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

- Rogue Medic

Should we urinate on patients, because ‘What if it improves outcomes?’


 

This week on EMS Office Hours, Jim Hoffman, Josh Knapp, John Broyles in the chat room, and I discuss a variety of topics, but mainly the absence of any relationship between standards of care and evidence of improved outcomes for patients.
 

Merit Badges Determining Standard Of Care and…
 

How do we end up with the many organizations creating standards of care for us?

They do not create the standards of care. They write guidelines with recommendations only to consider what they claim is based on evidence. The problem is that the evidence they look for is improved surrogate endpoints, rather than improved outcomes.

If you are bleeding internally, do you want treatment that will provide a better looking blood pressure when you arrive at the hospital, even though that treatment does not appear to do anything to improve survival?[1]

If you collapse due to cardiac arrest, do you want treatment that will provide a better looking blood pressure when you arrive at the hospital, even though that treatment does not appear to do anything to improve survival?[2]

Would the outcomes be any worse, if I were to urinate on the patient?[3],[4]

Probably not – as long as we are providing appropriate BLS care.
 

Image credit.
 

The patients might even be better off, because the urine might help to keep the drugs and tubes people (paramedics, nurses, and doctors) away from the patient. The drugs and tubes seem to produce worse outcomes, so the urine would protect the patient from these worse outcomes.
 

Or we can use the excuse that is used for so many of our dangerous treatments –

We wouldn’t want anyone to be able to say that we didn’t try everything.

We don’t care how much harm we cause as long as we seem like we are doing something.

It’s the thought that counts – as long as the thought doesn’t require actual thinking.
 

Go listen to the podcast.
 

This part of the podcast was part of a discussion of what I wrote about in Should Merit Badge Organizations Define Standards of Care?

Footnotes:

[1] Evidence of improved survival from uncontrolled hemorrhage due to administration of fluids

No evidence of improved survival.

[2] Evidence of improved survival from cardiac arrest due to administration of epinephrine

No evidence of improved survival.

[3] Evidence of improved survival from uncontrolled hemorrhage due to administration of urine

No evidence of improved survival.

[4] Evidence of improved survival from cardiac arrest due to administration of urine

No evidence of improved survival.

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