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

- Rogue Medic

Cardiac arrest victim Trudy Jones ‘given placebo’ – rather than experimental epinephrine

Mon, 26 Mar 2018 08:20:13 -0400 by
 

As part of a study to find out if epinephrine (adrenaline in Commonwealth countries) is safe to use in cardiac arrest, a patient was treated with a placebo, rather than the inadequately tested drug. Some people are upset that the patient did not receive the drug they know nothing about.[1]

The critics are trying to make sure that we never learn.

We need to find out how much harm epinephrine causes, rather than make assumptions based on prejudices.

When used in cardiac arrest, does epinephrine produce a pulse more often?

Yes.

When used in cardiac arrest, does epinephrine produce a good outcome more often?

We don’t know.

In over half a century of use in cardiac arrest, we have not bothered to find out.
 


 

We did try to find out one time, but the media and politicians stopped it.[2]

We would rather harm patients with unreasonable hope, than find out how much harm we are causing to patients.

We would rather continue to be part of a huge, uncontrolled, unapproved, undeclared, undocumented, unethical experiment, than find out what works.

Have we given informed consent to that kind of experimentation?

Ignorance is bliss.

The good news is that the enrollment of patients has finished, so the media and politicians will not be able to prevent us from learning the little that we will be able to learn from this research.[3]

Will the results tell us which patients are harmed by epinephrine?

Probably not – that will require a willingness to admit the limits of what we learn and more research.

What EMS treatments have been demonstrated to improve outcomes from cardiac arrest?

1. High quality chest compressions.
2. Defibrillation, when indicated.

Nothing else.

All other treatments, when tested, have failed to be better than nothing (placebo).

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Footnotes:

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[1] Cardiac arrest victim Trudy Jones ‘given placebo’
BBC News
23 March 2018
Article

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

Free Full Text PDF Download from semanticscholar.org
 

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

 

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

 

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[3] Paramedic2 – The Adrenaline Trial
Warwick Medical School
Trial Updates
 

Trial Update – 19 February 2018:
PARAMEDIC2 has finished recruitment and we are therefore no longer issuing ‘No Study’ bracelets. The data collected from the trial is in the process of being analysed and we expect to publish the results in 2018. Once the results have been published, a summary will be provided on the trial website.

 

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Edited 12-27-2018 to correct link to pdf of Jacobs study in footnote 2.

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Filed Under: 'Alternative' Medicine, ACLS, Cardiac Arrest, Cardiology, Correction, CPR, Critical Judgment, Ethics, Evidence, Journalism, Pharmacology, Placebo, Research, Risk Management, Science

If your Versed (midazolam) isn’t working, maybe it’s Zofran (ondansetron)

Fri, 03 Nov 2017 20:00:51 -0400 by
 
If you were giving a lot more midazolam (Versed) by intramuscular injection to stop a seizure and the seizure just would not stop, or got worse, maybe you were giving ondansetron (Zofran).

If you were giving a lot more midazolam by injection to sedate a patient and the sedation just wasn’t having its usual effect, maybe you were giving ondansetron. While rare, there can be very serious side effects from too much ondansetron.
 

Dose-dependent serious cardiac arrhythmias may be observed with higher dosages of ondansetron in those patients with certain pre-existing cardiac conditions. Patients may also be at risk for serotonin syndrome. Serotonin syndrome is associated with increased serotonergic activity in the central nervous system. Most reports of serotonin syndrome have been associated with concomitant use of certain drugs, some commonly used during surgery, such as fentanyl. Some of the reported cases of serotonin syndrome were fatal.[1]

 

How do you recognize serotonin syndrome?
 

Serotonin syndrome (SS) is a group of symptoms that may occur following use of certain serotonergic medications or drugs. [1] The degree of symptoms can range from mild to severe.[2] Symptoms include high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhea.[1][2] Body temperature can increase to greater than 41.1 °C (106.0 °F).[2] Complications may include seizures and extensive muscle breakdown.[2] [2]

 

2 mg of midazolam is much too low a dose to try to stop a seizure, unless it is the only packaging you have and you are giving 5 intramuscular injections at a time. The best response to prehospital treatment of seizures was by giving 10 mg of intramuscular midazolam to adults (over 40 kg) and 5 mg of intramuscular midazolam to children (under 40 kg).

Maybe you think that is too much midazolam. The highest quality and largest pre-hospital study does not support using lower doses.
 

Our data are consistent with the finding that endotracheal intubation is more commonly a sequela of continued seizures than it is an adverse effect of sedation from benzodiazepines.11 [3]

 

There are other uses for midazolam, so you should be aware of the possibility that what you think is midazolam is really ondansetron.

Are the syringes labeled incorrectly for the contents?
 

Fresenius Kabi USA is voluntarily recalling Lot 6400048 of Midazolam Injection, USP, 2 mg/2 mL packaged in a 2 mL prefilled single-use glass syringe to the hospital/user level. The product mislabeled as Midazolam Injection,
USP, 2 mg/2 mL contains syringes containing and labeled as Ondansetron Injection, USP, 4 mg/2 mL.[1]

 

Based on that, the syringes should be correctly labeled as ondansetron, but they are in blister packs labeled as containing midazolam or they are in boxes of blister packs listed as containing midazolam or both or something else.

If you use this packaging of midazolam, check the lot number, the syringe, and any other labels to make sure that they all agree.

What if you need some ondansetron pre-filled syringes?

Send them back anyway. Maybe only some of the syringes are labeled correctly.

What do the syringes look like?
 


 

What does the ondansetron syringe look like? This one is with a blister pack.
 


 

There are other possibilities for mislabeling that could be much more harmful, so read the syringe before you push anything by any manufacturer.
 


 

That probably would not be as harmful as it seems, because it would be pushed slowly, so it might be metabolized as quickly as it is pushed. The ones below would still be expected to produce a much greater respiratory depression than even an extreme midazolam respiratory depression.
 


 

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Footnotes:

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[1] Fresenius Kabi Issues Voluntary Nationwide Recall of Midazolam Injection, USP, 2 mg/2 mL Due to Reports of Blister Packages Containing Syringes of Ondansetron Injection, USP, 4 mg/2 mL
For Immediate Release
November 3, 2017
Voluntary Recall
Recall announcement

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[2] Serotonin syndrome
Wikipedia
Article

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[3] Intramuscular versus intravenous therapy for prehospital status epilepticus.
Silbergleit R, Durkalski V, Lowenstein D, Conwit R, Pancioli A, Palesch Y, Barsan W; NETT Investigators.
N Engl J Med. 2012 Feb 16;366(7):591-600.
PMID: 22335736 [PubMed – in process]

Free Full Text from N Engl J Med.

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Filed Under: FDA, Heresy, Legal Medicine, Midazolam, Risk Management, Sedation, Seizures

Irresponsibility and Intubation – The EMS Standard Of Care

Wed, 09 Aug 2017 11:00:03 -0400 by
 

There is a petition to save EMS intubation, but it claims to be a petition to save patients. The petition is not to save patients.
 


Image source
Details here and here.
 

The petition states that its intent is to protect patients, but it does not provide any evidence. It only makes the same claims that every other quack makes to promote his snake oil.

We are worse than homeopaths, because homeopaths do not actively harm patients by depriving patients of oxygen, as we do when we intubate.
 

 
We are the quack, witch doctor, homeopath, horseshit peddlers Dara O’Briain is describing.

 

Today we are possibly facing the removal of the most effective airway intervention at our disposal as paramedics, endotracheal intubation.[1]

 

Most effective?

There is some evidence that intubation can be – in limited situations, by highly trained, competent people – beneficial. There is also plenty of evidence that intubation is harmful. It is easy to kill someone by taking away the patient’s airway.

Most effective?

No.

This petition does not mention evidence, so it has no credibility when it comes to claims of whether intubation is effective. This petition expects us to believe in a faerie tale of magical improvement with intubation. This petition wants us to clap for Tinkerbell, because If we believe hard enough, it just might come true. Grow up.
 

Please sign this petition so that these patients have a chance to live[1]

 

Prove that requiring higher standards for intubation would take away a patient’s chance to live.

Prove that intubation improves outcomes.

This is a petition to keep standards low for paramedics.

This petition does not mention competence, or even what is involved in competence, because this petition is opposition to competence.

This is the Protect Incompetent Paramedics from Responsibility Petition.

Responsibility is for professionals. In EMS, we reject responsibility.

We are more concerned with whether our shoes are shiny, than whether we are harming, or helping, our patients. The reason EMS exists is to improve outcomes for patients.

We don’t deliver competent care, but only the appearance of competence. We are medical theater, putting on a fancy show. The TSA (Transportation Security Administration) is the same – all appearance and no substance.

Most effective? Maybe intubation is the most effective theater.

The outcomes of our patients are affected, but we refuse to learn if we are helping, harming, or doing equal amounts of harm and help.

We actually oppose learning. We are willfully ignorant – and proud of our defiant stand for ignorance.

How much hypoxia do we cause in our attempts to place the so called gold standard? The actual gold standard is helping the patient to protect his own airway, but who cares what’s best for the patient? Not those who sign the petition.

How much vomiting, and aspiration, do we cause?

How much airway swelling do we cause?

How many airway infections do we cause?

How much harm do we cause?

We don’t know. We don’t care. We oppose attempts to find out.

We are EMS and we believe that our actions should be protected from examination, because we are beautiful and unique snowflakes who demand our participation trophies without doing real work required to be competent.

Go ahead, snowflakes, demonstrate your incompetence by signing the petition, because this protect intubation petition is really a protect incompetence petition.

If we want to continue to intubate, and we want to improve outcomes for our patients, we need to demonstrate that intubation by EMS provides significant benefit and which patients are most likely to benefit. We can’t do that because we don’t care enough about our patients.
 

Brian Behn has a different reason for not signing the petition for low standards – Why I am Not Signing The Petition About Intubation.

Dave Konig also comments on the petition for low standards – Is ET Intubation Joining Backboards In Protocol?

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Footnotes:

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[1] Allow paramedics to continue to save lives with endotracheal intubation!
Anthony Gantenbein United States
Petition site

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Filed Under: Airway Management, Assessment, Critical Judgment, Education, Evidence, Heresy, Intubation, Malpractice, Risk Management, RSI

The March for Science is a March for Honesty and Accountability

Mon, 24 Apr 2017 02:00:13 -0400 by

 

There were some great signs at the March for Science because the march was about truth and it is difficult to go wrong defending the search for truth. The only time people seem to oppose the search for truth is when truth is seen as a threat to their ideology and/or income.

It is difficult to get a man to understand something, when his salary depends upon his not understanding it! – Upton Sinclair.

Scientists are accused of being arrogant, apparently because scientists don’t waste their time on ideas that cannot be tested or on ideas that repeatedly fail objective testing. Scientists learn by providing the most honest way of assessing the truth – they do everything they can to eliminate bias and to eliminate the effects of anything that is not being tested.

Is that arrogant?

Arrogance would be refusing to allow everyone to criticize your work, but science requires that scientists be open about their work and invite their harshest critics to poke holes in their work.

This means that nonsense will not survive for long. The better hypotheses will survive. Logical fallacies are eventually exposed and we learn the truth.
 


 

This is why science rejects claims that fail experimentation and claims that cannot be tested. These claims are not science.
 

Flat Earth claims are rejected. There is abundant evidence that the Earth is not flat, but people still claim that the Earth is flat. There is no scientific controversy about whether the Earth is roughly spherical in shape.[1]
 

Creationism claims are rejected. Creationism contradicts almost all of the sciences (geology, astronomy, physics, biology, . . .), so Creationism would need to be supported by some very well tested evidence. Creationism is not supported by scientific evidence, but that does not stop Creationists from claiming to be scientists.

The clearest evidence that evolution is real is provided by DNA (DeoxyriboNucleic Acid). When we want to confirm the relationship among different people, we use DNA, because it works. DNA confirms that we are related to baboons, bananas, and bacteria. DNA is able to show how close those relationships are. There is no scientific controversy about whether humans evolved along with the rest of life on Earth.[2]

 

I did not get a clear picture of the sign, but I have not changed the words.

 

Anti-GMO claims are rejected. GMOs (Genetically Modified Organisms) are recognized to be safe, nutritious, important in the prevention of widespread famine, overall much more beneficial than their critics claim, and dramatically better organic foods. Those opposed to GMOs claim that organic foods would not produce a famine, if everyone were to eat organic foods. Those opposed to GMOs claim that modification is bad, even though humans have been modifying crops for over 10,000 years. We even use chemicals and radiation to cause mutations to crops that are still considered organic.
 

From 1930 to 2014 more than 3200 mutagenic plant varieties have been released[1][2] that have been derived either as direct mutants (70%) or from their progeny (30%).[3] [3]

 

There is no scientific controversy about the benefits of GMOs.
 


 

Climate change denial is rejected. Climate change is real and harmful. Some people (not scientists) claim that natural factors are causing the unnatural warming. Some people (not scientists) claim that the unnatural warming is a good thing. Some people (not scientists) claim that the unnatural warming isn’t happening. There is no scientific controversy about the reality of climate change.
 


This chart[4] does not include 2016.

If you are a climate change denier, you were counting on 2016 being something other than the hottest year on record. Three years in a row would be unprecedented. 2017 was hotter than 2016, which contradicts the denier arguments.[5] If you are a climate change denier, you should realize that denying science is not going your way. You have had some political successes, but you can’t deny reality forever. There is no scientific controversy about the reality of climate change.
 

Anti-vaccine claims are rejected. Anti-vaxers claim that vaccines are dangerous and that vaccines do not work. Do vaccines work? We should have eradicated polio by now, but anti-vaxers have discouraged vaccination. If you don’t like your children getting the polio vaccine, blame the anti-vaxers. We did eradicate smallpox in the 1970s. We stopped vaccinating against smallpox. Smallpox was killing 2 million people a year. If you don’t worry about smallpox, thank a scientist. There is no scientific controversy about the safety and efficacy of vaccines.
 

Historical Comparisons of Morbidity and Mortality for Vaccine-Preventable Diseases in the United States – Table 1


 

In response to the evidence in Table 1,[6] anti-vaxers claim that improved sanitation and hygiene. The decrease in cases and deaths due to the various vaccine-preventable illnesses should be the same for all of these diseases, but that is not the case. The diseases have also produced epidemics when the vaccination level drops below herd immunity levels.[7] There is no scientific controversy about the safety and efficacy of vaccines.
 

Science is not perfect, but science is better than all other means of learning the truth.

When science produces mistakes, we learn about it from scientists, not from politicians, not from preachers, not from placebo pushers, not from psychics, and not from any other deniers of science.

Maybe the message of science got through.

Maybe we won’t need another March for Science.
 


??Gaby Mérida ??‏ @ThatSpanishLady Twitter
Click on the image to make it larger.

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Footnotes:

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[1] Flat Earth Rising
by Steven Novella
Neurologica
April 6, 2017
Article

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[2] Objections to evolution
Wikipedia
Article

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[3] Mutation breeding
Wikipedia
Article

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[4] The 10 Hottest Years on Record
January 20th, 2016
By Climate Central
Article

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[5] 2016 Was the Hottest Year on Record
Both NASA and NOAA declare that our planet is experiencing record-breaking warming for the third year in a row
By Andrea Thompson
January 18, 2017
Scientific American
Article

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[6] Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States.
Roush SW, Murphy TV; Vaccine-Preventable Disease Table Working Group..
JAMA. 2007 Nov 14;298(18):2155-63.
PMID: 18000199

Free Full Text from JAMA.

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[7] “Vaccines didn’t save us” (a.k.a. “vaccines don’t work”): Intellectual dishonesty at its most naked
by David Gorski
March 29, 2010
Science-Based Medicine
Article

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Filed Under: Critical Judgment, Ethics, Evidence, Heresy, Research, Risk Management, Science, Understanding

Texas bill would let firefighters, EMTs carry firearms

Thu, 16 Feb 2017 12:30:07 -0500 by
 

There is a bill in Texas to require employers to allow EMS personnel to carry guns on the job.
 

“I would be in favor of leaving guns in the hands of police officers,” Waco Fire Chief Bobby Tatum said. “We have a specific mission to save lives and property, and I think carrying a firearm would cross the line in that regard.” [1]

 

What is the possible benefit?

As I have written about this before –

When would armed EMS make any difference?

Other than those times it makes things worse, when would it make a difference?
 

Below, Dara O’Briain spends a minute on the frustration of trying to explain to people, who don’t understand statistics, that crime rates are definitely going down. Following that, I provide evidence.
 


 

And they go, but the fear of crime is rising.

Well, so what? Zombies are at an all time low, but the fear of zombies could be incredibly high.

 

Here is the murder rate in America from 1960 to 2012 (the most recent data available from the FBI when I made the graph for Thanksgiving in 2015). The 2012 murder rate was 4.7 per 100,000. 2013 and 2014 were lower, both at 4.5 per 100,000.
 

US Murder Rate - 1960 - 2014
 

This is the murder rate in Canada compared with the murder rate in America and whether the death penalty has an effect on either. In the chart, the murder rate of Canada is on a scale that is tripled to show similar changes year to year. This chart is a decade old, but the murder rate in the US and Canada continued to drop in the newer data.
 

Murder rates US vs Canada 1950 - 2005 aa
Source: John J. Donohue III, Justin Wolfers, Uses and Abuses of Empirical Evidence in the Death Penalty Debate, Discussion Paper No. 1949 (January 2006) available at http://papers.ssrn.com/sol3/papers.cfm?abstract_id=870312.
 

What about in the Good Ol’ Days, when everything was so much better than now?
 

Homicide rates (per 100,000 people) 14th - 20th centuries - Millennium by Ian Mortimer a
 

In the Good Ol’ Days, things were not good and few people lived long enough to get old.
 

I regularly criticize What if . . . ? fear mongering.

This is one of the greatest harms of EMS. We need to stop this dependence on scaring people with stories of monsters in closets. We need to deal with reality.

This fear mongering is lowering ourselves to the level of alternative medicine.
 

What will happen the first time someone in EMS shoots someone, fires a gun, points a gun at someone, or just brandishes a gun?

Was it justified?

What will the repercussions be?

When would any outcome have been better if EMS carried guns?

How would it have been better?

Assume that only 10% of the people in EMS who will carry guns on the job are below average (yes, that means that 90% are above average). How much trouble can that 10% cause?

Assume that only 1% are below average. How much trouble can that 1% cause with below average decisions?

There is nothing in this bill to prevent that 1% from carrying on every call. The carry license is both the floor and the ceiling for qualification for armed EMS.[2]
 

Sometimes doing nothing is the best thing we can do, but some people need to do something, even though there is no reason to expect it to do any good. This is another case of doing something just to do something.

If we are going to change how we do things, we should insist on thorough documentation of every intervention, just as we should for any other EMS intervention. The bill does not mention any kind of tracking of the effects of this legislation.[2]
 

Can employers require training/skills verification? Only possession of a valid carry license is mentioned. No further skill requirement is mentioned in the bill.[2]

What will happen to the insurance rates for the employer? Insurance companies are not looking to donate money to make EMS feel good.

Will people leave EMS in order to get away from partners they don’t trust with guns? How many do that now for bad driving?

Will we end up with more people who couldn’t get onto the police force, because lights and sirens and guns is better than lights and sirens?

Will EMS providers in Texas be told that this is a replacement for the raise they were going to get?

If some people feel unsafe without their guns, because they mistakenly believe that the murder rate is increasing, when it is definitely dropping, in what other ways are they making bad decisions? Will giving the confused fear of rising crime people guns act as a security blanket, so that they will feel safer and focus on their patients? Or will the confused fear of rising crime people use the guns to act on some other confusion? It probably won’t be that simple.
 

PS – Is this a Constitutional issue?

Employers are permitted to limit some other important civil rights, such as speech, during work hours. We can always choose to work in jobs that permit us to be armed on the job. Security guard, police officer, corrections officer

Of course corrections officers have to carry guns. They are surrounded by inmates.

Actually, corrections officers do not carry guns when they are around inmates. It seems that introducing a gun into that environment is not considered a good idea.

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Footnotes:

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[1] Texas bill would let firefighters, EMTs carry firearms – The bill would implement a statewide policy requiring jurisdictions to allow responders to carry while on duty
EMS1.com
Feb 14, 2017
By EMS1 Staff
Article

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[2] Texas House Bill 982
Bill Text: TX HB982 | 2017-2018 | 85th Legislature | Introduced
TX State Legislature page for text of HB982

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Filed Under: Guns, Heresy, Risk Management, Unicorn Medicine

Hundreds of Medical Groups Send a Vaccine Safety Letter to the President

Fri, 10 Feb 2017 12:55:48 -0500 by
autism-organic
Image credit
 

The rate of autism diagnosis has increased dramatically as people eat more organic food, but that does not mean that organic food causes autism. The way to find out is to study this.

Researchers have looked for any reason to believe that vaccines, or vaccine ingredients, cause autism. The results are the same, regardless of whether the study is in America, Europe, Asia, . . . , and regardless of whether the study is run by private organizations, governments, corporations, or universities.[1]

For example, does thimerosal cause autism? Here is just one study looking for causation. There isn’t even a correlation.
 

CONCLUSIONS:
The discontinuation of thimerosal-containing vaccines in Denmark in 1992 was followed by an increase in the incidence of autism. Our ecological data do not support a correlation between thimerosal-containing vaccines and the incidence of autism.[2]

 

If thimerosal causes autism, why does the rate of diagnosis of autism continue to increase after the removal of thimerosal?
 

Hundreds of medical organizations sent a letter to President Trump in an attempt to get the president to look at the evidence, rather than listen to the scientifically naive activists promoting conspiracy theories.
 

On behalf of organizations representing families, providers, researchers, patients, and consumers, we write to express our unequivocal support for the safety of vaccines.[3]

 

Unequivocal support means that they are completely confident that vaccines are safe, not that vaccines are 100% safe, Nothing is 100% safe, so demanding for 100% safety is an argument against everything – even breathing isn’t 100% safe.
 

Globally, vaccines prevent the deaths of roughly 2.5 million children per year.1 And, data shows that just for children born in the United States in 2009, routine childhood immunizations will prevent approximately 42,000 early deaths and 20 million cases of disease with savings of more than $82 billion in societal costs.2 [3]

 

Scare stories discourage us from doing what is best for our children.
 

RESULTS:
A greater than 92% decline in cases and a 99% or greater decline in deaths due to diseases prevented by vaccines recommended before 1980 were shown for diphtheria, mumps, pertussis, and tetanus. Endemic transmission of poliovirus and measles and rubella viruses has been eliminated in the United States; smallpox has been eradicated worldwide. Declines were 80% or greater for cases and deaths of most vaccine-preventable diseases targeted since 1980 including hepatitis A, acute hepatitis B, Hib, and varicella. Declines in cases and deaths of invasive S pneumoniae were 34% and 25%, respectively.[4]

 

Polio would have been eradicated by now, if it weren’t for the opposition of anti-vaxers.

Should we listen to those who, although they may mean well, do not understand what they are doing, or should we listen to doctors?

Doctors vaccinate themselves and their children because they understand that vaccines are safe and vaccines work.

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Footnotes:

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[1] 75 studies that show no link between vaccines and autism UPDATED to 107
Just the Vax
Friday, March 7, 2014
Edited to fix links and to add more studies for a new total of 107 on 11 March 2014
Guest blog, compiled by Allison Hagood, Luci Baldwin, Kathy McGrath and Nathan Boonstra and originally published on the “Your Baby’s Best Shot” Facebook page. I am grateful for the permission to repost!
List of studies

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[2] Thimerosal and the occurrence of autism: negative ecological evidence from Danish population-based data.
Madsen KM, Lauritsen MB, Pedersen CB, Thorsen P, Plesner AM, Andersen PH, Mortensen PB.
Pediatrics. 2003 Sep;112(3 Pt 1):604-6.
PMID: 12949291

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[3] Dear Mr. President:
February 7, 2017
AAP (American Academy of Pediatrics)
Letter in PDF format

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[4] Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States.
Roush SW, Murphy TV; Vaccine-Preventable Disease Table Working Group..
JAMA. 2007 Nov 14;298(18):2155-63.
PMID: 18000199

Free Full Text from JAMA

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Filed Under: Critical Judgment, Heresy, Risk Management, Vaccines

Does use of Lights and Sirens save lives?

Tue, 07 Feb 2017 16:00:21 -0500 by
AmboLights
 

A recent Fire Chief Magazine and the current JEMS have some articles on the use of lights and sirens and the effect on patient outcomes. Doug Wolfberg, one of the EMS lawyers who might be trying to defend your choice on use of lights and sirens, states –
 

Few cows are more sacred in fire service based EMS than the ones that flash, wail and yelp. The use of emergency lights and sirens is an inseparable part of everyday EMS life.[1]

 

and –
 

Yet when we look at the actual evidence, a few things become apparent about RLS use. First, it’s proven to be dangerous. Second, it’s not proven to be beneficial.[2]

 

In another article, several of the top medical directors in the country state –
 

Unlike fire emergencies, which can grow exponentially and spread quickly, only a small subset of medical emergencies is truly time sensitive. Most don’t dramatically worsen in the course of a very few minutes, and they don’t spread from person to person.[3]

 

In rare cases, such as those where we are not able to control bleeding, or breathing, and the hospital is close enough that the patient won’t be dead by the time we get there, does use of lights and sirens save lives? In those rare cases? Sometimes.

Wouldn’t it be better to improve the quality of the people treating these patients, rather than increase the speed of transport?

When is the last time you transported a patient to the emergency department for something that needed to be done immediately to save the life of the patient?

Why not do that before transport?

Was it out of your scope of practice, did you not know what was going on, did you not feel comfortable performing the skill, could you not make up your mind about what to do, . . .?

Can’t place an endotraceal tube successfully? Use an LMA (Laryngeal Mask Airway), King Airway, BVM (Bag Valve Mask or resuscitator bag), stimulate the patient to breathe for himself, . . .

Can’t place an IV successfully? The IV is not a life line, but you can place an IO (IntraOssesous) line, apply direct pressure to bleeding, lay the patient flat (Trendelenberg does not improve things for the patient, although it might make you feel like you are doing something good), consider IM (IntraMuscular) or IN (IntraNasal) administration of medication, . . .

But it is an emergency!
 

We used to drive cardiac arrests to the hospital quickly, because we thought that was better.

We were wrong. If we do not resuscitate people prior to arrival at the hospital, they will probably stay dead. Driving fast just increases the odds that we will be as dead as the patient.

There has never been any good evidence to support driving fast.

We need to develop a better understanding of the treatment we provide. We need to provide better assessments (and continue to assess). We need to provide appropriate treatment on scene prior to transport. We need to rush less.
 

Do you believe in frequent lights and sirens transport?

Here is a dare for you.

Keep track of the times you transport with lights and sirens (these should be sentinel events) and document the actual life saving treatment provided in the emergency department in the first 10 minutes.

Keep track of this for a month, or a year.

Do you have anything?

Was it really something that saved the patient’s life?

If you do come up with something, does it amount to more than 1% of lights and sirens transports?

If we have almost always beenwrong about what is going on, should we be endangering everyone on the road to cover for our ignorance?

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Footnotes:

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[1] Why running lights and sirens is dangerous
Fire Chief
June 5, 2016
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[2] Pro Bono: EMS Use of Red Lights and Siren Offers High Risk, Little Reward
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[3] The Case Against EMS Red Lights and Siren Responses
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Filed Under: Assessment, Cardiac Arrest, Critical Judgment, Driving, Evidence, Heresy, Risk Management, Traffic

I helped a Naturopath kill my son, because I believe in Quackery

Tue, 24 Jan 2017 16:00:48 -0500 by

tamara-ryan-lovett1

 
Would you kill this kid?

Like clapping for Tinkerbell, killing children for superstition is part of keeping reality at bay.

Am I too harsh?

7 year old Ryan Lovett died of strep, meningitis, and pneumonia. His slow death, over 10 days, is reported to have been extremely painful. His death was also preventable with real medicine, so I am not even remotely harsh.

Ryan Lovett’s mother is a true believer in magic. Defending her irrational beliefs means avoiding everything that has valid evidence of benefit. Oddly, she did call 911, after her son started seizing. Ryan Lovett could not be resuscitated by EMS.

Ryan Lovett’s mother took him to a Naturopathic clinic for an echinacea mixture. Meanwhile, her neighbor, not trained in the deadly art of Naturopathy, was trying to convince Ryan Lovett’s mother to take Ryan to a real hospital.
 

La Pointe (Barbara La Pointe, a former friend of Lovett’s who used to take Ryan to her home on weekends) testified she visited Ryan and his mother the day before he died. She described Ryan as being “in a state of supreme suffering” and offered to take the mother and son to a hospital or doctor, but Lovett refused.[1]

 

Naturopaths claim that they will tell patients to go to a real doctor if the patient has a serious illness, which requires real medicine, not the usual self-limiting illness that patients recover from in spite of the Naturopath’s prescriptions.

Ryan Lovett will tell you that doesn’t work. No, Ryan Lovett can’t tell you, because nobody at Naturopathic clinic did what Naturopaths claim their extensive training in quackery prepares them to do – send the patient to a real doctor.

The neighbor was much smarter than everyone at the Naturopathic clinic, since she does not appear to have been indoctrinated in the death before medicine quackery of Naturopathy.
 

Ryan did not have a birth certificate and had never seen a doctor because his mother “did not believe in conventional medicine,”[1]

 

Evil conventional medicine? Pediatricians use evidence based medicine on their own kids and on themselves. They will even give you copies of research articles that show that their treatments do work. Medicine works even when the manufacturer is not able to influence the results of the research.
 


 

“The court specifically found that Tamara Lovett actually knew how sick he was and simply refused to do something and therefore gambled with his life,” he (Prosecutor Jonathan Hak) told reporters.[1]

 

That is a misunderstanding of medicine and gambling. Medicine is probabilistic. No treatment is 100% successful, so it depends on being prescribed for the right condition, in the right dose, having the fewest side effects, or having side effects that are least likely to make the patient worse, . . . , in order to make it more likely that the patient has a good outcome. That is gambling (putting the odds in the favor of the patient). Medical education is what helps the doctor, PA, NP, nurse, paramedic, EMT to assess the patient in a way that identifies the actual medical condition, to understand the risks and benefits of the available treatments, and to decide what is best for that individual patient.

Evidence-based medical education is better at putting the odds in favor of a good outcome than anything else.

Ryan Lovett’s mother wasn’t gambling, she was praying that her superstition had real magic powers. Maybe Ryan Lovett’s mother was praying that Ryan had a self-limiting illness, which would get better as long as the Naturopathic chemicals did not poison Ryan. Why take Ryan to the Naturopathic clinic at all, if the Naturopathic clinic just sells chemicals that are merely supposed to distract people and make the Naturopath money?
 

Doctors testified the infection would have been treatable had the boy, who also had meningitis and pneumonia, been taken to a doctor and given antibiotics.[1]

 

But this is just one rare case, so it is not fair to criticize Naturopaths for scamming the gullible. The Quack didn’t know the kid would die.
 

Canadians across the country have kept a close eye on the case. It is one of several in southern Alberta involving parents who were charged criminally after their children died of conditions that could have been treated with conventional medicine.[1]

 

Some people just can’t deal with reality.

Reality will eventually kill us, regardless of what we do. In the mean time, we can increase the odds of living a long healthy life by avoiding unnecessary treatment and limiting the treatments we do use to stuff that has valid evidence that it really works.

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Footnotes:

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[1] Tamara Lovett found guilty of negligence, failure to provide necessaries of life in death of 7-year-old son
By Meghan Grant, Drew Anderson,
CBC News
Posted: Jan 23, 2017 5:00 AM MT
Last Updated: Jan 23, 2017 5:33 PM MT
Article

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Filed Under: 'Alternative' Medicine, Anti-Science, Children, Critical Judgment, Evidence, Heresy, Risk Management
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