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

- Rogue Medic

Backboards, Evidence and EMS Pay – EMS Office Hours Rapid Fire September 2013


On this week’s EMS Office Hours, Jim Hoffman, Josh Knapp, and I discuss EMS pay, reimbursement for patient care, and some topics covered last week at EMS Expo in Las Vegas (the absence of evidence of any benefit from strapping people to backboards, the value of research, and continuing anti-evidence attitude of many in EMS. We even discussed why acupuncture is just a fancy placebo with a lot of hand waving and poking.

Backboards, Evidence and EMS Pay | Rapid Fire September 2013

Why do we use backboards?

Because we don’t know what we are doing and we are afraid to find out how much harm we may be doing.

Dr. Bryan Bledsoe had a great presentation The Painful Truth About Backboards, that I will cover in more detail next week.

We continue to use a flat piece of plastic/wood to try to stabilize a series of over 30 articulated bones.

We claim that the solution is to pad the voids.

We need to focus on doing what’s best for the patient, rather than trying to defend an antiquated, inefficient, traditional practice that is harmful.

Why are we defending harming our patients?

Where is the evidence of benefit?

Evidence in EMS was also covered.

Other evidence-based presentations were by Dr. Jeff Beeson (Developing Evidence-Based Protocols), Baxter Larmon (Evidence-Based Medicine in Education), Raphael Barishansky (Are You Ready for the Next Pandemic?), Dr. Peter Antevy (Pediatric Refusals Gone Wrong), Dr. Paul Pepe (Sweet Spots, Snappy Concepts & Stutter CPR), Greg Friese (Distraction is Deadly), and the keynote presentation was The Evolution of Battlefield Medical Care by Lt. Col. Robert L. Mabry, MD, FACEP. I will write about most of these as well.

The premiere of the movie Paramedico – Around the World by Ambulance was at EMS Expo. The movie is based on the book by Benjamin Gilmour, a paramedic from Australia who filmed EMS care in a variety of places around the world. The full movie is available on line at the following link –




Why do we use evidence?

Wrong question.

Why do so many of us assume that we know it all and that we cannot learn from unbiased examinations of what we do?

The part we do not seem to like is the unbiased part. We want science to confirm our biases, but the bias of science is reality.

Reality does not care what our biases are.

Too many of us think that science has to be pleasant, or that it is impolite to point out to anti-science people that they are wrong. Intentional ignorance does not deserve any respect, but intentional ignorance still is powerful in EMS.

Go listen to the podcast.

We also discussed the scams of homeopathy and acupuncture. They are just placebos. We should save our money and use treatments that work better than placebos.[1],[2],[3],


[1] A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain.
Cherkin DC, Sherman KJ, Avins AL, Erro JH, Ichikawa L, Barlow WE, Delaney K, Hawkes R, Hamilton L, Pressman A, Khalsa PS, Deyo RA.
Arch Intern Med. 2009 May 11;169(9):858-66.
PMID: 19433697

Free Full text from PubMed Central.

Real acupuncture was not any better than fake acupuncture.

In conclusion, acupuncture-like treatments significantly improved function in persons with chronic low back pain. However, the finding that benefits of real acupuncture needling were no greater than those of non-insertive stimulation raises questions about acupuncture’s purported mechanism of action.


[2] Acupuncture for treatment of persistent arm pain due to repetitive use: a randomized controlled clinical trial.
Goldman RH, Stason WB, Park SK, Kim R, Schnyer RN, Davis RB, Legedza AT, Kaptchuk TJ.
Clin J Pain. 2008 Mar-Apr;24(3):211-8.
PMID: 18287826

The fake acupuncture was significantly more effective than real acupuncture and better than individualized expert acupuncture.

The sham group improved significantly more than the true acupuncture group during the treatment period, but this advantage was not sustained 1 month after treatment ended. The difference in pain between sham and true acupuncture groups at the end of treatment (0.75 points on 10-point scale), although statistically significant, probably does not represent a clinically discernible difference.


[3] Is Alternative Medicine Really ‘Medicine’? – Part I
Sun, 28 Jul 2013
Rogue Medic

[4] Homeopathy: what does the “best” evidence tell us?
Ernst E.
Med J Aust. 2010 Apr 19;192(8):458-60. Review.
PMID: 20402610

In conclusion, the most reliable evidence — that produced by Cochrane reviews — fails to demonstrate that homeopathic medicines have effects beyond placebo.

Added 01-10-2019 – In going through some old sources, I have been making a few corrections and occasionally adding updated information, such as this more recent study showing that acupuncture is just a placebo –

Acupuncture for Menopausal Hot Flashes: A Randomized Trial.
Ee C, Xue C, Chondros P, Myers SP, French SD, Teede H, Pirotta M.
Ann Intern Med. 2016 Feb 2;164(3):146-54. doi: 10.7326/M15-1380. Epub 2016 Jan 19.
PMID: 26784863

Free Full Text in PDF format from carolinashealthcare.org

CONCLUSION: Chinese medicine acupuncture was not superior to noninsertive sham acupuncture for women with moderately severe menopausal HFs. (Hot Flashes)



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