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

- Rogue Medic

Happy Friday the 13th – New and Improved with Space Debris


This is not your regular scary old Friday the 13th. This one is new and improved with Death from the Skies! Not the great book by Phil Plait, just the fear and anxiety of the What if . . . ?

This debris will not cause any harm to anyone, but the whole idea of superstition is to fear the unknown and come up with other superstitions to provide a feeling of control over the unknown. But look at the bones name!


It’s got to mean something!

It couldn’t just be a coincidence!

Those phrases are the basis of a lot of superstition and conspiracy theories.

For example, psychics aren’t going to be completely wrong all of the time, so they claim that their vague prediction, that is almost right if you ignore most of what really happened, is proof of their abilities, when it is only to be expected that nobody will be completely wrong all of the time unless they make very few predictions. Psychics make a lot of predictions in order to be able to say they got something right. Nostradamus was given credit for this for centuries, but he is just another one who makes vague predictions that cannot all be completely wrong.

Sylvia Browne is one of the most famous people to take advantage of this. She gets everything wrong, but spins it so that those who want to believe can ignore reality and continue to believe pay her millions of dollars.

Is a bunch of WTF debris on Friday the 13th something to worry about? No.

Our lack of understanding of probability is what we should really worry about. People do lie with statistics, but people lie much more often with words. How often do people claim that we should not understand English, because people lie with English? Why should we choose willful ignorance of probability and statistics, when the same argument would be ridiculed if it were made for something we like?


Florida County Eliminates Use of Magic Backboards for Possible Spinal injuries


More medical directors are rejecting the superstition that it is acceptable to harm patients to prevent fear of law suits.

There is no evidence that backboards do anything to protect the spine, but there is plenty of evidence that backboards cause harm.[1]


All treatments have side effects, so we need to have evidence of benefit to justify exposing our patients to those side effects. A treatment that does not provide any benefit to the patient exposes the patient to the side effects, but does not provide any benefit. This is indefensible, but many doctors, nurses, paramedics, basic EMTs, and others continue to defend this magical thinking and oppose EBM (Evidence-Based Medicine).

Fortunately, the defenders of superstitious nonsense seem to be losing support for belief in the magical properties of backboards.

Palm Beach County Fire Rescue just became one of the first agencies in the state to stop the use of rigid backboards for spinal immobilization.[2]



Instead of using the backboard, patients will be placed on a padded stretcher. Cervical collars will still be used when necessary to provide cervical stabilization.[2]


“The new procedures will reduce pain and suffering of patients, reduce complications, decrease on scene times and reduce injuries to crews who are attempting to carry immobilized patients,” said Cpt. Albert Borroto in a news release.[3]


Palm Beach County Fire Rescue joins a growing list of EMS agencies that are putting patients ahead of superstition –

Agencies/EMS Systems Minimizing Backboard use –

Let me know if I should add your agency to this list.

Alameda County

Albuquerque-Bernalillo County Medical Control Board

Bernalillo County Fire Department

CentraCare Health
Monticello, MN

Connecticut, State of

Durham County EMS

Eagle County Ambulance District

HealthEast Medical Transportation
St. Paul, MN

Johnson County EMS

Kenosha Fire Department
Kenosha, WI

Maryland, State of

MedicWest Ambulance

Milwaukee EMS

North Memorial Ambulance & Aircare
Minneapolis, MN

Palm Beach County Fire Rescue

Rio Rancho Fire Department

SERTAC (Southeast Regional Trauma Advisory Council)

Wichita-Sedgwick County EMS System

Xenia Fire Department
Xenia, OH

Outside of the US –

St. John Ambulance
New Zealand


Queensland, Australia


[1] New Kansas EMS policy limits use of backboards
Tue, 01 Apr 2014
Rogue Medic

[2] Palm Beach County Fire Rescue changes the way first responders handle patients
Katie Johnson
5:57 PM, Dec 10, 2014
5:40 AM, Dec 11, 2014
WPTV5 West Palm Beach

[3] Palm Beach County Fire Rescue making changes for backboard use
WPTV Webteam
8:47 AM, Dec 10, 2014
7:35 PM, Dec 10, 2014
WPTV5 West Palm Beach


Since the World is Ending Today, What Should We Do?


Oh no! It is the end of the world, again. What should we do?

If the end of the world causes you anxiety, you are probably already prescribed some anti-anxiety medicine. I recommend that you follow the directions on the label and stop annoying less anxious people. Avoid combining your sedatives with other sedatives (alcohol, heroin, propofol, . . . ) and find a way to distract yourself from what you do not understand.

Lunar activity is said to mark the END OF TIME, with some religious groups believing it to be a sign of the JUDGEMENT DAY.[1]


The end of times has probably been predicted since before writing was first used to record anything. There is one consistent thing about these predictions. They have been completely wrong. Eventually, one will be right, but that will probably be something we learn about from scientists, who will be the first to observe evidence of any problems.

What do scientists predict about the super moon? It will appear a little bit bigger and brighter than most normal full moons. That will be the only noticeable difference from a normal full moon.

Lunar activity is said to mark the END OF TIME, with some religious groups believing it to be a sign of the JUDGEMENT DAY.[1]


We are still waiting and none of the predictions have come true. None of the predictions are any more likely than any other predictions.

But what about he tsunami caused by a super moon?

Supermoons have been proven to cause sea levels to rise as the gravitational pull of the Earth’s closest neighbour increases as it gets closer.[1]


That is not true.

The relative amount of influence is proportional to the object’s mass and distance from the earth.[2]


The difference in distance will be tiny.

Here is what the distance will be from our planet to the super moon.

Aug 10 5:46 PM         356,922 km         221,796 mi         Closest for this year [3]


And here is what the distance was for the full moon on January 1, 2014.

Jan 1 9:01 PM         356,945 km         221,811 mi [3]


Only 15 miles different.

There is one important thing to understand about a 15 mile difference in the distance between the moon and us. It is not something that humans can notice without machinery to measure the distance.

Jul 28 3:39 AM         406,547 km 252,634 mi         Farthest away this year [3]


That is a difference of 30,838 miles between the farthest and closest distances. That is a 12% difference. The difference between the 2nd closest full moon and the super moon is 15 miles.


Or 1 our of 14,787. If this is seen by some as prophetic, important, or ominous, it is because those describing the problem lack all sense of perspective.

Some people are claiming that this is important, because they have no idea what they are commenting on, or they are trying to profit from the gullibility of others, or . . . .

But the moon being this close is unprecedented!

Jan 30 8:59 AM         356,606 km         221,600 mi         Closest for this year[4]


That was the closest distance between the moon and the earth in 2010. 221,600 miles. Today’s end of the world distance – because it is so incredibly close – is 221,796 miles or 196 miles farther than it was in 2010. So much for unprecedented. So much for scary.

If you think that the minuscule difference in distance was enough to cause a disaster, you seem to have the same problem with perspective as the prophets of doom.

If this were indeed the case, we would expect to see a correlation between rate at which earthquakes occur and the perturbations to the gravitational field. The dominant perturbation in the earth’s gravitational field generates the semi-diurnal (12 hour) ocean and solid earth tides which are primarily caused by the moon (due to its proximity) and the sun (due to its large mass). No significant correlations have been identified between the rate of earthquake occurrence and the semi-diurnal tides when using large earthquake catalogs.[2]


No valid mechanism, no perspective, and no evidence?

The only thing useful out of this is as another example of frauds taking advantage of the vulnerable, but we have no shortage of examples of that. We don’t even have a shortage of people defending the frauds.


[1] SUPERMOON LIVE: Beautiful lunar event could trigger ‘END OF DAYS’
By: Nathan Rao
Published: Sun, August 10, 2014
Sunday Express

[2] Can the position of the moon or planets affect seismicity?
Earthquake FAQ
Berkeley Seismological Laboratory Outreach Program

[3] Moon distances for UTC
Information page

[4] Moon distances for UTC
Information page


Friday the 13th and full-moon – the ‘worst case scenario’ or only superstition?

Today we get hit with a double whammy – Friday the 13th and a full moon. This will not happen again until August of 2049.

Is there anything about Friday the 13th, or the full moon, or the combination that would make today worse than usual?

Let’s look at the evidence.

The last combination of Friday the 13th and a full moon was in October 2000. Somebody decided to compare patient volumes by category against other full moon days and also against the average volume.

One of the oldest superstitions is about Friday, the number 13, and a full moon. There exists a very popular belief in the relationship between the number 13 and Friday as well as the moon’s phase and the incidence of bad luck. Among the emergency department “folklore” belongs the theory that shifts on such dates are always busy ones.[1]


We compared the number of overall admissions divided into medical, nontrauma-related surgical emergencies, mild and moderate trauma, multiple injured patients, and attempted suicides, on the full moon days and nights from February 2000 to Friday, October 13, 2000 with the average admission rate per day during this period.[1]


Here are the numbers.


Nothing unusual there.


Still nothing unusual.


A higher number of non-trauma surgical emergencies on Friday the 13th with the full moon, but this is the only one category. Does anything else suggest a connection?

Trauma will clearly show the power of this double hex day to do harm.


That seems to be beneficial. That can’t be right.


That, too.

This is downright depressing.


Worse than depressing – even the suicides were not increased.

The data analysis showed no significant difference between Friday the 13th of October compared with our average full moon admission rate (Table 2).

Even fewer trauma patients were seen on this day compared with other full moon days and nights. Furthermore, the present study could not show any difference in the admission rate on days with a full moon, compared with a normal day, disappointing once again a lot of believers in “hospital folklore.”[1]


It isn’t proof, but there is plenty of other evidence against full moon superstition and others.

Maybe someone will collect data on the volumes from today and compare them with normal days and with normal full moon days.

I have written about full moon superstitions before.

Blue Moon 2012 – Except parts of Oceanea – Fri, 31 Aug 2012

2009’s Top Threat To Science In Medicine – Fri, 01 Jan 2010

T G I Friday the 13th – Fri, 13 Nov 2009

Happy Equinox! – Thu, 20 Mar 2008


[1] Friday the 13th and full-moon: the “worst case scenario” or only superstition?
Exadaktylos AK, Sclabas G, Siegenthaler A, Eggli S, Kohler HP, Luterbacher J.
Am J Emerg Med. 2001 Jul;19(4):319-20. No abstract available.
PMID: 11447523 [PubMed – indexed for MEDLINE]


The Power of the ‘Death’ Chant will protect Us


In response to Up To, and Including, DEATH – The Anguish of Happy Medic is this comment from Garrett –

Upfront, I will admit that I’ve used similar phrasing and thought it stupid at the time. I think a big part of this comes not just from the litigious nature of US society, but in the uncertainly in the litigation process.


In other words, it is based on fear of the unknown.

How does that produce a reasonable approach?

I can just see it now: a minor cut which is treated with a 2×2 and tape. Done. However, a small clot gets jostled and makes its way to the brain leading to COMA and DEATH!


Please provide a real example of coma death because EMS was providing accurate informed consent/refusal information, rather than a prophesy of the death of the patient.

Otherwise, I assume that the example is an urban legend, made up to justify superstitious behavior.

Image credit.

On the witness stand:
“Did you let my patient know that they could have died without advanced medical treatment?”
“No – that’s highly unlikely and would only cause extra anxiety for the patient.”
“So unlikely that it … happened this time? Tell me, how do you explain that to her Poor, Orphaned children?”


When did that happen?

We should stick to Happy Medic‘s intelligent description of the possible complications.

If I am in court, my defense will be real, not a fairy tale.

But I used the magic incantation! This is not likely to convince a jury that you are a responsible person, but it may convince them that you are responsible for a bad outcome.

Why ignore real risks to the patient over some fixation on imaginary risks to you?

We are there to take care of the real patient, not our phobias.

That’s the problem – the odds of death occurring are pretty much the same as the odds of me having to testify about it.

Please provide evidence to support your claim.

Since this is just making up stories to scare kids sitting around the camp fire, we are just being silly.

We are ignoring reality and looking for a magic incantation to provide a cone of protection from lawyers.

This is how we lower standards in EMS.

In a decade, or two, I expect each EMS provider to be wearing a reflective vest, a helmet (with a flashing light on the helmet), and something that makes a sound like a backup alarm at all times. Maybe there will be a warning of Danger! EMS provider. Danger! along with the beeping. Someone could trip over an EMS provider!

As for refusals, they will be done by video link with a PA (Physician Assistant), because we have demonstrated that EMS is not capable of providing appropriate information for a person to make an informed decision about accepting/refusing care.

If our goal to avoid responsibility, we are too irresponsible to be allowed near patients.


The Main Stream Media and Superstition

Tomb of Lazarus image credit.

This sad story is resulting in a lot of promotion of superstition.

A girl went in for a routine operation and died.

My condolences go out to the family.

The mother of a 13-year-old Northern California girl declared brain dead after a routine tonsillectomy says her daughter had expressed fears she wouldn’t wake up after the surgery.[1]


This is the kind of comment that people will use to promote the superstition of precognition and other psychic powers.

Did she know what was going to happen?


Did she worry about what was going to happen?

Yes, it is what people do. We worry.

Is there any connection between that worry and the outcome?

There is no reason to believe that there is any connection.

The family claim to need time for a miracle.

“The medicine has not worked. It’s time to let God work,” said Omari Sealy, McMath’s uncle. “We are calling on God and calling on our faith.”[2]


How much time does it take for a miracle?

Since miracles defy the laws of nature, no time would be needed.

Why is life support needed for a miracle?

Since miracles defy the laws of nature, no life support would be needed.

No time or equipment is needed for a miracle.

Only a suspension of the laws of nature is needed for a miracle, so depriving other children of the care that could be provided by the staff and equipment devoted to this brain dead child is not necessary.

What is the history of miraculous recovery from death?

Lazarus and Jesus.

What kind of life support did they have?


Take a look at the picture. A morgue is more high tech than that tomb.

What kind of legal injunction did they require?


Both were buried in tombs.

The family could make an arrangement with a mortuary to wait for a miracle, but they should not interfere with the care of other patients who are not dead.

Is that cold?

Does the belief in miracles depend on the use of medicine?

Medicine cannot do anything for brain death, so requiring the use of medicine is of no benefit to the child.

Being cold allows other children to receive the care that could be provided by the staff and equipment devoted to this brain dead child.

This family is going through something no family should go through, but they are increasing the likelihood of another family having a bad outcome by depriving other patients of care.

Miracles are not a part of medicine.


[1] California girl had fears before tonsil surgery
By Associated Press,
Updated: Friday, December 20, 12:01 PM
Washington Post
Health & Science

[2] Family of Comatose Teen Battles Hospital for ‘Time to Let God Work’
Dec. 18, 2013
By Colleen Curry
Good Morning America


Happy Friday the 13th

This is a day for superstitious people to pretend that there is some sense to their superstition.

The number 13 will somehow cause bad things to happen.

This is from the elevator of the local Best Hospital in the World. While it is an administrative decision, what about administrative decisions that affect patient care.


When we make decisions based on superstition, how much harm do we do to our patients?

We will probably never know, because we use superstition to justify ignoring evidence or to justify preventing research to obtain evidence.

A black cat crossing your path will somehow cause bad things to happen.

A backboard and collar forced on a patient will somehow protect the spine from forceful worsening of an injury.[1]

A broken mirror will somehow cause bad things to happen.

Giving fentanyl to someone in pain will prevent them from giving consent to treatment.[2]

Speak of the devil and he will appear.

Response times matter for patients who are not dead.

This is based on superstition, because the only response times that have been shown to matter are for cardiac arrest.[3]

How much less superstitious are people in medicine than anyone else?

Probably even more superstitious.

Identifying information obscured to protect the superstitious.

People will wave their hands around to manipulate your imaginary energy fields.

People fall for this at many hospitals that claim to be the Best Hospital in the World.[4]

They are just demonstrating their lack of understanding of the placebo effect, random variation, reversion to the mean, and other things that lead us to believe that nothing is something.

Nothing Superstition is harm.


[1] The cause of neurologic deterioration after acute cervical spinal cord injury.
Harrop JS, Sharan AD, Vaccaro AR, Przybylski GJ.
Spine (Phila Pa 1976). 2001 Feb 15;26(4):340-6.
PMID: 11224879 [PubMed – indexed for MEDLINE]

All but two patients had complete injuries at admission. One patient with incomplete injury and another that was neurologically intact had early complete cervical cord injuries after cervical immobilization.


Four of the five patients in the early group (mean age 56 years) developed neurologic worsening during application of cervical immobilization less than 24 hours after injury.

[2] Refusal of base station physicians to authorize narcotic analgesia.
Gabbay DS, Dickinson ET.
Prehosp Emerg Care. 2001 Jul-Sep;5(3):293-5. No abstract available.
PMID: 11446548 [PubMed – indexed for MEDLINE]

Nevertheless, the notion that a patient’s decision-making capacity may be compromised by “excessive” analgesia seemingly permeates medical practice, but is not evidently supported by the medical literature.11


Even a more disturbing possible coercion is the possibility that when pain medication is withheld prior to consent, the patient is either directly or indirectly made to understand that once he or she provides consent, that pain medication will be given as a “reward” for agreeing to the procedure.

[3] 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

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.

[4] Shock Trauma Infested With Evil Spirits
Wed, 10 Jun 2009
Rogue Medic


Blue Moon 2012 – Except parts of Oceanea


Tonight is a Blue Moon and a Friday the Dyslexic 13th Full Moon.

As conspiracy theorists say, That can’t be a coincidence!

Of course it can be a coincidence.

The next Blue Moon is in 2015, unless you are near the International Date Line, in which case the Blue Moon is not this month, but at the end of next month (and then in 2015).[1]

Click on images to make them larger.

Does anything special happen during a Blue Moon?

There is more light, but they are really only uncommon.

The full moon does not have an influence on our lives, except to annoy the superstitious, to provide more light, and to give me another reason to throw some light on the lunacy of full moon superstition.

Image credit.

“Have you university types ever looked at whether dog bites happen more around the full moon? It’s a well known fact that they do.”[2]

They could accept the old farmer’s tale or they could examine it. It appears that even though the farmer seems to be set in his belief, he is still open to evidence.

The influence of the full moon remains one of the more resilient popular explanations of a wide range of mostly traumatic or bizarre events. There is a pale reflection of this in epidemiology—recall bias—where those affected by a rare or severe disease are more inclined to associate unrelated non-disease exposures to the disease.[2]

This is a lighthearted look at the numbers of admissions for dog bites and whether there is any association with the full moon.

The beginning of the dates is the first full moon, although it is not marked. There is no peak at the beginning of the chart, so this was not done to mislead. It might be because there were so many days with very few dog bite admissions at that full moon.

Altogether 1671 accident and emergency admissions for dog bites occurred during the study period (938 males, 733 females), representing an overall mean admission rate of 4.58 per day. Figure 1 shows 18 peak days (notionally >10 admissions/day), with the maximum peak centring on the New Year break (the highest peak (24) occurred on New Year’s Day 1998). Full moons coincided with none of these peaks.

There were 12 full moons, but none of the excessive dog bite days were at the time of any of the full moons.


If there is any causal relationship between the full moon and serious dog bites, the occurrence of the peaks should be greater than predicted by chance.

By my calculation, there is just over a 64% chance of any of these 18 peak dog bite days and any of the full moons occurring together by chance in that one year period. A longer time period would be better for making this clear, but there does not appear to be any suggestion of any association between full moons and admissions for dog bites.

Overall, full moon days were associated with slightly lower mean admissions (4.6 compared with 4.8 per day).[2]

During the study, there were fewer serious dog bites during the full moon, than at other times.

As the plot of dog bite admissions and full moons clearly shows, more caution with dogs might be exercised over Christmas and especially at New Year—irrespective of the full moon.[2]

It may not be a good idea to try to make friends with strange dogs on those days.

Correction (8/21/2013 20:08) – Here is an article that shows I was wrong about the two full moons in a month definition of a full moon.

What’s a Blue Moon?
The trendy definition of “blue Moon” as the second full Moon in a month is a mistake.

Sky & Telescope
by Donald W. Olson, Richard Tresch Fienberg, and Roger Sinnott
July 27, 2006


[1] How often do two full moons happen in the same month?
Friday, August 31

[2] Barking mad? another lunatic hypothesis bites the dust.
Chapman S, Morrell S.
BMJ. 2000 Dec 23-30;321(7276):1561-3.
PMID: 11124174 [PubMed – indexed for MEDLINE]

Free Full Text from BMJ

Chapman S, & Morrell S (2000). Barking mad? another lunatic hypothesis bites the dust. BMJ (Clinical research ed.), 321 (7276), 1561-3 PMID: 11124174