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

- Rogue Medic

Acute coronary syndrome on Friday the 13th: a case for re-organising services?

ResearchBlogging.orgAcute coronary syndrome on Friday the 13th - a case for re-organising services 1
 
There has been a bunch of research on the likelihood of bad things happening on Friday the 13th. These researchers thought that the big problem with all of the available research is that the populations studied have been too small. The authors took information on over 56,000 patients with acute coronary syndromes, broke them down into 217 day/date combinations (Friday the 1st, Saturday the 1st, . . . ,Wednesday the 31st, Thursday the 31st), and compared the outcomes of those 216 groups with their Friday the 13th group.

Cut to the conclusion –
 

Conclusion: On most days, there was no difference in the 13-year mortality rate for patients admitted with their first ACS from that for “unlucky” Friday the 13th. However, patients admitted on five day/number combinations were 20-30% more likely to survive at 13 years. These findings could be explained by subgroup analysis inflation of the type I error, although supernatural causes merit further investigation.[1]

 

No. Supernatural causes do not merit further investigation, at least, not based on anything in this paper.

The authors used Friday the 13th as their normal date for comparison with every other date, but the outcomes from Friday the 13th are not the true statistical mean. The outcomes on Friday the 13th were just chosen because of the superstition being investigated. Friday the 13th is so close to the statistical mean that this mistake is easy to make.
 

Surprisingly, however, we also identified five potentially “lucky” days on which mortality rates were significantly lower, by 20-30%.[1]

 

When analyzing 217 samples, it is not surprising that some of the data deviate from average by an amount that is expected to produce no more than one significant deviation out of every twenty comparisons. The authors had over 200 comparisons, so we should not have been surprised by up to 11 day/date combinations with p values of less than 0.05. There were only 5. Should anyone go looking for supernatural explanations for statistically normal outcomes?

While Friday the 13th was not the statistical mean, it was very close. Look at the five potentially “lucky” days and how close the ranges are to 1.00. If the range crosses (includes) 1.00, the results are not statistically significant according to the prospectively determined criteria of the authors. Crossing 1.00 is just another way of expressing P <0.05. Sunday the 1st and Monday the 29th each produced outcomes 29% worse than Friday the 13th. Saturday the 31st produced outcomes that were 36% worse. If we compared these with the actual statistical mean, Monday the 29th and Saturday the 31st become significantly “unlucky” using a p value of less than 0.05 and all of the significantly “lucky” days become insignificant.

As we should expect, the most extreme benefit and harm both fall on the 31st. Only 7/12 (58.3%) of months have 31 days, so these days have much smaller sample sizes. With smaller samples, the appearance of deviance is expected to be greater. The actual deviation is less important, because the sample size is smaller.

Friday the 13th is only slightly different from the statistical mean, using the data in this paper, which may be the largest examination of a possible Friday the 13th effect.

Once again, the biggest problem with Friday the 13th is that we end up listening to people promoting superstition.
 

I have also written about this kind of superstition here –

The Magical Nonsense of Friday the 13th – Fri, 13 May 2016

Happy Friday the 13th – New and Improved with Space Debris – Fri, 13 Nov 2015

Friday the 13th and full-moon – the ‘worst case scenario’ or only superstition? – Fri, 13 Jun 2014

Blue Moon 2012 – Except parts of Oceanea – Fri, 31 Aug 2012

2009’s Top Threat To Science In Medicine – Fri, 01 Jan 2010

T G I Friday the 13th – Fri, 13 Nov 2009

Happy Equinox! – Thu, 20 Mar 2008

Footnotes:

[1] Acute coronary syndrome on Friday the 13th: a case for re-organising services?
Protty MB, Jaafar M, Hannoodee S, Freeman P.
Med J Aust. 2016 Dec 12;205(11):523-525.
PMID: 27927150

Protty, M., Jaafar, M., Hannoodee, S., & Freeman, P. (2016). Acute coronary syndrome on Friday the 13th: a case for re-organising services? The Medical Journal of Australia, 205 (11), 523-525 DOI: 10.5694/mja16.00870

.

The Magical Nonsense of Friday the 13th

ResearchBlogging.org
 

Today we celebrate the fears of those who do not understand that magic does not affect reality. Our fears of magic can affect reality, when we act on those fears. Why should a special day cause more problems than a boring day? Many people believe in magic powers as being more than just the fictional entertainment we see in novels and movies.

Here is another study of the effects of Friday the 13th on emergency medicine/EMS that I have not written about. It is no surprise that they did not find what is not there – an influence of this magic date on the type or volume of patients in the emergency department.
 

CONCLUSIONS:
Although the fear of Friday the 13th may exist, there is no worry that an increase in volume occurs on Friday the 13th compared with the other days studies. Of 13 different conditions evaluated, only penetrating traumas were seen more often on Friday the 13th. For those providers who work in the ED, working on Friday the 13th should not be any different than any other day.
[1]

 

When measuring of a large number of variables, it is expected that one, or more, will appear to be statistically significant. This is why the p value of outcomes should be adjusted when there are multiple outcomes being measured. The p value is just a measure of how likely it is that the result occurred by chance (and thus meaningless), so the more chances, the more likely that the meaningless is considered significant.
 

Fear of Friday the 13th is mistakenly attributing some magical power to a day, to a number, to the calendar, and/or to some other variation of belief in the magic of numbers.

Numbers are important and can provide us with useful information about the risks in our lives. The risks we take confidently, cautiously, or those we don’t take. Often our decisions about risk are based on faulty information, such as the fear of a date. Mathematical literacy is necessary to understand the ways that we can use numbers to obtain valid information. John Allen Paulos created the term innumeracy to describe our lack of literacy in the language of numbers. He explained this in 1988 in his book Innumeracy: Mathematical Illiteracy and its Consequences.[2]
 

Innumeracy cover
 


 

Oh! But what about Lies, damned lies, and statistics?

Doesn’t using math make it easier for people to lie to us?

No. Ignorance of math makes it easier for people to lie to us with math.

People do not often lie with numbers. People lie with words. Maybe they lie with the salesman smile. Maybe they lie with the fear monger frown. Maybe they lie unintentionally, because they don’t know what they are talking about. They lie with words. Our ignorance of logic, not our understanding of math, is what allows us to fall victim to most lies.

Today is another Friday that is no more exciting than any other Friday.

Luck works in our favor when we are prepared for the results of our actions, but that is not the kind of luck many people want to understand.
 

Happy Friday the 13th – New and Improved with Space Debris – Fri, 13 Nov 2015

Friday the 13th and full-moon – the ‘worst case scenario’ or only superstition? – Fri, 13 Jun 2014

Blue Moon 2012 – Except parts of Oceanea – Fri, 31 Aug 2012

2009’s Top Threat To Science In Medicine – Fri, 01 Jan 2010

T G I Friday the 13th – Fri, 13 Nov 2009

Happy Equinox! – Thu, 20 Mar 2008

Footnotes:

[1] Answering the myth: use of emergency services on Friday the 13th.
Lo BM, Visintainer CM, Best HA, Beydoun HA.
Am J Emerg Med. 2012 Jul;30(6):886-9. doi: 10.1016/j.ajem.2011.06.008. Epub 2011 Aug 19.
PMID: 21855260

[2] Innumeracy: Mathematical Illiteracy and its Consequences
Wikipedia
Page on Wikipedia

.

2015 In Review – Superstitious Standards of Care Suffer Small Losses, But Continue to be Favorites

 

What changed, or almost changed in 2015?

Withholding epinephrine (adrenaline in Commonwealth countries) in cardiac arrest is still heresy. This use of epinephrine is not based on evidence of improved outcomes that matter to patients – unless the patient is a pig/dog/rat with no heart disease having an artificially produced cardiac arrest.

The Jacobs trial ways sabotaged by politicians, the media, and other opponents of science claiming that depriving patients of the standard witchcraft is unethical.[1] Using inadequately tested hunches on uninformed patients, as long as everyone else is doing it, appears to be their idea of ethical behavior. However, the Paramedic2 trial has been underway for about a year and should provide results in 2018.[2]
 

paramedic2_logo
 

There probably is some benefit for cardiac arrest patients who are not having heart attacks, but we do not currently try to identify them. We also do not know what dose or frequency is best or when to give epinephrine. Paramedic2 will only be able to answer some of those questions.
 

Withholding ventilation is a less defended heresy, at least in Pennsylvania.
 

AVOID endotracheal intubation and patient packaging during initial 10 minutes

Ventilation Options6:

  • No Ventilation
  • 1 ventilation every 10-15 compressions8 (Monitor Perfusion with Capnography[3]
  •  

    However, the AHA (American Heart Association) and ILCOR (International Liaison Committee On Resuscitation) 2015 resuscitation guidelines double down on baseless fears –
     

    2015 Evidence Review
    There is concern that delivery of chest compressions without assisted ventilation for prolonged periods could be less effective than conventional CPR (compressions plus breaths) because the arterial oxygen content will decrease as CPR duration increases.
    [4]

     

    There is no evidence to support this fear, but using reason against irrational beliefs is often unsuccessful, since the irrational appeals to emotion and avoids reason.
     

    Medical directors have been recognizing that backboards were used because of irrational fear and assumptions of benefit that were based on hunches. Therefore many medical directors now recognize the absurdity of the use of this malpractice device and discourage the use of backboards.
     

    Pennsylvania has also removed chilled IV fluid from protocols following the failure of the treatment to improve outcomes for cardiac arrest patients, when given by EMS.

    Chilled IV fluid therapeutic hypothermia does work in the hospital, but not when provided by EMS.

    This is one of the reasons EMS should not automatically adopt treatments that work in the hospital. It is difficult for many in EMS to understand, but many in EMS still think that occasionally intubating a patient makes a paramedic as good as an anesthesiologist.
     

    In general, the state of EMS is best summed up by this statement by Prachi Sanghavi –

    Our current ambulance system is based on little scientific evidence.

    The scary thing for patients is that many in EMS are proud of our ignorance.
     

    Elsewhere in medicine in 2015.

    Thousands of Americans travel to regions with outbreaks of Ebola and help to stop the spread of infection. This was in spite of the panic being encouraged by the scientifically illiterate. We should have welcomed them home as we welcome home out military. Both of these groups of Americans risk their lives to protect others and should be treated better. They are far more ethical than our isolationist politicians.

    We learned that we need to add rats to the growing list of the non-human animals that exhibit empathy and will sacrifice to help others.[5] It appears that comparing those who opposed sending Americans to rats is unfair to the rats.
     

    Finally, 2015 was the 100th anniversary of Albert Einstein explaining that Isaac Newton was wrong about gravity, but that is the way science improves.
     

    PS – We also had push dose pressors added to the Pennsylvania protocols in 2015.

    Footnotes:

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

    Free Full Text PDF Download of In Press Uncorrected Proof from xa.yming.com

     

    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.

     

    [2] Paramedic2 – The Adrenaline Trial
    Warwick Medical School
    About

    [3] General Cardiac Arrest – Adult
    3031A – ALS – Adult
    Pennsylvania Emergency Health Services Council
    PA ALS Protocols in PDF format

    [4] 2015 Evidence Review
    2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
    Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality
    Adult BLS Sequence—Updated
    2015 Evidence Review

    [5] Rats forsake chocolate to save a drowning companion
    Science Magazine
    By Emily Underwood
    12 May 2015
    Article

    .

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


     

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

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

    WT1190F

    It’s got to mean something!

    It couldn’t just be a coincidence!

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

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

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

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

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

    .

    Florida County Eliminates Use of Magic Backboards for Possible Spinal injuries

     

    More medical directors are rejecting the superstition that it is acceptable to harm patients to prevent fear of law suits.

    There is no evidence that backboards do anything to protect the spine, but there is plenty of evidence that backboards cause harm.[1]
     

    [youtube]eM4hxuooNN0[/youtube]
     

    All treatments have side effects, so we need to have evidence of benefit to justify exposing our patients to those side effects. A treatment that does not provide any benefit to the patient exposes the patient to the side effects, but does not provide any benefit. This is indefensible, but many doctors, nurses, paramedics, basic EMTs, and others continue to defend this magical thinking and oppose EBM (Evidence-Based Medicine).

    Fortunately, the defenders of superstitious nonsense seem to be losing support for belief in the magical properties of backboards.
     

    Palm Beach County Fire Rescue just became one of the first agencies in the state to stop the use of rigid backboards for spinal immobilization.[2]

     


     

    Instead of using the backboard, patients will be placed on a padded stretcher. Cervical collars will still be used when necessary to provide cervical stabilization.[2]

     

    “The new procedures will reduce pain and suffering of patients, reduce complications, decrease on scene times and reduce injuries to crews who are attempting to carry immobilized patients,” said Cpt. Albert Borroto in a news release.[3]

     

    Palm Beach County Fire Rescue joins a growing list of EMS agencies that are putting patients ahead of superstition –
     
     

    Agencies/EMS Systems Minimizing Backboard use –
     

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

    Alameda County
    CA
     

    Albuquerque-Bernalillo County Medical Control Board
    NM
     

    Bernalillo County Fire Department
    NM
     

    CentraCare Health
    Monticello, MN
     

    Connecticut, State of
    CT
     

    Durham County EMS
    NC
     

    Eagle County Ambulance District
    CO
     

    HealthEast Medical Transportation
    St. Paul, MN
     

    Johnson County EMS
    KS
     

    Kenosha Fire Department
    Kenosha, WI
     

    Maryland, State of
    MD
     

    MedicWest Ambulance
    NV
     

    Milwaukee EMS
    WI
     

    North Memorial Ambulance & Aircare
    Minneapolis, MN
     

    Palm Beach County Fire Rescue
    FL
     

    Rio Rancho Fire Department
    NM
     

    SERTAC (Southeast Regional Trauma Advisory Council)
    WI
     

    Wichita-Sedgwick County EMS System
    KS
     

    Xenia Fire Department
    Xenia, OH
     
     

    Outside of the US –
     

    St. John Ambulance
    New Zealand
     

    Norway
     

    QAS
    Queensland, Australia
     
     

    Footnotes:

    [1] New Kansas EMS policy limits use of backboards
    Tue, 01 Apr 2014
    Rogue Medic
    Article

    [2] Palm Beach County Fire Rescue changes the way first responders handle patients
    Katie Johnson
    5:57 PM, Dec 10, 2014
    5:40 AM, Dec 11, 2014
    WPTV5 West Palm Beach
    Article

    [3] Palm Beach County Fire Rescue making changes for backboard use
    WPTV Webteam
    8:47 AM, Dec 10, 2014
    7:35 PM, Dec 10, 2014
    WPTV5 West Palm Beach
    Article

    .

    Since the World is Ending Today, What Should We Do?


     

    Oh no! It is the end of the world, again. What should we do?

    If the end of the world causes you anxiety, you are probably already prescribed some anti-anxiety medicine. I recommend that you follow the directions on the label and stop annoying less anxious people. Avoid combining your sedatives with other sedatives (alcohol, heroin, propofol, . . . ) and find a way to distract yourself from what you do not understand.
     

    Lunar activity is said to mark the END OF TIME, with some religious groups believing it to be a sign of the JUDGEMENT DAY.[1]

     

    The end of times has probably been predicted since before writing was first used to record anything. There is one consistent thing about these predictions. They have been completely wrong. Eventually, one will be right, but that will probably be something we learn about from scientists, who will be the first to observe evidence of any problems.

    What do scientists predict about the super moon? It will appear a little bit bigger and brighter than most normal full moons. That will be the only noticeable difference from a normal full moon.
     

    Lunar activity is said to mark the END OF TIME, with some religious groups believing it to be a sign of the JUDGEMENT DAY.[1]

     

    We are still waiting and none of the predictions have come true. None of the predictions are any more likely than any other predictions.
     

    But what about he tsunami caused by a super moon?
     

    Supermoons have been proven to cause sea levels to rise as the gravitational pull of the Earth’s closest neighbour increases as it gets closer.[1]

     

    That is not true.
     

    The relative amount of influence is proportional to the object’s mass and distance from the earth.[2]

     

    The difference in distance will be tiny.

    Here is what the distance will be from our planet to the super moon.
     

    Aug 10 5:46 PM         356,922 km         221,796 mi         Closest for this year [3]

     

    And here is what the distance was for the full moon on January 1, 2014.
     

    Jan 1 9:01 PM         356,945 km         221,811 mi [3]

     

    Only 15 miles different.

    There is one important thing to understand about a 15 mile difference in the distance between the moon and us. It is not something that humans can notice without machinery to measure the distance.
     

    Jul 28 3:39 AM         406,547 km 252,634 mi         Farthest away this year [3]

     

    That is a difference of 30,838 miles between the farthest and closest distances. That is a 12% difference. The difference between the 2nd closest full moon and the super moon is 15 miles.

    15/221,811

    Or 1 our of 14,787. If this is seen by some as prophetic, important, or ominous, it is because those describing the problem lack all sense of perspective.

    Some people are claiming that this is important, because they have no idea what they are commenting on, or they are trying to profit from the gullibility of others, or . . . .

    But the moon being this close is unprecedented!
     

    Jan 30 8:59 AM         356,606 km         221,600 mi         Closest for this year[4]

     

    That was the closest distance between the moon and the earth in 2010. 221,600 miles. Today’s end of the world distance – because it is so incredibly close – is 221,796 miles or 196 miles farther than it was in 2010. So much for unprecedented. So much for scary.

    If you think that the minuscule difference in distance was enough to cause a disaster, you seem to have the same problem with perspective as the prophets of doom.
     

    If this were indeed the case, we would expect to see a correlation between rate at which earthquakes occur and the perturbations to the gravitational field. The dominant perturbation in the earth’s gravitational field generates the semi-diurnal (12 hour) ocean and solid earth tides which are primarily caused by the moon (due to its proximity) and the sun (due to its large mass). No significant correlations have been identified between the rate of earthquake occurrence and the semi-diurnal tides when using large earthquake catalogs.[2]

     

    No valid mechanism, no perspective, and no evidence?

    The only thing useful out of this is as another example of frauds taking advantage of the vulnerable, but we have no shortage of examples of that. We don’t even have a shortage of people defending the frauds.

    Footnotes:

    [1] SUPERMOON LIVE: Beautiful lunar event could trigger ‘END OF DAYS’
    By: Nathan Rao
    Published: Sun, August 10, 2014
    Sunday Express
    Article

    [2] Can the position of the moon or planets affect seismicity?
    Earthquake FAQ
    Berkeley Seismological Laboratory Outreach Program
    Article

    [3] Moon distances for UTC
    timeanddate.com
    Information page

    [4] Moon distances for UTC
    timeanddate.com
    Information page

    .

    Friday the 13th and full-moon – the ‘worst case scenario’ or only superstition?


     
    Today we get hit with a double whammy – Friday the 13th and a full moon. This will not happen again until August of 2049.

    Is there anything about Friday the 13th, or the full moon, or the combination that would make today worse than usual?

    Let’s look at the evidence.

    The last combination of Friday the 13th and a full moon was in October 2000. Somebody decided to compare patient volumes by category against other full moon days and also against the average volume.
     

    One of the oldest superstitions is about Friday, the number 13, and a full moon. There exists a very popular belief in the relationship between the number 13 and Friday as well as the moon’s phase and the incidence of bad luck. Among the emergency department “folklore” belongs the theory that shifts on such dates are always busy ones.[1]

     

    We compared the number of overall admissions divided into medical, nontrauma-related surgical emergencies, mild and moderate trauma, multiple injured patients, and attempted suicides, on the full moon days and nights from February 2000 to Friday, October 13, 2000 with the average admission rate per day during this period.[1]

     

    Here are the numbers.
     


     

    Nothing unusual there.
     


     

    Still nothing unusual.
     


     

    A higher number of non-trauma surgical emergencies on Friday the 13th with the full moon, but this is the only one category. Does anything else suggest a connection?

    Trauma will clearly show the power of this double hex day to do harm.
     


     

    That seems to be beneficial. That can’t be right.
     


     

    That, too.

    This is downright depressing.
     


     

    Worse than depressing – even the suicides were not increased.
     

    The data analysis showed no significant difference between Friday the 13th of October compared with our average full moon admission rate (Table 2).

    Even fewer trauma patients were seen on this day compared with other full moon days and nights. Furthermore, the present study could not show any difference in the admission rate on days with a full moon, compared with a normal day, disappointing once again a lot of believers in “hospital folklore.”[1]

     

    It isn’t proof, but there is plenty of other evidence against full moon superstition and others.

    Maybe someone will collect data on the volumes from today and compare them with normal days and with normal full moon days.

    I have written about full moon superstitions before.
     

    Blue Moon 2012 – Except parts of Oceanea – Fri, 31 Aug 2012

    2009’s Top Threat To Science In Medicine – Fri, 01 Jan 2010

    T G I Friday the 13th – Fri, 13 Nov 2009

    Happy Equinox! – Thu, 20 Mar 2008

    Footnotes:

    [1] Friday the 13th and full-moon: the “worst case scenario” or only superstition?
    Exadaktylos AK, Sclabas G, Siegenthaler A, Eggli S, Kohler HP, Luterbacher J.
    Am J Emerg Med. 2001 Jul;19(4):319-20. No abstract available.
    PMID: 11447523 [PubMed – indexed for MEDLINE]

    .

    The Power of the ‘Death’ Chant will protect Us

     

    In response to Up To, and Including, DEATH – The Anguish of Happy Medic is this comment from Garrett –
     

    Upfront, I will admit that I’ve used similar phrasing and thought it stupid at the time. I think a big part of this comes not just from the litigious nature of US society, but in the uncertainly in the litigation process.

     

    In other words, it is based on fear of the unknown.

    How does that produce a reasonable approach?
     

    I can just see it now: a minor cut which is treated with a 2×2 and tape. Done. However, a small clot gets jostled and makes its way to the brain leading to COMA and DEATH!

     

    Please provide a real example of coma death because EMS was providing accurate informed consent/refusal information, rather than a prophesy of the death of the patient.

    Otherwise, I assume that the example is an urban legend, made up to justify superstitious behavior.
     


    Image credit.
     

    On the witness stand:
    “Did you let my patient know that they could have died without advanced medical treatment?”
    “No – that’s highly unlikely and would only cause extra anxiety for the patient.”
    “So unlikely that it … happened this time? Tell me, how do you explain that to her Poor, Orphaned children?”

     

    When did that happen?

    We should stick to Happy Medic‘s intelligent description of the possible complications.

    If I am in court, my defense will be real, not a fairy tale.

    But I used the magic incantation! This is not likely to convince a jury that you are a responsible person, but it may convince them that you are responsible for a bad outcome.

    Why ignore real risks to the patient over some fixation on imaginary risks to you?

    We are there to take care of the real patient, not our phobias.

    That’s the problem – the odds of death occurring are pretty much the same as the odds of me having to testify about it.

    Please provide evidence to support your claim.

    Since this is just making up stories to scare kids sitting around the camp fire, we are just being silly.

    We are ignoring reality and looking for a magic incantation to provide a cone of protection from lawyers.
     

    This is how we lower standards in EMS.

    In a decade, or two, I expect each EMS provider to be wearing a reflective vest, a helmet (with a flashing light on the helmet), and something that makes a sound like a backup alarm at all times. Maybe there will be a warning of Danger! EMS provider. Danger! along with the beeping. Someone could trip over an EMS provider!

    As for refusals, they will be done by video link with a PA (Physician Assistant), because we have demonstrated that EMS is not capable of providing appropriate information for a person to make an informed decision about accepting/refusing care.

    If our goal to avoid responsibility, we are too irresponsible to be allowed near patients.

    .