug. The problem is with the actions of the people giving the drug. Most of the evidence shows death increased, but we ignore that.

Naloxone and tPA are both given based on a rush to treatment and a fear of not giving the standard of care – the Yuppie Nuremberg Defense.
 

Everyone’s got a mortgage to pay. [inner monologue] The Yuppie Nuremberg defense.[4]

 

Will this be a matter of providing naloxone, rather than providing ventilations?
 

An epidemic of naloxone-resistant heroin overdoses due to fentanyl adulteration has led to significant morbidity and mortality throughout the central and eastern United States. According to records of the Philadelphia County Medical Examiner’s office, at least 250 overdose deaths have been associated with fentanyl between April 1, 2006, and March 1, 2007.[5]

 

What about people who take more than one drug?

If the opioid is reversed, will there be problems?
 

All were initially lethargic and became agitated and combative after emergency medical service (EMS) personnel treated them with parenteral naloxone, which is routinely used for suspected heroin overdose to reverse the toxic effects of opioids (e.g., coma and respiratory depression). All patients received diazepam or lorazepam for sedation, and signs and symptoms resolved during the next 12-24 hours.[6]

 

Will we identify the patients who have other medical conditions that may respond after naloxone, but not because of naloxone, such as hypoglycemia, stroke, seizures, clonidine overdose, arrhythmia, head trauma, dehydration, syncope, et cetera?
 

Six of the 25 complete responders to naloxone (24%) ultimately were proven to have had false-positive responses, as they were not ultimately given a diagnosis of opiate overdose. In four of these patients, the acute episode of AMS was related to a seizure, whereas in two, it was due to head trauma; in none of these cases did the ultimate diagnosis include opiates or any other class of drug overdose (which might have responded directly to naloxone). Thus, what was apparently misinterpreted as a response to naloxone in these cases appears in retrospect to have been due to the natural lightening that occurs with time during the postictal period or after head trauma.[7]

 

The problem is not with the administration of naloxone, but with the faulty assumption that because a patient wakes up after naloxone, the patient woke up because of naloxone.

Doctors, nurses, and paramedics do not do a good job of identifying the difference currently. We need to educate them, rather than encourage others to replicate their mistakes.

Pharmacology is poorly understood by people with medical education.
 

The documented indication for nebulized naloxone administration was suspected opioid overdose in 70 patients (66.7%), altered mental status in 34 patients (32.3%), and respiratory depression in one patient (0.9%).[8]

 

The indication for naloxone is respiratory depression.

The treatment for respiratory depression is to supplement oxygen and/or ventilations. We have decided to give naloxone in stead.

Naloxone was used appropriately in fewer than 1% of patients.

How good bad will our naloxone by everyone education be?

Don’t wait with bated breath – someone my administer naloxone.
 

Also read –

Should Basic EMTs Give Naloxone (Narcan)?

The Myth that Narcan Reverses Cardiac Arrest

To Narcan or not Narcan

What About Nebulized Naloxone (Narcan) – Part I

Footnotes:

[1] I’ve heard that PA is looking to follow down the “Narcan for everyone” route, in allowing PD and BLS folks to give intranasal naloxone. . . .
Facebook
Narcan post

[2] NALOXONE HYDROCHLORIDE injection, solution
[Hospira, Inc.]

DailyMed
Adverse reactions
Overdosage
FDA Label

[3] The Guideline, The Science, and The Gap
Wednesday, April 17, 2013
Dr. David Newman
Smart EM
Article

[4] Thank You for Smoking
Movie, based on the book by Christopher Buckley
Wikiquote
Quote page

[5] Heroin: what’s in the mix?
Muller AA, Osterhoudt KC, Wingert W.
Ann Emerg Med. 2007 Sep;50(3):352-3.
PMID: 17709054 [PubMed - indexed for MEDLINE]

[6] Scopolamine Poisoning among Heroin Users — New York City, Newark, Philadelphia, and Baltimore, 1995 and 1996
MMWR (Morbidity and Mortality Weekly Report).
Vol 45, No 22;457;
Free Full Text from the Centers for Disease Control and prevention.

[7] The empiric use of naloxone in patients with altered mental status: a reappraisal.
Hoffman JR, Schriger DL, Luo JS.
Ann Emerg Med. 1991 Mar;20(3):246-52.
PMID: 1996818 [PubMed - indexed for MEDLINE]

[8] Can nebulized naloxone be used safely and effectively by emergency medical services for suspected opioid overdose?
Weber JM, Tataris KL, Hoffman JD, Aks SE, Mycyk MB.
Prehosp Emerg Care. 2012 Apr-Jun;16(2):289-92. doi: 10.3109/10903127.2011.640763. Epub 2011 Dec 22.
PMID: 22191727 [PubMed - indexed for MEDLINE]

.

Dispatch – Activate Our Honeybee Swarm Removal Plan


 

Delaware does have a honeybee swarm removal plan. Up until this week, the plan was probably used more as a punchline for jokes than anything else. The plan was created in 1995, but Yesterday was its first use.

Why have a honeybee swarm removal plan?

If you are dealing with a swarm of bees, your ability to solve problems may not be that good.

Who ya gonna call?

Dispatch.

Whom will dispatch call?

Probably someone who does not know what to do. Unfortunately, that person – the one who does not know what to do – probably will suggest something. Well, I’m not 100% certain, but . . . . This is when you should just disconnect the line, because not 100% certain means I haven’t the slightest idea, but my ego won’t let me admit the truth out loud. This is the equivalent of the guy with a beer in one hand, doing something reckless, and saying, Watch this!

More dangerous than the guy who is not 100% certain is the person who takes advice from him. Maybe pouring gasoline all over the highway and setting it on fire will control the bees, but I would rather get that information from someone who is familiar with bees and can tell me of a specific instance when it has worked, how this scene is the same/different, and how I can get further information about it. Anecdotes can be very dangerous. Experts citing anecdotes may not be any better than the guy who is not 100% certain.

As it turns out, Kill it with fire was not a part of the honeybee swarm removal plan.

What is needed for a plan like this?

A list of several emergency contacts and numbers where they can be reached at night, on the weekends, and during holidays.

Descriptions of how to deal with the variations of the emergency that can be anticipated.

Contact numbers for people outside of the area, who would be needed in the event of a very large disaster of this kind.

Recommendations for first responders who are probably already in the middle of things when the plan is initiated.

Tuesday, a truck carrying bees overturned on I-95. Bees can be a problem. Drivers may not respond to emergencies the way we would like. A swarm of bees may lead people to panic.

How many bees?

16 to 20 million bees.

Am I going to be able to give an accurate estimate of 20,000 bees, 200,000 bees, 2,000,000 bees, or 20,000,000 bees?
 


 

First responder – Dispatch, we appear to have a bit of a bee problem. Do we have some sort of disaster plan?

Dispatch – Today is your lucky day. We do have a bee swarm plan.
 

The plan, which was updated in March, involves a response network of beekeepers statewide. Three beekeepers from New Castle County responded to the scene after Tuesday’s accident. The initial response including using fire hoses to tamp down the swarms.[1]

 

This worked well, but having a plan does not guarantee any kind of success. Reality does not come with guarantees, so having people who understand how to adapt to change is important.

No plan survives the first contact intact, but well prepared people produce their own luck.

What number do people call when things go wrong? 911. We deal with what happens when it is worse than expected. We should have some sort of plan, even if only cursory, for the things that cause us to call for help. Rare things happen rarely, but they do happen.

Footnotes:

[1] Delaware motorists warned to watch out for bees
By Associated Press
Published: May 20
Updated: Wednesday, May 21, 1:46 PM
Washington Post
Article

.

Up To, and Including, DEATH – The Anguish of Happy Medic


 

Happy Medic explains that in reviewing refusal of transport charts, he comes across this magical invocation repeatedly.
 

This is a phrase I see a lot in my line of work. There are a number of variations including another favorite “seizure, coma, death” that are designed to cover the hind quarters of the author in some half cracked attempt at documentation.[1]

 

Even Sylvester Stallone correctly ridicules seizure, coma, death reasoning, so evil it must only be be spoken of in the most reverent terms.
 


Download YouTube Video | YouTube to MP3: Vixy | Replay Media Catcher
 

Happy Medic has a question for those who use either murder, death, kill seizure, coma, death or Up To, and Including, DEATH as a part of their documentation of a refusal for minor injuries.

I confess that I was trained to do this and it took me a while to realize how ridiculous it is.
 

Funny part is that this blanket statement calls into question the rest of your document most times. Do you really believe the hand abrasion will lead to death? In what fashion? If it is such a risk, why isn’t the patient being transported?[1]

 

Please, explain how this laceration will lead to death.

This must be a death that would be prevented by immediately taking a magical trip to the ED (Emergency Department) by our magic carpet ambulance.

In the ED, they are able to use stronger spells than seizure, coma, death. :oops:

What we are trying to state is I am not responsible.

This seems to be the motto of the least competent in EMS.

If I follow the protocol, I am not responsible for the harm I cause the patient.

If I follow medical command orders, I am not responsible for the harm I cause the patient.

If I follow orders, I am not responsible for the harm I cause.

Is that really what we aspire to?

If people enter EMS with this attitude, we should do our best to get rid of this attitude.

If people enter EMS without this attitude, we should do our best to get rid of those of us encouraging this attitude.

EMS is not magic. We are not magicians, sorcerers’ apprentices, or flying monkeys.

We are pretending that magic is a solution to ignorance and/or incompetence.

The I am not responsible attitude is dangerous to us and dangerous to our patients.

Please stop being dangerous.
 

Go read Happy Medic’s solution to this magical incantation.

Footnotes:

[1] Up To, and Including, DEATH
Jan 23, 2014
Happy Medic
Article

.

What Can EMS Expect From 2014? #1 Ketamine Again


 

What changes need to be made in 2014, if they have not already been made?

Ketamine – for those of you who already have ketamine, great work. Continue to improve patient care. Do not let the rest of us slow you down.

Excited delirium – ketamine is the fastest way to sedate a violent patient.

Pain management – ketamine dissociates without respiratory depression.

RSI (Rapid Sequence Induction/Intubation) – ketamine dissociates without respiratory depression.

Asthma – ketamine opens the airway.

Awake intubation – ketamine dissociates without respiratory depression.

Sedation for extrication – ketamine dissociates without respiratory depression.

Seizures- ketamine stops seizures.
 

Safety – ketamine is safe.
 

Ketamine has a wide margin of safety; several instances of unintentional administration of overdoses of ketamine (up to ten times that usually required) have been followed by prolonged but complete recovery.[1]

 

Is any other sedative that safe?
 

Here are some podcasts to explain in more detail.

Dr. Mel Herbert on ketamine.
Ketamine Update.
Free mp3 Download From Free Emergency Medicine Talks

Dr. Baruch Krauss on ketamine.
Ketamine in the Emergency Department.
Free mp3 Download From Free Emergency Medicine Talks

Dr. Sergey Motov on ketamine.
Ketamine for Everything.
Free mp3 Download From Free Emergency Medicine Talks

Dr. Scott Weingart on ketamine.
Podcast 104 – Laryngoscope as a Murder Weapon Series – Hemodynamic Kills
Page with a link to the free mp3 download, but watch the video first – it is excellent.

More from Dr. Weingart.
EMCrit Podcast 40 – Delayed Sequence Intubation (DSI)
Free mp3 DownloadFrom EMCrit.

Dr. Jim DuCanto on ketamine.
Podcast 73 – Airway Tips and Tricks with Jim DuCanto, MD
Page with a link to the free mp3 download, but watch the video first – it is excellent.

Dr. Minh LeCong on ketamine myths –

PHARM Podcast 75 Ketamine MythBusters
Part 1 – Blowing your mind

PHARM Podcast 76 Ketamine MythBusters
Part 2 – Take the pressure down

PHARM Podcast 77 Ketamine MythBusters
Part 3 – Are you mad enough?

PHARM Podcast 78 Ketamine MythBusters
Part 4 – A fitting end?

 

Would you prefer to have something to read about ketamine?
 

 

Dr. Reuben Strayer on ketamine.

The Ketamine Brain Continuum
December 25th, 2013
by reuben in PSA & analgesia
Article

Awake Intubation: A Very Brief Guide
July 7th, 2013
by reuben in airway
Article

Ketamine as a suicidality reversal agent
June 4th, 2011
by reuben in psychiatry
Article

Taming the Ketamine Tiger
January 27th, 2011
by reuben in PSA & analgesia
Article

Ketamine for RSI in Head Injury
April 3rd, 2010
by reuben in .trauma-general, .trauma-head & face, airway
Article

Another reason to use ketamine for RSI in sepsis
November 24th, 2009
by reuben in airway
Article
 

Is there any good reason to not be using ketamine in EMS?

Footnotes:

[1] Ketamine Hydrochloride (ketamine hydrochloride) Injection, Solution, Concentrate
[Bedford Laboratories]

FDA Label
DailyMed
Label

.

Should Basic EMTs Give Naloxone (Narcan)?

 
Should basic EMTs be giving naloxone (Narcan) when paramedics do not really understand the drug?

If a patient wakes up after naloxone, does that mean the patient had a drug overdose?

No – but most paramedics do not understand that.[1]

As of January 1, 2014, there will be even more people giving Narcan with little understanding of what they are doing.
 


Peter Thomson.
 

La Crosse firefighters soon could start carrying a life-saving drug for heroin users. The department is applying to be one of the state’s first groups of emergency medical technicians to administer Narcan, the antidote to an opiate overdose.[2]

 

Does naloxone save lives or just make it less work for first responders?

If the basic EMTs are not good at basic ventilation, will they be any better at drug administration?

Are drugs the cure for ventilation problems?
 

The department has witnessed a 53 percent jump in the number of potential drug overdoses since 2009, Chief Gregg Cleveland said.

In 2012, firefighters responded to 98 potential overdoses and 86 so far this year.[1]

 

A 53% increase?

98 last year.

86 so far this year (as of October).

10 months in, so an average of 8.6 per month = 103.2 for the whole year.

Going from 98 to 103 is not a 53% increase.

It isn’t even a 5.3% increase, but only 5.1%
 

Only 5% – not 53%.
 

Bad math.

Correction (13:00 12/28/2013) – the math is not based on the numbers in the article and I did not read the article correctly. The bad math is mine, not Chief Gregg Cleveland’s. Thank you to Christopher Jennison, Jordan L, and Parastocles for pointing out my error.

I apologize to Chief Gregg Cleveland for misrepresenting his statement as bad math, when it was my mistake.
 

Bad decisions.

What kind of time would be saved by having the fire department give naloxone?

What kind of bad outcomes would be prevented?

What kind of better outcomes would be expected?

What is the added cost of implementing this program?

What other programs would be deprived of this money?

Those are just some of the questions that should be asked.

The main question is –

If your fire department is doing such a bad job of managing BLS skills (BVM, positioning, painful stimulus, . . . ), why should we allow you to harm patients with ALS skills?

If your department is not harming patients, then where is the need?

Naloxone does not appear to be the answer to either problem.

Will naloxone cure the math problems of these drug pushing managers?

Footnotes:

[1] Acute heroin overdose.
Sporer KA.
Ann Intern Med. 1999 Apr 6;130(7):584-90. Review.
PMID: 10189329 [PubMed - indexed for MEDLINE]
 

Six of the 25 complete responders to naloxone (24%) ultimately were proven to have had false-positive responses, as they were not ultimately given a diagnosis of opiate overdose. In four of these patients, the acute episode of AMS was related to a seizure, whereas in two, it was due to head trauma; in none of these cases did the ultimate diagnosis include opiates or any other class of drug overdose (which might have responded directly to naloxone). Thus, what was apparently misinterpreted as a response to naloxone in these cases appears in retrospect to have been due to the natural lightening that occurs with time during the postictal period or after head trauma.

[2] Firefighters could be getting medication to save drug users
October 31, 2013 12:00 am
By Anne Jungen
ajungen@lacrossetribune.com
LaCrosse Tribune
Article

.

A Recalled AED is Better Than No AED


 
Cardiac arrest. CPR in progress. Do not use the AED, because it has been recalled!

Wrong.
 


 

HeartStart automated external defibrillators from Philips Healthcare have been recalled.

What does the FDA (Food and Drug Administration) mean by recall?

Well, why was the recall issued?
 

Certain HeartStart automated external defibrillator (AED) devices made by Philips Medical Systems, a division of Philips Healthcare, may be unable to deliver needed defibrillator shock in a cardiac emergency situation, the U.S. Food and Drug Administration said today in a new safety communication for users of these previously recalled devices.[1]

 

A shock might not be delivered.

What does the FDA recommend?
 

“The FDA advises keeping all recalled HeartStart AEDs in service until you obtain a replacement from Philips Healthcare or another AED manufacturer, even if the device indicates it has detected an error during a self-test,” said Steve Silverman, director of the Office of Compliance in the FDA’s Center for Devices and Radiological Health.[1]

 

Do not take these AEDs out of service service until a replacement is present.

Why?

What about the lawyers?

But it’s defective!

Thinking is dangerous!
 

“Despite current manufacturing and performance problems, the FDA considers the benefits of attempting to use an AED in a cardiac arrest emergency greater than the risk of not attempting to use the defibrillator.”[1]

 

The benefit is greater than the risk.

There is risk with everything.

Anyone who tells you otherwise is selling something.

There is not benefit with everything.

Since the detection of an error during the self-test does not guarantee that the AED will not deliver a shock when needed, removing the AED without a replacement is more dangerous than leaving the AED in service.

These recalled AEDs are better than no AED.
 

Of course, if needed for use in an emergency, make every attempt to clear the error and use the device normally, as described in the Owner’s Manual.[2]

 

The manufacturer and the FDA agree that, in the case of these AEDs, something is better than nothing.

Are we really going to make a dead patient more dead by using a defective AED?

Footnotes:

[1] FDA issues safety communication on HeartStart automated external defibrillators from Philips Healthcare
FDA News Release
For Immediate Release: Dec. 3, 2013
Media Inquiries: Jennifer Rodriguez, 301-796-8232, jennifer.rodriguez@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA
News Release

[2] Philips HeartStart FRx and OnSite (HS1) automated external defibrillators (AEDs)
Phillips Healthcare
Maintenance Advisory

.

My Response to A Discussion on Evidence from EMS Expo

 

Last week I wrote A Discussion on Evidence from EMS Expo about one of the conversations that I had at EMS Expo about evidence and patient care.

What were the conditions for the treatment being discussed?
 

Everybody knows the treatment works.

If the treatment is not used, the patient dies.

If the treatment is used, the patient lives.

We should ignore demands for evidence, because evidence-based medicine does not exist in this primitive culture.

Who are we to question the ways of this culture?

Isn’t it arrogant to try to impose our values on this culture?

It works for them, so shouldn’t we accept that?

 

The primitive culture being discussed was not EMS, but everything about the discussion does apply to the primitive culture of EMS.

We are Emergency Medical Shamans.
 


Original source of edited image.
 

We choose to ignore evidence and use magic rituals that do not work.

We use these magic rituals to harm patients.

We claim that these magic rituals are so beneficial that we should not deprive patients of the magic, because that would be dangerous.

We insist that intubation saves lives and claim that evidence of improved survival should not be obtained, because it would deprive patients of the standard of care harm by EMS. Too many people would be harmed by not receiving the standard of care.

We insist that spinal immobilization saves lives and protects spines and claim that evidence of improved survival should not be obtained, because it would deprive patients of the standard of care harm by EMS. Too many people would be harmed by not receiving the standard of care.

We insist that ventilation in cardiac arrest saves lives and claim that evidence of improved survival should not be obtained, because it would deprive patients of the standard of care harm by EMS. Too many people would be harmed by not receiving the standard of care.

We insist that epinephrine in cardiac arrest saves lives and claim that evidence of improved survival should not be obtained, because it would deprive patients of the standard of care harm by EMS. Too many people would be harmed by not receiving the standard of care.

We insist that IV fluid for uncontrolled hemorrhage saves lives and claim that evidence of improved survival should not be obtained, because it would deprive patients of the standard of care harm by EMS. Too many people would be harmed by not receiving the standard of care.

If the treatment is not used, the patient dies.

If the treatment is used, the patient lives.

Ask for the evidence and the absence of evidence becomes Everybody knows that . . .
 


 

Why do we believe the people who tell those EMS lies?

We are reckless and refuse to look at the evidence that shows how dangerous we are.

We are primitives who pretend that science does not work, because science does not support our biases.

When will we stop killing our patients with this ignorance?

.

EMS Witch Doctors at Work

 


John J. Jankowski Jr./Special to The News Journal[1]
 

Is it really fair to place all of the blame on the people walking patients to the magic backboards?

They are probably doing what their medical directors and quality control departments tell them must be done.
 


John J. Jankowski Jr./Special to The News Journal[1]
 

However, why are medical directors encouraging this charlatanism?

Why is quality control discouraging quality patient care?

Is there any evidence that anyone walking will benefit from laying on a backboard?
 


John J. Jankowski Jr./Special to The News Journal[1]
 

This is a legitimate question. If someone has good evidence that placing a walking patient on a backboard has improved the patient’s outcome, please produce that evidence.
 

Even the ACS COT (American College of Surgeons Committee On Trauma) does not recommend a backboard for patients walking on scene. The ACS COT are the authors of the PHTLS (PreHospital Trauma Life Support) guidelines.

The NAEMSP (National Association of EMS Physicians) does not require a backboard for patients walking on scene.
 

Spinal precautions can be maintained by application of a rigid cervical collar and securing the patient firmly to the EMS stretcher, and may be most appropriate for:

  • Patients who are found to be ambulatory at the scene
  • Patients who must be transported for a protracted time, particularly prior to interfacility transfer
  • Patients for whom a backboard is not otherwise indicated[2]

 

A collar and no board appears to be the standard of care.
 

What kind of defense will work if there is disability to a patient when they were walking on scene before being placed on this backboard that is clearly not recommended?

Something like –

We really really believe in witchcraft!!!11!!!

Annie was walking before we put her on the board, but now she can’t walk.

Is there any reason to believe that does not happen?

should we expect the ACS COT and/or the NAEMSP to defend this use of witchcraft?

Here is what the ACS COT and NAEMSP write about not putting walking patients on backboards –
 

This is the official position of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma regarding emergency medical services spinal precautions and the use of the long backboard.[2]

 

When the experts eliminate some witchcraft, should we continue that witchcraft?

When the experts admit that they were wrong, should we continue doing things the wrong way?

Are we here to try to protect our reputations or to try to protect our patients?

Is EMS a profession with ethical standards?

Are we capable of learning to be better?

Footnotes:

[1] DART bus crash
delawareonline
John J. Jankowski Jr./Special to The News Journal
Article

[2] EMS spinal precautions and the use of the long backboard.
[No authors listed]
Prehosp Emerg Care. 2013 Jul-Sep;17(3):392-3. doi: 10.3109/10903127.2013.773115. Epub 2013 Mar 4.
PMID: 23458580 [PubMed - in process]

Free Full Text in PDF Download format from NAEMSP.

.