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

- Rogue Medic

Trauma – New NBC Drama To Ridicule EMS

3 minutes and 43 seconds. No shortage of stupidity, misrepresentations, and bad examples to write about. As if we do not have enough problems in EMS, we have this onslaught of stupid.

They like helicopters. A lot. This is the same network that used helicopters to attack a doctor on ER. Twice. The same doctor. Perhaps if we were to look at helicopters as useful tools, when used appropriately, then EMS would be a lot better off. I don’t have a problem with helicopters, just with the misuse of helicopters. Maryland has been the poster child for misuse of HEMS (Helicopter EMS). Could be bad – better fly the patient. The Maryland You can’t be too careful attitude is dangerous, but it is the MIEMSS (Maryland Institute for Emergency Medical Services Systems) philosophy.

Medical helicopters in San Francisco? Really?

It has been a long time since I was in San Francisco, but I don’t remember any medical helicopters being used in the city. The city has no need for them. Manhattan, in New York city, is about the same size, but with a much larger population, but they do not need medical helicopters, either. What would be the point?

One line from the trailer is typical of how too many people view medical treatment – We are going to do everything we can!

Doing something just because you can do it. That is bad medicine. A much better line would be – We are only going to do what is appropriate, because medicine has limitations. I don’t expect to hear anything like that from this show. Dramas, such as Trauma, are a part of why people believe in homeopathy, naturopathy, and other alternative treatments that do not work. They believe that because they want it to work, it will work. Because they are special. But that is not the way that medicine works.

Yelling at dead people as a resuscitation technique? Of course. And it is effective, too. How silly of me to scoff at something that works on TV.

If you want to learn how to kill people, here is your interactive training. You see something dramatic and say, I’ve gotta do that!

The people who watch this, but do not use the opportunity to ridicule the show, may be the ones we need to worry about.

This is the Ghost of EMS Yet to Come. This is a warning of the way that EMS can be warped by those, who think that louder, faster, more intense, more hopeful, . . . is what makes a difference. Well they do make a difference, but they are all harmful. This show is medical toxic waste.

The most important part of EMS is calming everybody down.

How many people will decide on a job in EMS because of this show? These will be the wrong people for EMS. These will be people who think that they can make something work, just because they want it to work. These will be people who think that they can make something work, just because they want it to make them look good.

One small positive in the show. They do show people dealing with bad outcomes. This is something that might be presented well, but considering the rest of the show . . . .

There was a letter written to Resuscitation that described part of the problem with intubation instruction.

Many trainees reported limited supervision or hands-on training. Remarkably, however, when asked how they had therefore learned, after “trial and error”, a surprising number answered that television medical dramas had been an important influence. Almost all had seen intubation on television, and “ER” was by far the most common source.[1]

In examining the problem, they looked at how well ER portrayed positioning of the head for intubation.

We therefore assessed these three components in the 41 intubation attempts that occurred over the 42 episodes that comprised the latest two seasons of “ER”. Fourteen were excluded due to inadequate view, and 5 more involved cervical-spine precautions which precluded optimal positioning. Of the remaining 22, none (0/22) achieved more than one, let alone all three, components of optimal airway positioning.[1]

In other words, if you are trying to learn from a TV drama, I pity your patients.

You are looking at TV drama for examples of good patient care. You see that they have a bunch of people listed.

Michael Goto …. technical advisor: medical scenes / technical advisor:medical / … (101 episodes, 2003-2009)

Mel Herbert …. medical consultant (42 episodes, 2006-2009)

Greg Moran …. medical consultant (42 episodes, 2006-2009)

Jon W. Fong …. technical advisor (35 episodes, 2000-2009)

Armand Dorian …. technical advisor / medical technical advisor (13 episodes, 2007-2009)[2]

These are the medical consultants/advisors for the episodes studied. All except for Michael Goto are listed as doctors. This is what is written about how Michael Goto became a medical technical advisor on ER.

He was playing a video game online and “met” one of the “ER” property masters, who invited him onto the set. After being around for several days, he was hired as a technical assistant.[3]

He was probably just between shifts at his other job as emergency physician.

If that is what it takes to make medical decisions on ER, imagine what the qualifications are for Trauma.

He and another monkey were copulating with a football and “met” one of the “Trauma” property masters, who invited them onto the set. After being around for several days, they were hired as medical experts.

Horatio Alger would be proud.

I will use this show just as I did ER. As a tool for pointing out errors in patient care and skills performance. TV is great at providing us with object lessons. We need to be familiar enough with the backgrounds of our students to use media appropriately to educate. We need to counter the bad education of the TV drama.

Facial immersion in ice water is one of the AHA vagal maneuvers that used to be listed in the guidelines. ER could not pass up the opportunity to use it. They actually used facial immersion in ice water appropriately, but it is a hard procedure to justify. I don’t know if they used the digital circumferential sweep of the anus on ER, but that is another vagal maneuver from ACLS.


^ 1 Positioning prior to endotracheal intubation on a television medical drama: Perhaps life mimics art.
Brindley PG, Needham C.
Resuscitation. 2009 May;80(5):604. Epub 2009 Mar 18. No abstract available.
PMID: 19297069 [PubMed – in process]

^ 2 ER
Combined details

^ 3 Michael Goto