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

- Rogue Medic

The Myth of Response Times

In response to my post A Comment on Myths and the 2015 ACLS Cardiac Arrest Algorithm, which contains a quote from 2015 ACLS Cardiac Arrest Algorithm is an objection from Tom Bouthillet of EMS 12 Lead.

The response suggests that I got Tom’s ST segment a bit elevated, but that was not my intention. Goozfraba, Tom.

First, I should repeat my objectionable statement, since that is what Mr. M objected to as well. Mr. M’s objection was by reference to The Myth of the Golden Hour.

SSM (System Status Management) continues to burn out crews and vehicles, but some administrators continue to believe. Since they administrate in back offices, we do not know where their hands are. Improved response times? The difference in response times is insignificant and response times have never been shown to be important outside of cardiac arrest.

Tom avoids incantations of The Myth of the Golden Hour, but his more eloquent wording amounts to essentially the same thing.

The Myth of Response Times.


Image information at Wikipedia.

No, Tim, the bizarre claim that response times are insignificant comes from non-fire based EMS and their desperate attempt to show that their inability to respond to emergencies in a timely manner is irrelevant.

Gosh, Tom, do you have anything to support that claim?

When did you become a spokesperson for the IAFF (International Association of Fire Fighters)?

Show me the fire based EMS research that provides support for The Myth of Response Times. Please.

Craig D. Newgard, MD, MPH wrote –

To date, patients with out-of-hospital cardiac arrest remain the only field-based patient population with a consistent association between time (response interval) and survival.18,19 Despite the paucity of outcome evidence supporting rapid out-of-hospital times for the broader population of patients activating the 911 system, EMS agencies in North America are generally held to strict standards about intervals, particularly the response interval.[1]

Tom, are you claiming that Dr. Newgard is a part of some sort of non-fire based EMS Illuminati?

Or is that non-fire based EMS, but desperate Illuminati?

Are strict standards good, if they are irrelevant and lead to promotion of myths?

Fire based EMS may be held to many strict standards, but that does not mean that these are in any way relevant to patient care just because they are strict standards. Standards Of Care are just the popular adoption of a temporarily appealing mythology.

We are discussing fashion, not function. Just like having your nail polish match your panties. I admit that I do not know how strict fire based EMS is on a standard for polish/pantie pairing. What if one if fire red, but the other is fire engine red? How strict is the standard? Lives are at stake. Think of the children. Tom, if you do not wear nail polish, does that mean that you go commando? Think of the children. Think of the strict standards based on our old friend wishful thinking.

The problem is that third-service EMS can’t function without fire department first response but it’s become the monster that’s slipped its leash.

Really?

Systems that do not have fire department first response can’t function?

Based on what?

Why not have the police provide first response?

I have worked in places where the police do provide first response, so I know it can be done – and done well.

A police officer meets me on scene and provides a brief report on the patient’s condition, a list of medications, allergies, and history. The patient would already have oxygen, immobilization, or other BLS treatments initiated by the same police officer prior to my arrival. One officer in one police car.

Is this a continuation of that charming rivalry between fire and police that led to excessive deaths on 9/11/2001? When The Finest and The Bravest compete to be The Dumbest, we all lose.

When we let our dislike for the personality, or job category, or skin color, or gender, or politics, or sexual orientation, or religion, or native country, or anything else that is irrelevant to patient care affect how we work together, we need to abandon all claims at responsibility. We abandon credibility if we let the irrelevant dictate patient care.

Why not have the post office provide first response?

Or we could train the public to provide Hands-Only Compressions. Without bystander chest compressions, most cardiac arrest response times are too long. And cardiac arrest is the only condition with evidence of benefit from quick response times.

It really doesn’t matter anyway because it’s the taxpayers through their elected representatives who decide what kind of response times they’re willing to pay for,

You start out by claiming that fire based EMS is doing what is best for patient, but end up stating that this is just politics. We know that the public has no understanding of good patient care, so why pretend that the opinions of the public have anything to do with whether response times make a difference?

Yes, the public has been sold The Myth of Response Times.

The public used to believe that the world was flat. That did not make the world flat.

Why can’t you come up with some evidence that response times are relevant to outcomes?

and if that doesn’t having milk shooting out your nose,

It’s a little early for milk.

you know how I feel about the fun and games associated with response time reporting. It’s time for everyone to grow up and work together because it doesn’t matter what response times are reported.

And you know how I feel about the fun and games associated with promoting myths.

It’s time for everyone to grow up and work together, because myth-based EMS harms patients.

Myth-based EMS delays efficacious treatments.

Myth-based EMS encourages/sets strict standards for treatments that have no potential for benefit, but plenty of potential for harm.

Myth-based EMS encourages lowering our lowest common denominators even more than we already have in our delusional quest for faster response times.

What is your quest?

I seek the Holy Grail of universal fire based EMS.

What is your strict standard for response times?

7 minutes and 59 seconds in 90% of responses.

What is this based on?

Purely psychological manipulation of those who do not know any better.

Right. Off you go.

What matters is whether or not patients live or die.

Other than for cardiac arrest, what does that have to do with response times?

You can have excellent response times on paper and abysmal survival from sudden cardiac arrest. Clearly there’s more to EMS quality than how fast the meat wagon shows up. But insignificant? You need to ventilate your office my friend.

Then provide some evidence that, other than for cardiac arrest, response time is in any way significant.

As long as people keep claiming that response times are important, I will keep pointing out that this is just The Myth of Response Times.

We used to bleed patients to get rid of their bad humors.

Now, everybody knows how dangerous that is.

Except.

Back then, everybody knew that it was significant.

And it was significant, because if you bleed everyone, you will kill some people, but we didn’t know any better.

How is this myth any different from that myth.

Why are we still encouraging a belief in mythology?

 

More frantic ≠ better.

 

More rushed ≠ better.

 

More attention to the wrong details ≠ better.

 

Tom, you know better than to believe in magic response times.

Footnotes:

[1] Emergency medical services intervals and survival in trauma: assessment of the “golden hour” in a North American prospective cohort.
Newgard CD, Schmicker RH, Hedges JR, Trickett JP, Davis DP, Bulger EM, Aufderheide TP, Minei JP, Hata JS, Gubler KD, Brown TB, Yelle JD, Bardarson B, Nichol G; Resuscitation Outcomes Consortium Investigators.
Ann Emerg Med. 2010 Mar;55(3):235-246.e4. Epub 2009 Sep 23.
PMID: 19783323 [PubMed – indexed for MEDLINE]

Free Full Text with link to Free Full Text PDF Download from PubMed Central

.

Comments

  1. Here we go, battle of the minds… and… go

  2. Would just like to chip in that London Ambulance, a “third service” ems service, responds perfectly well without the fire brigade doing first response work whatsoever.

  3. What about the studies done in Toronto, by the Toronto FD none the less, that showed no correlation between response times and patient outcome (with 3 noted exceptions I believe, maybe 4). They also did a second study that showed the majority of FD first response was completely unnecessary and a waste.

    And to anon, I visited the LAS headquarters and dispatch center. What an operation! Very awesome.

  4. The Eagles benchmarking paper in 2008 sited problems with using response times to measure performance. Crews either burn out from ssm schemes or don’t get enough exposure to sick patients to get good at treating them. Fast response times say nothing about the quality of care, and may actually make it worse.

Speak Your Mind