The only reason we get away with giving such large doses of epinephrine to these patients is that they are already dead.

- Rogue Medic

Homeopathic Product Recalled for Containing Real Medicine


 

Homeopathic products are supposed to be diluted down to where they contain nothing.

They definitely are not supposed to contain antibiotics, since antibiotics were not understood when Samuel Hahnemann made up the idea of homeopathy.
 

FDA has determined that these products have the potential to contain penicillin or derivatives of penicillin, which may be produced during the fermentation process. In patients who are allergic to beta-lactam antibiotics, even at low levels, exposure to penicillin can result in a range of allergic reactions from mild rashes to severe and life-threatening anaphylactic reactions.[1]

 

The law of similars. Find a poison that produces similar symptoms, preferably not the cause of the illness (not that a homeopath would know) and dilute the poison down to nothing.

The water (or alcohol) is expected to remember the poison, but forget everything else that has been in the water, and magically cure the illness by doing the opposite of what the poison would do.

The water is diluted to 1% of what was in it enough times that there should not be any poison left. The homeopath also hits the water a lot to teach the water to remember the poison. This is the magic memory of water.

The result is nothing.
 


Image credit.
 

When blood-letting was a common treatment, this was better than going to a doctor, but still not as good as staying at home and saving your money, because who needs to go buy nothing?

The idea that the more dilute the solution, the more potent the “medicine” is ridiculous. Somebody would be able to demonstrate the differences in strengths, but homeopathy is just another placebo with just another excuse to scam people.

At what concentration of nothing does it start to work?

At what concentration of nothing does it become dangerous?

Is it still a solution when there is nothing in it?

 

Hover text –

Dear editors of Homeopathy Monthly: I have two small corrections for your July issue. One, it’s spelled “echinacea”, and two, homeopathic medicines are no better than placebos and your entire magazine is a sham.[2]

 

One of the problems with dealing with a fraud is the inability to tell the difference between incompetence and intentional fraud.

Homeopath X is a true believer. He believes that homeopathy works, but is too incompetent to keep real medicine out of his nothing.

Homeopath XX is willing to sell anything that pays. He knows that homeopathy is nonsense, but wants to add real medicine to make it seem that the water is having some sort of effect beyond a placebo effect. He adds real medicine after the dilution for that effect. This is not rare.

Homeopaths claim that their medicines are safe and that real medicines are dangerous, so why add medicine?

Since homeopathy is all lies, should we believe anything a homeopath says?

If you dilute a lie enough times, does it become truth?

We have enough problems with believing in magic with real medicines without adding the problems of homeopathy, where there is nothing real except fraud.

-

Footnotes:

-

[1] Pleo Homeopathic Drug Products by Terra-Medica: Recall – Potential for Undeclared Penicillin – Includes Pleo-FORT, Pleo-QUENT, Pleo-NOT, Pleo-STOLO, Pleo-NOTA-QUENT, and Pleo-EX
Posted 03/20/2014
FDA
Safety Alert

-

[2] dilution
xkcd
Comic

.

In Defense of No Improvement by Medic Madness – Part II

 

Continuing from Part I, in response to what I wrote about the failure of the LUCAS,[1] Sean continues with -
 

No, there isn’t much data to suggest that using a LUCAS improves outcomes. Likewise, we aren’t discovering that it’s hurting people either. So at the very worst, it’s a luxury item.[2]

 

No.

I am critical of treatments that do not work. Once we start making excuses to use these treatments, we take decades to get rid of them.
 

No difference in survival or neurological outcome was seen for up to 6 months after the cardiac arrest as, by then, the vast majority of survivors had CPC scores of 1 or 2, and most patients with initial CPC scores of 3 or 4 had either improved or died. The numbers of serious adverse events and device-related adverse events were low.[3]

 

The LUCAS failed.

Unless your idea of success is to make no difference in outcomes, because improving resuscitation outcomes is not important.
 

Moving out of the big city and going to work in an area that utilizes volunteers as first-responders means that I often find myself working a resuscitation with just me and my partner. If – and I emphasize the word “if” – we happen to get first-responders to these calls, we still have no idea what kind of training or experience they have.[2]

 

The LUCAS as an excuse to tolerate incompetence.

Over, and over, and over, . . . this has been the main argument for the LUCAS.

We can’t expect EMS to perform high quality CPR.

We are too busy doing other things that do not improve outcomes to make sure that compressions are done well.

There are only two things that a paramedic needs to make sure are done well – compressions and defibrillation.

What do paramedics want to do?

We want to do things that do not improve outcomes, because we do not understand what we are doing and are easily distracted by shiny things. Maybe they can put a flashing light on the LUCAS, or give out badges with each use, and raise the price by $5,000 $10,000.
 


Rather than courage, we can award a LUCAS Save! medal – a shiny one.
 

If I am to take Sean seriously, perhaps it will be because he has taken the same argument against intubation and advocated for protecting patients from incompetent EMS by replacing endotracheal tubes with almost foolproof LMAs (Laryngeal Mask Airways).

More consistent, frees up a set of hands, probably less liability, . . . .

What?

Sean hasn’t applied the same logic to intubation in cardiac arrest?

I am shocked. :shock:
 

I too have been a volunteer and I know the value of the care they provide. Having said that, it’s hard to get strict on training when they are already going out of their way to provide service to their community.[2]

 

I don’t blame the volunteer for the quality of care they provide when working with a paramedic right there.

I blame the paramedic.

It is my job to make sure that what is going on is done well. Compressions and defibrillation are all that matter. If I can’t manage that, intubation is definitely beyond my capabilities.
 

What’s the harm of treatments that do not improve outcomes alternative medicine?

I look at the criticisms of the actual research in Part III and Part IV.

Dr. Brooks Walsh also explains the failure of the LUCAS in this study in “We had a LUCAS save!” – No, you didn’t.

Peter Canning describes the failures of judgment in advocating for the LUCAS in Whup Kits and Chihuahuas.

-

Footnotes:

-

[1] The Failure of LUCAS to Improve Outcomes in the LINC Trial
Wed, 05 Mar 2014
Rogue Medic
Article

The LUCAS, Research, and Wishful Thinking
Fri, 07 Mar 2014
Rogue Medic
Article

-

[2] In Defense of the LUCAS
March 12, 2014
by Sean Eddy
Medic Madness
Article

-

[3] Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the LINC randomized trial.
Rubertsson S, Lindgren E, Smekal D, Östlund O, Silfverstolpe J, Lichtveld RA, Boomars R, Ahlstedt B, Skoog G, Kastberg R, Halliwell D, Box M, Herlitz J, Karlsten R.
JAMA. 2014 Jan 1;311(1):53-61. doi: 10.1001/jama.2013.282538.
PMID: 24240611 [PubMed - indexed for MEDLINE]

Free Full Text in PDF Download format from PEHSC.org.

.

Man Sues Rescuers Because of Unreasonable Expectations


 

Who encourages these unreasonable expectations? Frequently, we do.

Jamie Davis makes some important points about how we may be able to decrease these law suits. The story begins at 7:15 of the podcast, but listen to/watch the whole podcast.
 

MedicCast Episode 377
 

There is a commercial for an insurance company that has the insurance agents magically appearing at the side of the insured person and then, just as magically, transporting the insured person away from whatever danger the person had gotten himself into.

Should we be encouraging people to expect magic?

EMS person come help!
 


 

A number of cars went into Rock Creek on Sept. 12, when Dillon Road washed out. Roy Ortiz, who was among those rescued from their vehicles, could sue emergency responders claiming they did not rescue him quickly enough. ( David R. Jennings )[1]

 

Should EMS have shown up, disregarded procedures that are based on what happens when rescuers rush in and end up needing to be rescued?

We cannot help if we are in need of rescuing. Other rescuers cannot help if they are busy trying to rescue us.

No plan survives first contact intact, but that does not mean that we should rush in recklessly.

What would be the expectations in your community?

If your community is like mine, the expectation is –

EMS person come help!
 

The document claims first responders, . . . , failed to see Ortiz was trapped in the car, and that he ended up spending two hours submerged in Rock Creek until he was rescued.

In the document, Ferszt stated Ortiz survived “by pure grace.”[1]

 

He blames everyone else for getting him in to trouble, but when they get him out, he does not give his rescuers any credit. He sues all of the rescuers involved. Magical thinking is something we ought to discourage.

The article does not mention whether a backboard was used appropriately as an extrication device or whether the patient remained on the extrication board and it became a magic transportation board. Our patients are not the only one who use magical thinking.
 

Go watch/listen to the podcast.
 

-

Footnotes:

-

[1] Broomfield man rescued from Rock Creek during September floods could sue his rescuers
By Megan Quinn, Enterprise Staff Writer
Posted: 03/05/2014 11:52:53 AM MST UPDATED: 13 DAYS AGO
Denver Post
Article

.

In Defense of No Improvement by Medic Madness – Part I

 

I wrote about treatment with the LUCAS CPR machine and stated that There is no price that justifies no improvement.[1]

There are plenty people who want to justify the use of placebo treatments – treatments that do not improve outcomes. Here is one –
 

Before writing this response, I took some time to examine the equipment I use on a daily basis. Needless to say, I was shocked to discover that we spend a lot of money of items that really don’t improve patient outcomes at all. One example is the Stryker Power Cot.[2]

 

The LUCAS is a treatment that is a potential substitute for manual chest compressions.

The selling point was supposed to be that the LUCAS improves outcomes – survival with a working brain – that is the whole purpose of the research I have been writing about.
 

Thus, in clinical practice, CPR with this mechanical device using the presented algorithm can be delivered without major complications but did not result in improved outcomes compared with manual chest compressions.[3]

 

The LUCAS failed.

However, Sean is taking my statement about the outcome of a treatment and applying it to the choice of equipment.

Does a power stretcher improve the survival of patients?
 


 

I do not know of any studies that examine this question, but the stretcher is not used as a treatment. The stretcher is used as a means of moving the patient.

What Sean appears to be asking is – since I am going to use a stretcher (is there any state that does not require a stretcher in an ambulance), shouldn’t I use the cheapest stretcher that meets the requirements? Or am I going to base my decision on something other than outcomes?

Is the choice to pay more for a power stretcher based on the outcomes of patients?
 

Although I tried, I couldn’t find any studies that compared patient outcomes to those transported using a manual cot.[2]

 

It is not based on the outcomes of patients, but the choice is based on outcomes.

In a study comparing the injury rate among FTEs (Full-Time Employees), the rate of injury was cut in half after the introduction of a powered stretcher.[4]

Maybe EMS should not consider the outcomes for employees when making decisions?

What is Sean’s next gotcha?
 

Another major purchase was the LifePak 15 ECG monitor / defibrillator. Once again, I couldn’t find anything showing improved patient outcomes.[2]

 

Sean couldn’t find any evidence that waveform capnography improves outcomes for patients?[5] :sad:

Sean couldn’t find any evidence that an EMS 12 lead ECG (ElectroCardioGram) improves outcomes for patients?[6] :oops:

Sean couldn’t find any evidence that EMS defibrillation improve outcomes for patients?[7] :shock:

Perhaps Sean works in a state that does not require a defibrillator, 12 lead capability, and/or waveform capnography as minimum paramedic equipment and thinks these are just fun to have toys.

Sean appears to be suggesting that the choice of brand and options, except as mandated by EMS regulatory organizations, must be limited to the cheapest available item. Otherwise, I am misleading people by stating – There is no price that justifies no improvement.

Should I be worried at Sean’s failure to find the valid evidence, when I only provided a small sample of the valid evidence?

Does this affect Sean’s argument? The argument is really just a bait and switch – a logical fallacy known as a straw man.[8] I wrote about one thing and Sean represented my argument as something else, because he has an argument against the argument I did not make. However, his argument does not address the claim I actually did make.
 

That is not the only argument Sean makes. I address the rest in Part II, Part III, and Part IV.

Dr. Brooks Walsh also explains the failure of the LUCAS in this study in “We had a LUCAS save!” – No, you didn’t.

-

Footnotes:

-

[1] The Failure of LUCAS to Improve Outcomes in the LINC Trial
Wed, 05 Mar 2014
Rogue Medic
Article

The LUCAS, Research, and Wishful Thinking
Fri, 07 Mar 2014
Rogue Medic
Article

-

[2] In Defense of the LUCAS
March 12, 2014
by Sean Eddy
Medic Madness
Article

-

[3] Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the LINC randomized trial.
Rubertsson S, Lindgren E, Smekal D, Östlund O, Silfverstolpe J, Lichtveld RA, Boomars R, Ahlstedt B, Skoog G, Kastberg R, Halliwell D, Box M, Herlitz J, Karlsten R.
JAMA. 2014 Jan 1;311(1):53-61. doi: 10.1001/jama.2013.282538.
PMID: 24240611 [PubMed - indexed for MEDLINE]

Free Full Text in PDF Download format from PEHSC.org.

-

[4] Evaluation of occupational injuries in an urban emergency medical services system before and after implementation of electrically powered stretchers.
Studnek JR, Mac Crawford J, Fernandez AR.
Appl Ergon. 2012 Jan;43(1):198-202. doi: 10.1016/j.apergo.2011.05.001. Epub 2011 May 31.
PMID: 21632034 [PubMed - indexed for MEDLINE]

-

[5] The effectiveness of out-of-hospital use of continuous end-tidal carbon dioxide monitoring on the rate of unrecognized misplaced intubation within a regional emergency medical services system.
Silvestri S, Ralls GA, Krauss B, Thundiyil J, Rothrock SG, Senn A, Carter E, Falk J.
Ann Emerg Med. 2005 May;45(5):497-503.
PMID: 15855946 [PubMed - indexed for MEDLINE]

-

[6] Effect of prehospital triage on revascularization times, left ventricular function, and survival in patients with ST-elevation myocardial infarction.
Sivagangabalan G, Ong AT, Narayan A, Sadick N, Hansen PS, Nelson GC, Flynn M, Ross DL, Boyages SC, Kovoor P.
Am J Cardiol. 2009 Apr 1;103(7):907-12. doi: 10.1016/j.amjcard.2008.12.007. Epub 2009 Feb 7.
PMID: 19327414 [PubMed - indexed for MEDLINE]

-

[7] Treatment of out-of-hospital cardiac arrests with rapid defibrillation by emergency medical technicians.
Eisenberg MS, Copass MK, Hallstrom AP, Blake B, Bergner L, Short FA, Cobb LA.
N Engl J Med. 1980 Jun 19;302(25):1379-83.
PMID: 7374695 [PubMed - indexed for MEDLINE]

-

[8] Straw man
Wikipedia
Article

.

More EMS Agencies Eliminating Backboards

 

All of these departments are going to get in trouble for not using backboards – aren’t they?

Trouble?

For not harming patients with witchcraft?

Does that really happen?

Or is it just another EMS myth?
 


 

RIO RANCHO, N.M. (KOB) – When the call is made, firefighters and paramedics quickly respond to the scene of an accident. Their goal: get the victim out of harm’s way and to the hospital. Most first responders in the country still pick up a person and strap them onto a board similar to this one no matter what. That will no longer be the case in the City of Vision. Dr. Darren Braude, the Medical Director for the Rio Rancho Fire Department, says the feedback has been excellent regarding the new method.[1]

 

The typical response is –

But I could be sued and then the patient will own the department and this magic treatment prevents badness!!!11!!!!

Is there any truth to that?

I could be sued?

We can be sued for anything. The backboard has nothing to do with whether we can be sued. Frivolous law suits are expected to be dismissed by the judge. The plaintiff needs to convince a jury that there was harm as a result of our actions to win a law suit. I am not a lawyer, but this is what lawyers tell me.

The backboard, and the harm it may cause, may be what justifies a law suit being successful against us and our departments.

The backboard is a magic treatment.

Magic = belief that X works, even though there is no valid evidence that X works.

Using that definition, we can see that backboards are no better than magic.

There is no evidence that backboards prevent injury.

There is no evidence that backboards protect patients with unstable spinal injuries from disability.

There is evidence that backboards make disability more likely – disability is twice as likely with backboards.

Since there is no evidence of benefit, and plenty of evidence of harm, should we just stop pretending that we are good witches and helping patients? Clearly, we are not helping patients.
 


Image credit from Voodoo Medicine Man.
 


 

RESULTS:
There was less neurologic disability in the unimmobilized Malaysian patients (OR 2.03; 95% CI 1.03-3.99; p = 0.04). This corresponds to a <2% chance that immobilization has any beneficial effect. Results were similar when the analysis was limited to patients with cervical injuries (OR 1.52; 95% CI 0.64-3.62; p = 0.34).
[2]

 

What is our liability?

We need to understand what we are doing, because ignorance is not a good defense.

If our defense is – I am too stupid to be competent – we should not expect to win any law suit.

If we were constantly asking, Is this going to be on the test? – well, real patient care situations are the test that really matter. Life is the test.

 

it may be common or customary for EMS providers to use a long spine board or collar, decisions of standard of care and negligence are not based on what is the best, reasonable care, not on what is usually done.66 [3]

 

If we are providing bad patient care, because that is what everyone else is doing, we are failing our patients.

We are failing the test.
 

Rio Rancho Fire Department, Albuquerque Fire Department, and Bernalillo County Fire Department will be making this change.

Thanks to Dr. Darren Braude and everyone else involved.
 

If I have not written about your system, tell me about how your system has eliminated the requirement to use a magic backboard for trauma.
 

Here is what I have written about other systems that do not require backboards for trauma –
 

Another System Eliminates Backboarding for Potential Spinal Injuries
 

The Lateral Trauma Position: What do we know about it and how do we use it
 

The Slow, Agonizing Death of Conventional Spinal Immobilization
 

Stop the Madness! Reducing Unnecessary Spinal Immobilizations in the Field – Part I
 

-

Footnotes:

-

[1] NM Fire Department Using Alternative to Backboards – Rio Rancho looks at new evidence on immobilization
Monday, March 10, 2014
JEMS
Article/Video

-

[2] Out-of-hospital spinal immobilization: its effect on neurologic injury.
Hauswald M, Ong G, Tandberg D, Omar Z.
Acad Emerg Med. 1998 Mar;5(3):214-9.
PMID: 9523928 [PubMed - indexed for MEDLINE]

Free Full Text from Academic Emergency Medicine.

-

[3] Board to Death – The state of prehospital spinal injury care in 2013
Rommie L. Duckworth, LP
Created: July 15, 2013
EMS World
Article

.

Who Needs a 12 Lead ECG?

ResearchBlogging.org
 

Do we do too many 12 lead ECGs on patients who do not have chest pain?

This is something that some people worry about.

Save the electrodes!

Those poor little electrodes are being abused!

Are electrodes being abused?
 

Women and the elderly with STEMI are particularly likely to present with atypical chief complaints such as dyspnea and weakness. Such patients experience significant delays in door-to-ECG time and treatment and have increased morbidity and mortality compared with patients who present with chest pain.5,9-12 [1]

 

Tiredness/weakness is the second best predictor of STEMI (ST segment Elevation Myocardial Infarction).

After chest pain (pressure, tightness, heaviness, squeezing, et cetera), the best predictor of STEMI is dyspnea in akll age ranges, but dyspnea indicates 20% of STEMIs in patients over 80 years old.

Are we helping anyone by avoiding 12 lead ECG (ElectroCardioGram) assessment?
 

Presenting chief complaints among 6,464 patients with STEMI. Chest pain decreased in frequency with age, whereas a chief complaint of dyspnea, weakness, syncope, or altered mental status all increased in frequency with age.[1]

 


Click on images to make them larger.
 


 

The advantage of a logarithmic chart is that there is greater distinction among the smaller numbers (such as the other complaints that make up less than 5% in the image above). The disadvantage is that large changes are flattened. I modified the dyspnea line to show how it would look on a linear scale (from 5% to 20%). As you can see, the ability to predict STEMI increases dramatically with age – more dramatically than the logarithmic scale suggests.
 


 

How should we remember all of this?

The authors came up with a nice simple flow chart (below).

This is for the ED, but is there a good reason for EMS to ignore these STEMIs?
 


 

Even in the 18-49 year old patients, dyspnea is about as likely to predict a STEMI as weakness is likely to predict a STEMI in an 80+ year old patient.

Chest pain still indicates about 50% of STEMI patients over 80, but we will miss half of STEMIs in this population if we only do 12 leads on chest pain patients.

Can an 80+ year old patient have a good quality of life after a STEMI?

Absolutely.

Also see When should you get an ECG? at Mill Hill Ave Command.

-

Footnotes:

-

[1] Development and validation of a prioritization rule for obtaining an immediate 12-lead electrocardiogram in the emergency department to identify ST-elevation myocardial infarction.
Glickman SW, Shofer FS, Wu MC, Scholer MJ, Ndubuizu A, Peterson ED, Granger CB, Cairns CB, Glickman LT.
Am Heart J. 2012 Mar;163(3):372-82. doi: 10.1016/j.ahj.2011.10.021.
PMID: 22424007 [PubMed - indexed for MEDLINE]

-

Glickman SW, Shofer FS, Wu MC, Scholer MJ, Ndubuizu A, Peterson ED, Granger CB, Cairns CB, & Glickman LT (2012). Development and validation of a prioritization rule for obtaining an immediate 12-lead electrocardiogram in the emergency department to identify ST-elevation myocardial infarction. American heart journal, 163 (3), 372-82 PMID: 22424007

.

The LUCAS, Research, and Wishful Thinking


 

Does the LUCAS improve outcomes?

No. The authors state that clearly.[1]

Do people think that we should use the LUCAS anyway?

Yes. The excuses are presented by many people.

What are the possible benefits?

1. The LUCAS allows us to free up a pair of hands to do other things that do not benefit the patient, so this adds nothing useful.

2. The LUCAS allows us to transport the patient safely. This is a rehash of #1, since routine transport does not improve outcomes.

3. Treatment will be consistent, regardless of the quality of the EMS. Rather than improve quality, we will have a machine take over something we think is done poorly, so that EMS can harm the patient by doing other things poorly.

4. The LUCAS can take over one of the two treatments that can improve outcomes. An AED can take over the other. We no longer need to have EMS respond to cardiac arrest calls until after ROSC (Return Of Spontaneous Circulation).

If the dramatic success of Seattle is due mostly to the frequency of bystander CPR, that would suggest that the best use of the LUCAS is in the hands of bystanders, not EMS.
 


Download YouTube Video | YouTube to MP3: Vixy
 

If that is too much adult material, we can do the version for kids.
 


Download YouTube Video | YouTube to MP3: Vixy
 

Or we can do the version for toddlers.
 


Download YouTube Video | YouTube to MP3: Vixy
 

If EMS cannot manage that, should we be giving them equipment to free them up to mess up intubation or drugs or other things that do not improve outcomes.

Why are we so eager to add treatments that do not help patients?

Ethical patient care means limiting ourselves to treatments that improve outcomes.
 

Dr. Brooks Walsh also explains the failure of the LUCAS in this study in “We had a LUCAS save!” – No, you didn’t.

Also see -

The Failure of LUCAS to Improve Outcomes in the LINC Trial

-

Footnotes:

-

[1] Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the LINC randomized trial.
Rubertsson S, Lindgren E, Smekal D, Östlund O, Silfverstolpe J, Lichtveld RA, Boomars R, Ahlstedt B, Skoog G, Kastberg R, Halliwell D, Box M, Herlitz J, Karlsten R.
JAMA. 2014 Jan 1;311(1):53-61. doi: 10.1001/jama.2013.282538.
PMID: 24240611 [PubMed - indexed for MEDLINE]
 

The current sample size has a 95% confidence interval for the 4-hour survival ranging from −3.3% to +3.2%. Translated another way, while the point estimate for treatment effect was near 0.0, our study could not rule out the possibility of a 3.2% benefit or a similarly sized harm from mechanical CPR relative to standard CPR.

 

Not just not helpful, but this could be harmful.

.

Issues and Challenges Discussed by Medical Directors at Eagles Conference – Part 2

 

Continuing from Part 1, where A.J. Heightman writes that there are several issues that are important to the medical directors attending the Gathering of Eagles. The conference is over. Here are the rest of the issues –
 

Need for exchange of data between hospital and EMS systems;[1]

 

I can find out what happened to my patients much more easily than most people, because I know the unofficial ways to get the information.

That should not be necessary and HIPAA does allow sharing of this information.
 

Active Shooter management, policies and integration issues, particularly in their Police & EMS integration;[1]

 

It isn’t about who is in charge.

It is about having everyone recognize the same person as being in charge and having that person know how to handle the scene. The person should probably be a specialist, rather than cross-trained to do everything with just the appearance of minimum competence.
 


Images credit from Life in the Fast Lane.
 

STEMI transfers – Hospital are demanding valuable ALS resouces to transfer STEMI and stroke patients when, in some cases, BLS units could handle the task;[1]

 

Why were these patients taken to hospitals that need to transfer the STEMI and stroke patients?

If they were transported by paramedics initially, what good is that kind of paramedic during any transport.

I can’t recognize a stroke or a STEMI, but I am here because you think I am someone who understands strokes and STEMIs.

If the problem is that the protocols require transport to the wrong hospitals, change the protocol.
 


 

Intranasal Narcan delivery by police and firefighters (There is a national push for this by responders who arrive on scene before EMS);[1]

 

It is popular?

So was blood-letting.

Being popular does not mean that it is safe, effective, or a good idea.

What about the well documented opioid overdose mimics that paramedics have trouble with – stroke, hypoglycemia, seizures, et cetera?

What are the outcomes for these patients in systems that make naloxone a BLS treatment, or even just an advanced first aid treatment?
 

Consistency in approach to patient refusals;[1]

 

The patient has the capacity to make informed decisions.

EMS is able to provide adequate information for a person to make an informed decision.

EMS is not coercing refusals.

EMS is competently assessing patients and communicating with patients.
 

Use of video laryngoscopes and capturing the data from them for QA review and documentation;[1]

 

Maybe we should find out if video laryngoscopy is the right tool before we make it the standard of care.

EMS loves standards of care. We don’t care how dangerous they are.
 

Limited funds to bring people in for continuing education;[1]

 

More than continuing – expanding education.

Keeping up with original paramedic education is not enough.

What we need to know changes. We need to keep up, with the changes, not with the past.
 

Airway management and monitoring (particularly failure by crews to use waveform capnography) continues to be an issue;[1]

 

The medic did not include waveform capnography tracings with the chart?

There is less than 100% QA/QI/CYA of intubations?

The medical director does not understand waveform capnography, airway management, and/or oversight?

Not using waveform capnography is due to a critical failure of management that has been adopted by paramedics who have a ceremonial understanding of EMS – enough to pass a test to get a patch, but not enough to provide competent care.

-

Footnotes:

-

[1] Issues and Challenges Discussed by Medical Directors at Eagles Conference – Editor-in-Chief A.J. Heightman reports from the 2014 Eagle Creek Retreat in Dallas
A.J. Heightman, MPA, EMT-P
Wednesday, February 26, 2014
JEMS
Article

.