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

- Rogue Medic

Gathering of Eagles 2012 Preview

Fossil Medic posted the schedule for tomorrow’s Gathering of Eagles conference.

I wish I could be there, but it is not in my budget.

What are the most interesting topics?

The Results Are In: The Outcomes of Recent Outcome Studies!

A block of 10 minute summaries of these recent outcomes studies. Unfortunately, I do not think that 10 minutes is appropriate coverage for these, because they have some important, but subtle points that probably cannot be adequately covered in 10 minutes.

9:00am-9:10am Epileptic Fix: Hot-Off-the-Press Results from the RAMPART Trial
Jason T. McMullan, MD (Cincinnati)

I have already written a few posts about this.[1]

My 30 second coverage –

This is a well done study that confirms what we should already have been doing. IM (IntraMuscular) midazolam (Versed) works significantly faster and significantly more often than IV (IntraVenous) benzodiazepines (lorazepam [Ativan] in this case).

There was no good reason to avoid using IM midazolam as the initial treatment before this study.

There is much less reason to avoid using IM midazolam as the initial treatment after this study.

9:15am-9:25am To ITD or Not To ITD: Reconciling the ROC and ResQ Trial Results
R. J. Frascone, MD (St. Paul)

Dr. Keith Wesley should have a lot to say about this.

I wonder about the wisdom of stopping any trial early because of the appearance no difference in outcomes.

In what way is that a good idea?

A study is supposed to generate the information we need to make decisions about future treatment. If there is no apparent difference, almost no reason to stop the trial early. Most of the money is already spent. There is no increased protection to patients. The people who think the intervention was a good idea will not be satisfied that it has been convincingly shown to be useless. Subgroup analyses that might lead to hypotheses for future studies may not be possible with smaller numbers.

Stopping this early was just a bad idea. Like a kid who does not see immediate results and decides he won’t play any more.

9:30am-9:40am CIRCular Arguments: Was It Win, Lose or Draw in the CIRC
Auto-Pulse Trial ?
David E. Persse, MD (Houston)

CIRC (Circulation Improving Resuscitation Care) will probably continue to produce more excuses than benefits.

The problem is the poor quality of human CPR.

The answer is not to get a machine to perform the CPR.

The answer is to improve our understanding of CPR. We do not think about what we are doing when we are compressing the chest. All other parts of CPR are a waste, so our misunderstanding encourages us to ventilate and transport.

Ventilation has not been demonstrated to improve outcomes.

Transportation has not been demonstrated to improve outcomes.

CPR machines have not been demonstrated to improve outcomes.

We have just been making excuses for bad education, bad oversight, and bad outcomes. The AutoPulse does not improve any of these.

9:45am-9:55am A Very Cool Way to Save Lives: Intra-Arrest Therapeutic Hypothermia
John P. Freese, MD (New York)

An interesting idea.

Is this a way to decrease the damage done by epinephrine?

Is this something that does improve outcomes?

10:10 am-10:30am The Eagles Wing It: Lightning Rounds # 1
with above speakers and several others…
U.S. Metropolitan Municipalities EMS &
Federal Agency Medical Directors

This should be very interesting. Fortunately, it is 20 minutes, rather than just 10 minutes.

And a topic I write about a lot –

2:40pm-3:00pm Do You Have the Backbone for this Debate?
Is Spinal Immobilization Really Good for You?
Neal J. Richmond, MD (Louisville) vs.
Jonathan Jui, MD, MPH (Portland)

The question is easy to answer.

 

We have no evidence to support the current use of spinal immobilization.

 

None.


Image credit from Voodoo Medicine Man.

We have evidence of pain, increased neck and back pain, decubiti, and airway compromise.

There is evidence of significantly increased disability with spinal immobilization.

We all want to decrease the rate of disability among people with unstable spinal fractures. There is no reason to assume that the current method of spinal immobilization does what its advocates claim it does – protect patients from worsening injury. There is evidence that it does exactly the opposite.

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]

There is a lot more we should know about spinal immobilization, but this is the best available evidence.

Any advocate of spinal immobilization MUST come up with better evidence to justify continuing this demonstrably harmful practice.

Anything else is unethical.

Footnotes:

[1] Intramuscular Midazolam for Seizures
Rogue Medic

Part I

Part II

Part III

Part IV

Part V

Part VI

Images from Gathering of Eagles Presentation on RAMPART

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Comments

  1. Damn, I’d love to be there if I could.

    Once again, I disagree with you about the spinal immobilization study. That study is far too flawed to be of any use. There is no data on where the injuries happened, no comparison between on-scene vs. hospital assessment, and the MOI for the two hospitals provide an additional confounding factor that is unaccounted for. Without any of that info, the study says NOTHING about pre-hospital immobilization.

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