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

- Rogue Medic

The Need for Evidence Before Assessing Guilt

Cliff Tuttle at Pittsburgh Legal Back Talk has another post about blaming the medics in the death of Curtis Mitchell. I use his title for this post – The Need for Evidence Before Assessing Guilt.

This is the point we seem to have trouble with. This is another case of cognitive dissonance.[1] We make judgments based on the first thing we hear, or read. Based on that initial information, regardless of the accuracy of the information, we form opinions. When we demand punishment of the obviously guilty party, we have taken a position that we may feel that we must defend, regardless of the facts.

Chad writes in the comments to the earlier post at Pittsburgh Legal Back Talk – Medic’s Perspective on Mitchell Case.

The calls were cancelled after 2 hours, 1.5 hours, and 10 hours, respectively? Am I reading this correctly?

Yes, the time from the 911 call to cancellation was a long time in each case.

The important information that has not been released includes the amount of time from each 911 call to the dispatch of each ambulance.

This was an emergency for the city. Pittsburgh had many more 911 calls than ambulances. They had to decide when to send ambulances to which calls.

Curtis Mitchell called for abdominal pain, which their system identifies as a low priority call, so ambulances were sent to other calls first.

Other important information includes the time from each ambulance notifying dispatch that the ambulance was stuck in the snow/ice until the time that each ambulance was canceled.

How much time from the ambulance being stuck in the snow until a supervisor arrived with a 4 wheel drive vehicle?

What were the orders for the medics, when they notified dispatch that they were stuck?

Were they told to try to make it to the caller?

Were they told to try to dig themselves out?

Were they told to wait for a supervisor?

Were they told to wait for a snowplow?

There is a lot that we do not know, but that has not stopped people from blaming the medics.

This lack of information, that some people have decided to fill with misinformation, has not stopped people from claiming that they know what the medics should have done.

6 medics, an unknown number of supervisors, and unknown others were involved in 3 attempts to get to Curtis Mitchell.

Each attempt was canceled prior to the medics reaching Mr. Mitchell.

Public Safety Director Michael Huss spoke at a press conference –

Mr. Huss said they should have walked to Mr. Mitchell’s home to retrieve him. “It’s that simple,” he said.[2]

Any time someone is telling us that something is simple, we need to be suspicious. When I am told that something is simple, I expect to learn something or I expect to be lied to. I don’t think I learned anything from the statement.

Public Safety Director Michael Huss is reported to have had the call review from the city’s medical director before the press conference. He is reported to have released this document, labeled This is a confidential document generated as part of the Continuous Quality Improvement program for the City of Pittsburgh Department of Public Safety and the Allegheny County Emergency Operations Center,[3] to the press.

Then Public Safety Director Michael Huss stated that the explanation for the death of Curtis Mitchell is as simple as placing all of the blame on the medics.

However, the medical director did not place the blame on the medics in his call review.

Why did Public Safety Director Michael Huss ignore the findings of the medical director?

As Cliff Tuttle states –

We need facts, based on solid evidence — not the kind presumed in political rhetoric spread about by persons who have no personal knowledge of how these 911 calls were handled.[4]

This is not as simple as the statement of Public Safety Director Michael Huss.

This is not as expedient as the statement of Public Safety Director Michael Huss.

This is the only way that we will find out what did happen.

We need to find out what the facts are.

We need to consider re-evaluating our opinions, if the facts do not agree with our opinions.

My other posts on the death of Curtis Mitchell –

City may discipline EMS workers – Public Safety Director Michael Huss – 02/18/10

Where Was Public Safety Director Michael Huss during the Death of Curtis Mitchell? – 02/20/10

Public Safety Director Michael Huss and Others Continue to Blame the Medics for the Snow – 02/22/10

The Need for Evidence Before Assessing Guilt – 02/24/10

Anonymous Comments on the Death of Curtis Mitchell – 03/02/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part I – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part II – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part III – 03/22/10

What kind of punishment do you get for NOT disobeying dispatch? – 03/23/10

The Scapegoats Will Be Punished – 03/23/10

Pittsburgh – Punishment, not Planning – 03/24/10

Josie Dimon was the Scapegoat of Public Safety Director Michael Huss in the Death of Curtis Mitchell – 02/16/11

Michael Huss – Pittsburgh EMS Only Needs Someone Good With a Shovel – 02/16/11

Links updated 02/16/11.

Footnotes:

[1] Cognitive Dissonance
Wikipedia
Article

[2] City may discipline EMS workers – Man died at home despite repeated calls to 911 during snowstorm
Thursday, February 18, 2010
By Sadie Gurman,
Pittsburgh Post-Gazette
Article

[3] Medical Call Review for 5161 Chaplain Way 2/6/2010
Ron Roth, MD Final 2/15/10
Medical Director, City of Pittsburgh, Department of Public Safety
Medical Director, Allegheny County Emergency Operations Center
Free Full Text

[4] The Need for Evidence Before Assessing Guilt
Pittsburgh Legal Back Talk
Article

.

Public Safety Director Michael Huss and Others Continue to Blame the Medics for the Snow

Cliff Tuttle at Pittsburgh Legal Back Talk has a couple of posts about the death of Curtis Mitchell. The Power of Saying “I’m Sorry”. Then there is the posting of what I wrote in the comment section. Medic’s Perspective on Mitchell Case.

The original post by Cliff Tuttle is good. I agree that the problem was one of not enough snow plows. My only complaint was that the apology of Public Safety Director Michael Huss is not a real apology. Public Safety Director Michael Huss is only passing the buck and blaming the medics.

It is as if Public Safety Director Michael Huss is saying, I confess! They did it!

A comment from EMS PRACTITIONER makes the following assertions.

The fault lies with the medics and them alone.

That makes me wonder if this is a pseudonym of Public Safety Director Michael Huss or someone else at City Hall.

and

Even if the ambulance is stuck in the snow… SOMEONE should have WALKED to the house to verify and left their partner with the truck awaiting dig out.

Why even provide ambulances to the medics, at all? The lazy slobs only need to get out and walk and just make it happen (which is the Enron motto). It’s as simple as that. They really are squandering resources that might be better used by the management for vacations and other more important things.

Because, in the eyes of the alleged EMS PRACTITIONER, all EMS does during a snow storm is sit around waiting for someone to pull them out of the snow.

I was shoveling for hours that weekend. With all of that shoveling, I only cleared a small amount of ground. The wind was blowing some of the snow right back where I shoveled. Nobody needed to come pull me out of the snow, because I dug myself out of the snow. I was exhausted, wet, and frustrated. And I didn’t even try to walk a quarter of a mile up and down a steep snow-covered and ice-covered bridge, leaving my partner behind to make excuses about where I went.

What would my partner say?

Dispatch. I don’t care that we are canceled. I don’t care that you are ordering us to leave this location and respond to another patient.

We are unable to respond to any more calls, because my partner decided to head off into the snow to be able to say that somebody got to the residence. He brought a flag to plant as proof that we made it.

Tell all of the other patients that since we are psychic, we know that only this patient will die if we do not reach him. Now leave us alone!

Then maybe a half hour later, maybe 2 hours later, . . .

Dispatch! I see something!

I can’t tell if it is my partner, the patient, or something else. If the patient left the residence by one of the other roads in the area, my partner wouldn’t see him. Or, if my partner took the wrong road, and the patient took the main road, the result would be the same.

I hope it isn’t the patient, because we are out of service until my partner returns.

I would probably get a raise. Public Safety Director Michael Huss and EMS PRACTITIONER would probably hold a press conference praising me. Yeah, that’s the ticket!

I’m sure that’s the way it would happen. There would be no auto-da-fé with me as the main course. I take that on faith.

Too Old To Work, Too Young to Retire has a post that is also mostly a comment from an earlier post. Comment From Someone In Pittsburgh. Here is a bit of what the media have not been covering.

Our units all trucked through the snow to patients that were critical and life threatening, and even some that weren’t. Several vehicles were stuck for up to 9 hours. Plow requests were being denied because the orders were the trucks couldn’t deviate from their assigned routes.

and

We still remain third service and do all rescue within the City. The Public Safety Director is exploiting this incident to further his agenda.

Public Safety Director Michael Huss had the report from the medical director before his press conference. The medical director’s report did not blame the medics. Public Safety Director Michael Huss has been blaming the medics without any good reason.

Well, maybe there is a good reason. If he does not point the finger at someone else, then he might start to look like the one who was responsible for not arranging for extra snow plows and other means of transport for emergency conditions.

Public Safety is about preparing for emergencies.

It looks as if the plan of Public Safety Director Michael Huss is just blame the medics.

Blame the people who actually transported close to three time their normal number of patients, in spite of the snow-covered and ice-covered roads.

We know where the medics were during the storm.

Where was Public Safety Director Michael Huss?

EMS crews were running without any breaks.

EMS crews were dealing with snow on every call.

It is not lazy to go to the next call, when you are ordered to.

Only excuses are coming from Public Safety Director Michael Huss.

Where were the extra snowplows?

Where were the 4 wheel drive vehicles?

Expecting the medics to make up for the lack of preparation by the city is irresponsible.

We know where the medics were during the storm.

Where was Public Safety Director Michael Huss?

My other posts on the death of Curtis Mitchell –

City may discipline EMS workers – Public Safety Director Michael Huss – 02/18/10

Where Was Public Safety Director Michael Huss during the Death of Curtis Mitchell? – 02/20/10

Public Safety Director Michael Huss and Others Continue to Blame the Medics for the Snow – 02/22/10

The Need for Evidence Before Assessing Guilt – 02/24/10

Anonymous Comments on the Death of Curtis Mitchell – 03/02/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part I – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part II – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part III – 03/22/10

What kind of punishment do you get for NOT disobeying dispatch? – 03/23/10

The Scapegoats Will Be Punished – 03/23/10

Pittsburgh – Punishment, not Planning – 03/24/10

Josie Dimon was the Scapegoat of Public Safety Director Michael Huss in the Death of Curtis Mitchell – 02/16/11

Michael Huss – Pittsburgh EMS Only Needs Someone Good With a Shovel – 02/16/11

Links updated 02/16/11.

.

Where Was Public Safety Director Michael Huss during the Death of Curtis Mitchell?

As I wrote in my previous post, City may discipline EMS workers – Public Safety Director Michael Huss, the statement by Public Safety Director Michael Huss is one that suggests that he is covering something up with an absurdly simplistic attempt to blame EMS. What did he say?

Mr. Huss said they should have walked to Mr. Mitchell’s home to retrieve him. “It’s that simple,” he said.[1]

Apparently, Public Safety Director Michael Huss is not aware that there was a snow storm that resulted in a huge delay in responding to calls.

There were 3 dispatches of ambulances while the patient was presumed to be alive.

Each time the ambulance became stuck in the snow about a quarter of a mile from the patient’s residence.

Each time the ambulance was canceled by the caller or the 911 center.

First call. 911 call placed at 02:09 02/06/2010. Call canceled by caller at 03:57 02/06/2010.[2]

Second call. 911 call placed at 04:53 02/06/2010. Call canceled by caller at 06:23 02/06/2010.

Third call. 911 call placed at 11:18 02/06/2010. Call canceled by dispatch at 21:31 02/06/2010.

Fourth call. The next day 911 was called for a DOA (Dead On Arrival).

At no time did EMS crews refuse to transport anyone.

It appears that, after being canceled, EMS continued to dig themselves out of the snow, then they were dispatched to other calls. It appears that all crews were continually assigned to calls.

Where was Public Safety Director Michael Huss during the death of Curtis Mitchell?

Was Public Safety Director Michael Huss doing anything to assist his overworked crews deal with this emergency?

Afterward, Public Safety Director Michael Huss is blaming the crews.

Apparently, Public Safety Director Michael Huss just does not have a clue.

My other posts on the death of Curtis Mitchell –

City may discipline EMS workers – Public Safety Director Michael Huss – 02/18/10

Where Was Public Safety Director Michael Huss during the Death of Curtis Mitchell? – 02/20/10

Public Safety Director Michael Huss and Others Continue to Blame the Medics for the Snow – 02/22/10

The Need for Evidence Before Assessing Guilt – 02/24/10

Anonymous Comments on the Death of Curtis Mitchell – 03/02/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part I – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part II – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part III – 03/22/10

What kind of punishment do you get for NOT disobeying dispatch? – 03/23/10

The Scapegoats Will Be Punished – 03/23/10

Pittsburgh – Punishment, not Planning – 03/24/10

Josie Dimon was the Scapegoat of Public Safety Director Michael Huss in the Death of Curtis Mitchell – 02/16/11

Michael Huss – Pittsburgh EMS Only Needs Someone Good With a Shovel – 02/16/11

Links updated 02/16/11.

Footnotes:

[1] City may discipline EMS workers – Man died at home despite repeated calls to 911 during snowstorm
Thursday, February 18, 2010
By Sadie Gurman,
Pittsburgh Post-Gazette
Article

2 Medical Call Review for 5161 Chaplain Way 2/6/2010
Ron Roth, MD Final 2/15/10
Medical Director, City of Pittsburgh, Department of Public Safety
Medical Director, Allegheny County Emergency Operations Center
Free Full Text

.

The Gold Standard

Some terminology seems to be designed by administrators for the purpose of harming patients. Anecdotally speaking, the use of administrative action words and similar terminology seems to disproportionately correspond with misinformation. Should certain terms/phrases be aggressively criticized as a way of countering such nonsense, or do the speakers ever make sense?

My favorite example is The Gold Standard.

I am not limiting this to The Gold Standard because of an inability to think of other terms, but because there is too much to write about just The Gold Standard.

Why does anyone pay any attention to anyone who suggests that some specific treatment is more important than patient care?

In airway management, the goal is ventilation and oxygenation. There is usually no need for intubation. However, many people will tell you that intubation is The Gold Standard.

Right now, sitting here, banging away at the keyboard, I do not feel as if my airway would be better managed with an endotracheal tube. If someone were to attempt to use The Gold Standard on me, I could probably satisfy a jury that the resulting death of that person was entirely reasonable and satisfies the criteria for self defense.

Clearly, you misunderstand the situation! The Gold Standard is only for an impaired airway.

Someone who only needs to have supplemental oxygen, or airway positioning, may fall into the category of impaired.

What about BVM (Bag Valve Mask) ventilation? I feel that transporting a patient to the ED with only BVM ventilation is appropriate. The ED staff have not been supportive of this approach, but that lack of support is not an indicator of any understanding of appropriate patient care.

In a system without the possibility of pre-intubation sedation, without the possibility of RSI (Rapid Sequence Induction), and with only the possibility of small doses of post-intubation sedation after this semi-conscious stroke patient demonstrates the negative effects of intubation of vital signs, how can I justify the patient abuse that is intubation?

But it’s The Gold Standard

It is bad for the patient, but good for the chart, which is all that matters to the QA/QI/CYA department and the lawyers. We harm patients just to defend The Gold Standard. This is not patient care. This is patient abuse. Why does anyone defend it?

But what if the patient vomits?

An important, but little used, part of my airway equipment is known as portable suction, not that there is any reason to believe that avoiding intubation increases the need for the portable suction.

Where is the evidence that intubation does anything to decrease the incidence of aspiration of stomach contents?

Where is the evidence that intubation does not increase the incidence of aspiration of stomach contents?

How can anyone claim that intubation is The Gold Standard?

Shouldn’t The Gold Standard be a patent airway by whatever means necessary??

Maybe we should just leave the term The Gold Standard to the officious users of administrative action words. The Gold Standard, The Golden Hour, Immobilize ‘Em All and Let Cat Scan Sort ‘Em Out, et cetera. We should probably avoid these nonsense terms, except as punchlines.

Maybe The Gold Standard is just an indicator of a lack of understanding of patient care.

.

The Twisted Mind of Andrew Wakefield

An interesting and very brief post at Black Triangle. It is so brief that I cannot take just a sample, but include the whole post. He has other interesting posts that are worth reading.

The upside of infection

How Wakefield spoke at an US anti-vaccine conference in the early 2000s (transcribed from audiotape sample no longer on web).

the upside of infection, yes the upside of infection, we are survivors of infection, we are here not in spite of infection, but because of infection. Our immune system has been conditioned over millions and millions of years by infection, and if we alter the way in which infection is delivered to our systems we must expect that by changing the ecosystem, there will be a downside, there will be attrition, we will render some children damaged.

That was the whole post.

Andrew Wakefield appears to have an interesting interpretation of evolution.

If we have survived thrived because of an improved intelligence, then we should ignore that and try to survive on the merits of a less capable naturally acquired immunity. Another way of describing natural immunity is those who do not die from an illness that confers immunity.

If we accept that logic, maybe we should stop wearing clothing. . . . we must expect that by changing the ecosystem, there will be a downside, there will be attrition, we will render some children damaged.

If we accept that logic, maybe we should stop taking medicine. . . . we must expect that by changing the ecosystem, there will be a downside, there will be attrition, we will render some children damaged.

If we accept that logic, maybe we should stop using technology. . . . we must expect that by changing the ecosystem, there will be a downside, there will be attrition, we will render some children damaged.

If we accept that logic, maybe we should stop using research. . . . we must expect that by changing the ecosystem, there will be a downside, there will be attrition, we will render some children damaged.

If we accept that logic, maybe we should stop using money. What? I must be taking this logic thing a bit too far. Andrew Wakefield would never give up those things he feels he has a natural right to – or maybe that he earned with his dishonesty and irresponsibility.

An alternative is to understand that the reason we appear to be the dominant species on the planet. We use our intelligence to modify our environments.

We wear clothing that allows us to live almost anywhere we desire. Does clothing work against evolution? That depends on whether we think that intelligence is evolutionary.

We take medicine that allows us to live longer, healthier lives than would be possible without medicine. Does medicine work against evolution? That depends on whether we think that intelligence is evolutionary.

We use technology that also allows us to live longer, healthier lives. Does technology work against evolution? That also depends on whether we think that intelligence is evolutionary.

We also use research that allows us to live longer, healthier lives. Does research work against evolution? That similarly depends on whether we think that intelligence is evolutionary.

Certainly arguments can be made that individuals, or even groups of people should not survive, because they pass on genes that decrease the likelihood of the species surviving. Yet, with our intelligence, we make it possible for them to pass on their genes. We defeat evolution.

However, the same could be said for just about any other evolutionary change. There is advantage and disadvantage. What evolution does is select for changes that overall increase the chances of survival of the species in that particular environment. Individuals, or even small groups, do not prevent that.

If we believe that research is contrary to the survival of humans, then maybe we should make Andrew Wakefield do some honest physical labor, instead of taking advantage of his evolutionary superiors.

If we believe that taking care of our fellow human beings is an evolutionary flaw, then we agree with Andrew Wakefield. Screw the kids! It’s their own fault they died. Protecting children is wrong.

I do not agree with Andrew Wakefield.

I think that intelligence is important.

.

Andrew Wakefield and Cognitive Dissonance.

He made up a syndrome.

He performed unnecessary and risky medical procedures on children.

He received hundreds of thousands of pounds from lawyers for a study to look for that imaginary syndrome, because the imaginary syndrome could make the lawyers a lot of money.

He was horribly incompetent in his research methods.

He lied about what he did.

He sued Brian Deer, the investigative reporter who uncovered most of the fraud. He had to withdraw the law suit and pay the expenses of Brian Deer.

In 2004, when they became aware of the fraud, 10 of the 13 authors of the study had their names removed from that study.

On January 28, 2010, a little over a week ago, The General Medical Council released its verdict.

The Fitness to Practise Panel has heard this case under The General Medical Council Preliminary Proceedings Committee and Professional Conduct Committee (Procedure) Rules Order of Council 1988. It has considered which, if any of the facts not admitted by Dr Andrew Wakefield, Professor John Walker-Smith and Dr (now Professor) Simon Murch have been found proved and then went on to consider whether such facts found proved together with those admitted, would be insufficient to support a finding of serious professional misconduct.[1]

The Panel has accepted in full the advice of the Legal Assessor as to the approach to be taken. The three doctors have nothing to prove, the burden of proof is on the GMC throughout. If the Panel were not sure beyond reasonable doubt, the sub-head of charge was found not proved in favour of the doctor, in accordance with the criminal, as opposed to the civil, standard of proof.[1]

A lot of findings of Admitted and found proved.

A lot of findings of Found proved.

The occasional finding of Found not proved.

A lot of irresponsible – Found proved.

A lot of dishonest – Found proved.

Some crazy people are still defending Andrew Wakefield.

You would have to be crazy to defend that fraud.

Or dishonest and irresponsible.

These people have convinced themselves that vaccines cause autism, even though research has repeatedly shown no connection.

So, in order to protect themselves from having to admit that they endangered their children and other children, they need to defend this, even though Andrew Wakefield has admitted some of the fraud and a court has determined that he is guilty of a lot more.

When people should admit that they made a mistake, some will actually become even more defensive of their clearly mistaken position.

A clear case of cognitive dissonance.[2]

If you wish to read about the research that has been done on autism and vaccines, there are scores of studies.[3] Studies paid for by many different organizations – governments, universities, non-profit groups, and even drug companies. They don’t find any connection between vaccines and autism.

Andrew Wakefield was receiving hundreds of thousands of pounds from lawyers to show a connection. Is it surprising that he did?

Andrew Wakefield was working on a vaccine to compete with the MMR vaccine, so he has another reason he might benefit financially from making false accusations about the MMR.

Andrew Wakefield has shown that he is willing to subject children to risky procedures for no benefit to the children, as long as he makes his money.

There has been a lot written by others on the topic. In the comments the anti-vaccinationists will try all sorts of misleading approaches. Some will claim that they are not anti-vaccinationists, but that they only want safe vaccines.

Vaccines are safe.

How much safer could vaccines be?

There are a some examples in response to Dear Jenny McCarthy . . . at A Day In The Life Of An Ambulance Driver. Another is at Asshole doctor responsible for false MMR/autism claim gets his at Cranky Epistles.

In The martyrdom of St. Andy at Respectful Insolence, there is far more detail about the dishonest and irresponsible conspiracy to link autism and vaccines. A listing of a lot of posts on this topic, even some defending the fraud, can be found in On The Lancet’s Retraction of Wakefield’s 1998 Paper Alleging A Connection Between the MMR Vaccine and Autism at I Speak of Dreams.

The unfortunate thing is that Andrew Wakefield is still making over a quarter of a million dollars a year to spread his lies for Thoughtful House, an anti-vaccination organization in Texas. When it comes to Andrew Wakefield, follow the money – he does. He came to the US, but he is not a doctor in the US.

If you know of Andrew Wakefield pretending to be a doctor, call the police.

And vaccinate your children for their sake.

More information is available at Brian Deer’s website.

Footnotes:

^ 1 Fitness to Practice Panel Hearing
UK General Medical Council
January 28, 2010
Free Full Text

^ 2 Cognitive dissonance
Wikipedia
Article

^ 3 Vaccines and Autism
Science-Based Medicine
Article

.

Helicopter EMS Abuse Addressed in the 2011 US Budget

Not much has been done to improve HEMS (Helicopter EMS) safety, in spite of all of the hearings about the alarming fatality rate. That may change. The 2011 US Budget may provide some long overdue oversight.

Fights Waste and Abuse in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Reducing fraud, waste, and abuse is an important part of restraining spending growth and providing quality service delivery to beneficiaries. In November 2009, the President signed an Executive Order to reduce improper payments by boosting transparency, holding agencies accountable, and creating incentives for compliance. This Budget puts forward a robust set of proposals to strengthen Medicare, Medicaid and CHIP program integrity actions, including proposals aimed at preventing fraud and abuse before they occur, detecting it as early as possible when it does occur, and vigorously enforcing all penalties and recourses available when fraud is identified. It proposes $250 million in additional resources that, among other things, will help expand the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, a joint effort by HHS and DOJ. As a result, the Administration will be better able to minimize inappropriate payments, close loopholes, and provide greater value for program expenditures to beneficiaries and taxpayers. Also, to improve quality and safety, the Administration will strengthen its Medicare requirements to assure that air ambulance operators comply with aviation safety standards.[1]

The last line is the one that matters – Also, to improve quality and safety, the Administration will strengthen its Medicare requirements to assure that air ambulance operators comply with aviation safety standards.

I would prefer that the regulations not be coming from Medicare requirements, but they are unlikely to be worse than the current safety standards that some HEMS operators use. It may be that this method helps to target some of the most abusive HEMS operators.

One that may be exempt is MSPA (Maryland State Police Aviation), since they take their money directly from motor vehicle fees. This appears to have been a shrewd tactic to avoid oversight. Few may have the ability to investigate the excessive use of HEMS in Maryland, since MSPA and Shock Trauma (their customary destination hospital) have set the system up to by-pass those who might protect the citizens. When someone does attempt to improve the system, the ability of MSPA and Shock Trauma to produce political protests by their mindless true believers scares off most people.

If reimbursement were through insurance companies, someone might question why arrival at the hospital is delayed, just to put the patient in a much more expensive transport vehicle. Surely, if the important contribution of the helicopter is speed, this delay makes no sense. Fortunately, this has decreased since the crash of Trooper 2. Similarly, the concept that EMS must not attempt to assess patients, but must assess the vehicles the patients were in, would eventually be brought to the attention of insurance risk management people. The saddest part is that those most responsible for oversight of the safety of the patients have been most irresponsible in defending the treat the vehicle, not the patient flight criteria.

They promised us that there would be death, destruction, maybe even an apocalypse.

“Whenever someone says they want to ratchet it back,” says Dr. Thomas M. Scalea, physician in chief at Shock Trauma, “I tell them ‘OK, how many people can die next year to make that worthwhile?'”[2]

Dr. Scalea is the top trauma surgeon in the state of Maryland. This statement was several days after the crash of Trooper 2. This was before the flight criteria in Maryland were significantly restricted. That is, the flight criteria were ratcheted back, to use the words of Dr. Scalea.

He predicted that this would lead to more deaths.

Where are the bodies? Where are the news conferences? Flights in Maryland have been at about half the rate that they were before the Trooper 2 crash. The fatality rate does not appear to have changed.

What if we cut the flights by another half?

Dr. Scalea would again be promising death. If you doubt me, ask him.

Should we believe the doctor who cries Wolf and Golden Hour and What if the injured patient was your child or your loved one?

These are not the words of someone trying to persuade you with logic, but the words of someone trying to scare you. This tactic often works because we tend to let emotion suppress our ability to reason. This is why you are prohibited from yelling Fire! in a crowded theater.

This appeal to emotion should be a warning. A warning that the speaker does not have a rational argument. The speaker is only trying to intimidate and scare you to get something from you. We should not listen to that speaker.

I provide more detail about misleading comments by Dr. Scalea in –

Helicopters and Bad Science

A Response to Dr. Scalea’s Letter to EMS

Secrecy and EMS Policy are a Bad Combination

The Maryland Panel Meets

Maryland Helicopter EMS Panel Supports Fewer Medevac Flights

NTSB HEMS Hearings – Helicopter Association International

Footnotes:

^ 1 United States Federal Budget for Fiscal Year 2011
Free PDF

^ 2 Advantages of medevac transport challenged
Baltimore Sun
October 5, 2008
Article

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Maurice White Arrested

Unlike the previous incident with Daniel Martin, Maurice White, Jr. actually was arrested, this time.

Daniel Martin is the Oklahoma State Police Trooper, who claimed that he may arrest the only paramedic taking care of a patient, without making any arrangements to continue the care of the patient.

Why?

Some police have defended the actions of Daniel Martin, or have claimed that it is acceptable, based on their extensive knowledge of patient care delusions of grandeur,[1] for them to make patient care decisions.

Why?

I will avoid the psychological/psychiatric explanations for this desire to practice medicine without a license. I think that the main reason is ignorance. They do not know what is going on with patient care, but rather than admit that ignorance, they decide that something must be done.

I agree that there are times when something must be done. In the absence of any immediate threat, that something should only be done after the transfer of patient care. If not, after first arranging for someone to care for the patient, the police officer/trooper should also be arrested.

Would the police go into surgery and arrest a surgeon during the middle of an operation? I hope not. So why do some feel it is acceptable for the police to make medical decisions about how sick/injured this patient is compared to a patient in surgery? Some of my patients will be more unstable than surgical patients, but a person with no training/minimal training in emergency medical assessment/treatment is not someone who has the competence to make these decisions.

We should hope that people, not trained/educated to the level to understand the medical care a patient is receiving, would seek expert advice prior to taking actions to discontinue that patient care. Even if most of the time, this police misconduct might not result in harm to the patient, that does not excuse the behavior.

Why do I bring this up now?

Maurice White Jr., 56, was booked into the Sequoyah County jail on complaints of resisting arrest, failure to obey a lawful order, speeding and failure to comply with the compulsory insurance law, Vian Assistant Police Chief Brian Chandler said.[2]

While I would like to see the dashboard cam video of this, Assistant Police Chief Chandler does seem to present the events objectively. Objectivity is an important part of professionalism that was lacking in the behavior of Trooper Daniel Martin on May 24, 2009.

Driving his personal vehicle, White was stopped for allegedly speeding around 9:15 a.m., Chandler said. While Chandler was completing a citation, White approached the police car and was asked to return to his vehicle, police said.

“I asked him again to go back to his vehicle, and he said, `What was I going to do’ if he didn’t?” Chandler said. “It went downhill from there.”[2]

Chandler said, “I treat everyone the same. The way I want to be treated. It didn’t matter who he was, he was simply not complying with me.”[3]

Which is exactly what we should expect from the police. The police should be treated with respect, even if writing a ticket that we might feel is unjustified. The time to dispute this is in court. The police should not put up with abusive treatment (and I am only going by the statements from Chandler in connecting this to the arrest of Maurice White).

For those who think that I am lacking objectivity in criticizing Daniel Martin (and those who think that Daniel Martin was correct in attempting to make patient care decisions, I have written a lot about this. Even in my original post, I stated that Maurice White contributed to the escalation that was not in the best interest of the patient.

OHP vs. Creek Nation EMS from the beginning, post by post:

Oklahoma Highway Patrol, Creek Nation EMS, and Abandonment 5/31/09

More on Abandonment, OHP and EMS 6/06/09

OHP Trooper Update 6/11/09

OHP Trooper Update II 6/11/09

OHP Trooper Update III 6/13/09

OHP Trooper Update IV – Holy Stammering Obscurantists 6/16/09

OHP Trooper Update V – Over an Hour of the Holy Stammering Obscurantist 6/17/09

OHP Trooper vs. EMS comment from anonymous 6/18/09

Some Corrections on OHP vs. Creek Nation EMS 6/20/09

OHP Trooper Update VI – A little Background on the Participants 6/22/09

OHP Trooper Update VII – A Little More Background on the Participants 6/22/09

Daniel Martin Suspended for 5 Days 6/22/09

Trooper Daniel Martin Subject of a Lawsuit 7/22/09

OHP Official Position – Don’t Get Caught On Camera, Otherwise Good Job. 7/23/09

An Interesting Development in the Daniel Martin Case 7/24/09

Trooper Daniel Martin In Trouble, Again 10/06/09

Maurice White Arrested 01/11/10

Footnotes:

^ 1 Grandiose delusions
Wikipedia
Redirected from Delusions of grandeur
Article

Grandiose delusions are distinct from grandiosity, in that the sufferer does not have insight into his loss of touch with reality.

In colloquial usage, one who is said to have ‘delusions of grandeur’ is considered to be one who overestimates ones own abilities, talents or situation. This is generally due to excessive pride, rather than any actual delusions.

^ 2 Paramedic involved in OHP incident arrested
By Rhett Morgan World Staff Writer
Published: 1/11/2010 2:18 PM
Last Modified: 1/11/2010 4:05 PM
Tulsa World
Article

^ 3 EMT Arrested
By Sally Maxwell
Sequoyah County Times
Article

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