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

- Rogue Medic

Is EMS Research Provincial

Also posted over at Paramedicine 101. Go check out the rest of what is posted there.

During the third episode of the EMS Research podcast – Reading EMS Research: EMS Research Episode 3 – Dr. Keith Wesley suggested that research from other countries is not as valid as US research.

One of the reasons is the varied methods of delivering EMS, with Spain and Germany using doctors on ambulances, while France and the UK often use nurses.

The study that Dr. Wesley was commenting on as not as valid to US research was a review article published in the UK.

The article examined the evidence that oxygen is harmful.

Routine use of oxygen in the treatment of myocardial infarction: systematic review.
Wijesinghe M, Perrin K, Ranchord A, Simmonds M, Weatherall M, Beasley R.
Heart. 2009 Mar;95(3):198-202. Epub 2008 Aug 15. Review.
PMID: 18708420 [PubMed – indexed for MEDLINE]

Does the location of the research matter, especially if the research demonstrates harm to patients, when determining whether we should avoid treatments?

Does oxygen cause more damage, if delivered by a nurse, or by a doctor?

Do Americans react to oxygen differently?



  1. I am one of the co-hosts from a new podcast called Standing Orders (emsstandingorders.com) and I am the associate director for prehospital research at the Mayo Clinic.

    While I haven’t heard the entire podcast by Dr. Wesley, what you posted needs clarification. To answer your question about location of research and validity, it depends.

    There are a few types of validity. Likely what Dr. Wesley is referring to is called external validity. Better understood in this way: can what was done via the methods be replicated in my current situation / system? Further, you have to understand the population where the intervention was delivered and the inclusion / exclusion criteria used for the subjects. As you can imagine, it is imperative that you read the methods section with a critical eye and consider the confounding variables taken or not taken into account.

    So while the location of the research has to be taken into consideration for comparison with your own environment, it does not mean that it serves as a litmus for throwing away data or considering it useless.

  2. France and the UK often use nurses?

    France might, I don’t know, but the UK certainly doesn’t. In the UK, nurses in the ambulance service are either dual-trained as paramedics as well, and employed as such, or have completed training as an “Emergency Care Practitioner” (a role open to both nurses and paramedics) and, in theory at least, perform a role bridging the gap somewhat between EMS and primary care, although nurse trained ECPs are a rare (or certainly not a common) breed


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