"EMS is a hoax"

[EMmedic]

Medicine is based on evidence. Well, designed scientific studies that tell people which interventions help the patient, which do nothing, and which harm the patient. We know who is at risk for certain diseases, what treatment is effective, and what is too risky based upon this tangible evidence. What people on this forum are trying to say is that EMS needs to get on board with this. You may feel that you are making a difference or that an intervention is appropriate, but you have no proof of this. Maybe you are, but maybe you aren't. I am a giant advocate of EMS, but if you want respect (like you imply in your post), then you have to earn it. You have to back up what you say with evidence.

You can shout all day long from the highest building about how you saved the lives of 25 hemophiliac children after a school bus accident at the same time having a schizophrenic patient aim a gun at your head. In the rain.

It doesn't matter what you say unless you have proof that your actions changed an outcome. Anecdotes don't count.

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[EMmedic]

you're right, there is a lot of routine bs but at a busy station it's not uncommon to get 1 "real" call per shift like the medical or trauma arrest, the tricyclic overdose, the big mi, the multivehicle mva with several critical pts, etc
In backwater nowhere this is probably a lot less common but in LA, ny city, detroit, etc good calls are not that rare.

Yeah, I'm not saying that they don't happen or that they aren't part of the job. I work(ed) in and around a city where there are 5 level I trauma centers. We got great calls and we got mundane calls. I just hate it when people use "the big bad one" (whether they were there or not) to try to claim their importance/worth. I'm not saying EMS isn't important (I think just the opposite). I just think there are better ways to convince people of this than exaggerating what you do on a daily basis.

 

[deleted6669]

fair enough. if ems had been all good calls I would still be a medic. I just couldn't imagine being 50 and having to get up at 3 am for a bs interfacility nonemergent transfer or a 911 call for chronic toe pain x 6 yrs. and carrying 400 lb pts down multiple flights of stairs may have had something to do with my decision as well. I do miss the good ems calls though...and with gps navigation in most ambulances now my other hatred of finding obscure addresses would be a thing of the past....

 

[EMmedic]

fair enough. if ems had been all good calls I would still be a medic. I just couldn't imagine being 50 and having to get up at 3 am for a bs interfacility nonemergent transfer or a 911 call for chronic toe pain x 6 yrs. and carrying 400 lb pts down multiple flights of stairs may have had something to do with my decision as well. I do miss the good ems calls though...and with gps navigation in most ambulances now my other hatred of finding obscure addresses would be a thing of the past....

Well, if it makes you feel any better the GPS in the ambulances where I worked isn't for the medics. Dispatch can see where you are with it but there is no way to use it in the truck to actually get directions anywhere. Makes no sense. Its still all about the map books.

 

[leviathan]

Well, if it makes you feel any better the GPS in the ambulances where I worked isn't for the medics. Dispatch can see where you are with it but there is no way to use it in the truck to actually get directions anywhere. Makes no sense. Its still all about the map books.

Gotta love it...

 

[firecoins]

You can shout all day long from the highest building about how you saved the lives of 25 hemophiliac children after a school bus accident at the same time having a schizophrenic patient aim a gun at your head. In the rain. .

Did you see me at the Empire State building or something? That was my call! Why medical control ordered me to have a schizophrenic patient hold a gun to my head is beyond me!

 

[Florida Cracker]

In my state, BLS is able to intubate (though only with a combitube), give epinephrine for anaphylaxis, and give glucagon to the unresponsive diabetic, as well as aspirin, nitro, charcoal, and albuterol when needed. With another 100 hours of training after getting your EMT-B license, you could also put in an IV, run saline, D50, narcan, and a few others that slip my mind at this point.

But it's not the dispatching of an ALS unit when a BLS unit is appropriate that runs up costs. It's the dispatching of an ambulance for something that needs no interventions whatsoever, and the inability to tell that person that they are not going to be taken to the hospital.

This reminds me of a patient I had while doing my ride-alongs. We were dispatched to an apartment complex for a traumatic injury with bleeding. We got there to find a 6 year old girl who had a possible shoulder dislocation, no bleeding. It seemed like a pretty standard call and nothing was too weird about it. But once we got her and her mother into the ambulance I was shocked to see her father and the rest of the family get in their own car and follow us to the hospital... I guess it never registered to them that they could have driven the girl there in that car too.

 

[bkz]

They might have been thinking she'd get seen faster if she came in an ambulance

 

[howelljolly]

They might have been thinking she'd get seen faster if she came in an ambulance

Of course thats what they were thinking

 

[fiznat]

It is really nice to come here every once in a while and see EMS providers who understand the power of science over ancedote. I get really sick of the "war stories" and people who seem to always have had "this one patient who..." to prove their point.

The sad part is that it seems these enlightened EMS providers are also people who have left the profession for bigger and better things.

 

[jkelly2]

No feedback from the ER, no feedback from the ICU.

Hell, most of the time they never even find out if their initial assesment and/or diagnosis was correct. They just walk away thinking they saved a life, but they can't really know, can they?

And to me, this is the most frustrating part of EMS. No feedback means no learning from experience. Rarely do systems have a mechanism in place to channel feedback to field providers. Seems like a good quality management project. . .

 

[Medicmovingon]

Here's some science...Not everybody lives in the world of war stories and anecdotes (although it makes for good cocktail party conversation)

http://www.kingcounty.gov/healthservices/health/ems/ceems.aspx

Based on these studies, our services appear to have a favorable impact on long term patient survival. Of course, it could be the clouds, or something in the water...

 

[Medicmovingon]

I am pleased that after lurking for a year, registering a few months ago, and finally posting today; the first reply I receive is a bit of a "slap down" from none other than Tired (for whom I have a great deal of respect)

You're quite correct, this page has not been updated in a bit. The point of the link was simply to demonstrate that many of your physician collegues are actively attempting to address the lack of EBM when it comes to pre-hospital care.

The Resusctation Outcomes Consortium (ROC) study is showing a 46% save rate in King County (utilizing Utstein criteria) for witnessed VF. Contrast this with Detroit's <1%. There may be something to this whole EMS thing (when properly executed)

 

[jkelly2]

A literature review from 2005 found:
ALS shows little, if any, benefits for urban trauma patients. Cardiac arrest studies show that ALS does not provide additional benefits over BLS-defibrillation care, but more research is needed in this area. In two small studies, ALS care did not provide benefits over BLS care for patients with myocardial infarctions or altered mental status. Larger-scale studies are needed to evaluate which specific ALS interventions improve patient outcomes.

Of course, a lit review is isn't as strong as a prospective study. But, it should make you want to find out more.

Isenberg DL; Bissell R. (2005). "Does advanced life support provide benefits to patients?: A literature review." Prehosp Disaster Med. 20(4):265-70.

 

[howelljolly]

Therein lies the fundamental fallacy of the entire system. Paramedic arrives on scene, determines patient has respiratory arrest, advanced airway placed, they drop off and feel like the man. No feedback from the ER, no feedback from the ICU. God forbid someone actually apply some science to this.

Hell, most of the time they never even find out if their initial assesment and/or diagnosis was correct. They just walk away thinking they saved a life, but they can't really know, can they?

EMS is worse than the surgeons in terms of "I don't care what the evidence says, in my experience . . . "

True

except for the FDNY. Paramedics document their presumptive Dx on the chart, and it is crosschecked. Theres a 96 to 97% agreement rate.

Seems like if we followed recent EBM, Medics wouldnt do anything.

 

[45408]

About how many med. students here and doctors do not understand the medical system outside of a hospital. I am also amazed that EMS services still use BLS ambulances. But I see it every day.

Having spent plenty of time running on a BLS rig, I can safely say that BLS rigs can do the vast majority of 911 calls, and the majority of 911 calls didn't need to be called.

EMS is needed. In Texas Paramedics are protocoled very well and truely make a diff. They give all prehospital cardiac meds, PAI, Pericardiocentisis, Pressors, Of course airway managment, Pain medication.c-spine clearance......

Very dangerous, and often precipitates total hemodynamic collapse. How often do they do it, and what percentage of patients survive that procedure?

These Med students should have to ride on a ambulance, pull up to a scene with a family of 5 ejected onto a roadway, some screaming, some with agonal respirations,some dead.Then as you and your 1 partner (who may be a basic) are to handle this. Help is on the way but its 20-25 min till they arrive. Its dark maybe raining. This is emergency medicine

Med students could run a thousand calls and never see such a scenario. The majority of calls I responded to could have been handled by a taxi. Probably 30-40% of them didn't need to go to a hospital, another 30-40% could've driven themselves, and the last portion really needed to go with some sense of urgency.

EMS certainly has a purpose, but like Tired pointed out, there's a TON of money being shoveled out the door. My county's fire department has these rigs that must cost a quarter million apiece.

 

[howelljolly]

That's interesting, but my question is this: in the six years I spent working in ERs, the paramedic diagnosis was almost always something like "respiratory distress" or "chest pain" rather than a true medical diagnosis. If the FDNY is using clinical signs/symptoms as their diagnosis, that makes the agreement ratio kind of meaningless, doesn't it?



That was kind of my argument from the beginning of this thread.

For the most part, the presumptive diagnosis on an FDNY chart is a medical diagnosis, not a clinical assessment. ...asthma, exacerbation of COPD, acute pulmonary edema, suspected MI... In fact, an FDNY medic couldnt write something like 'respiratory distress' as the presumptive diagnosis, because they would never get away with running a particular protocol, because the protocols are entitled "asthma protocol.... exacerbation of COPD protocol.... acute pulmonary edema protocol...

suspected MI protocol... There are separate Rapid A-fib and SVT protocols...

So, if you "diagnose" respratory distress, how can you justify running the COPD protocol, and not the Asthma protocol....?

But, different ALS units are different.

A lot of ALS research is in the "untestable" bin, I think. You'll never get a good valid study, because you cant randomize a patient into getting no treatment.

 

[45408]

because the protocols are entitled "asthma protocol.... exacerbation of COPD protocol.... acute pulmonary edema protocol...

suspected MI protocol... There are separate Rapid A-fib and SVT protocols...

So, if you "diagnose" respratory distress, how can you justify running the COPD protocol, and not the Asthma protocol....?

So what's the COPD protocol and what's the asthma protocol?

suspected MI protocol... There are separate Rapid A-fib and SVT protocols...

That's different. You can easily have a 12-lead in the field, and you can make a fair number of assessments based on an EKG.

 

[jbar]

True

except for the FDNY. Paramedics document their presumptive Dx on the chart, and it is crosschecked. Theres a 96 to 97% agreement rate.

Seems like if we followed recent EBM, Medics wouldnt do anything.

Not sure about how most FDNY guys do their charting, but at a lot of places they fill in vitals and demographics in the rig, drop off the patient, then sit down to finish their run sheet. So they may end up having feedback from the doc or nurse as they give report, like "oh, this may be pericarditis."

Not saying that FDNY medics can't make diagnosis, but if their run forms are filled out after they talk to the docs the fact that their diagnosis is the same doesn't impress me much.

 

[fiznat]

True

except for the FDNY. Paramedics document their presumptive Dx on the chart, and it is crosschecked. Theres a 96 to 97% agreement rate.

FDNY: god's gift to EMS.

What's the point here, that the diagnostic skills of FDNY medics is as good as a physician's 97% of the time? Seriously? Its this kind of hubris that gets us in trouble.

 

[leviathan]

Although you can commonly make diagnosis based off history and physical exam without diagnostic tests, it's ridiculous to make the statement that 97% of all patients can be diagnosed by PARAMEDICS based only off these signs.

 

[howelljolly]

So what's the COPD protocol and what's the asthma protocol?


That's different. You can easily have a 12-lead in the field, and you can make a fair number of assessments based on an EKG.

gosh, sorry guys...

the only comment ill respond to is this one...

I dont remember the medic protocols... but off the top of my head, you get more drugs and larger doses for the Asthma protocol.... and you can give only one dose of albuterol or metoproteronol for a COPD exacerbation

 

[firecoins]

NYC paramedic protocols
http://www.nycremsco.org/images/articlesserver/05-ALS Protocols January 2009 v010109a.pdf

asthma gets albuterol and ipotrpium.

We as medics do make a differential diagnosis. Its based on history, signs, symptoms and an ekg for possible cardiac. If we right "chest pain" its because that is the patient's chief complaint, not a diagnosis.

 

[mlw47]

The thing with prehospital (and even ED) diagnoses is that while they may be partly right, they often fall way short on the final diagnoses made after the patient has been worked up (tests and imaging and all) on the floor or ICU.

While a diagnosis of "respiratory distress" may be sufficient in a prehospital setting to initiate protocols, that answer won't fly on the floor when your attending asks you what's going on with the patient. A prehospital diagnosis of "respiratory distress" is kinda weak when it's really something like "T2N1M1 small cell carcinoma of the lung causing brochiectasis with lung consolidation". Paramedics really only diagnose symptoms, but that's OK because that's all they need to do to follow their protocols.

 

[EMmedic]

The thing with prehospital (and even ED) diagnoses is that while they may be partly right, they often fall way short on the final diagnoses made after the patient has been worked up (tests and imaging and all) on the floor or ICU.

While a diagnosis of "respiratory distress" may be sufficient in a prehospital setting to initiate protocols, that answer won't fly on the floor when your attending asks you what's going on with the patient. A prehospital diagnosis of "respiratory distress" is kinda weak when it's really something like "T2N1M1 small cell carcinoma of the lung causing brochiectasis with lung consolidation". Paramedics really only diagnose symptoms, but that's OK because that's all they need to do to follow their protocols.

I don't know about you guys, but I definitely don't consider "respiratory distress" to be a diagnosis. Its a symptom.

 

[mlw47]

I mean, that was kinda my point....there is no real diagnosing going on in the EMS world, it's just symptom identification and symptomatic treatment, for the most part. I should also mention that in my neck of the woods the medics and basics don't include a presumptive diagnosis on their charts, they just include the chief complaint.

I'm not trying to insult the hard working EMS professionals out there, I was an EMT-B and FF for 6 years. I'm just trying to point out that medics and basics are trained to recognize and treat constellations of symptoms and provide symptomatic relief, for the most part.

Yes, someone with a monitor can actually diagnose and begin treatment for a STEMI, but consider the vast majority of other calls out there. Take a 33 y/o female with RLQ stomach pain with nausea and vomiting. Could be physiologic cyst, ovulation pain, ectopic, ovarian torsion, appendicitis, right sided diverticulum, teratoma.... At the end of the day for the medic, does it really matter what her final diagnosis is? No. She's going to get the same prehospital treatment and monitoring no matter what. The medic is just going to monitor her vitals and treat whatever symptoms he or she can. There is no real diagnosing going on the back of the rig.

 

[EMmedic]

I mean, that was kinda my point....there is no real diagnosing going on in the EMS world, it's just symptom identification and symptomatic treatment, for the most part. I should also mention that in my neck of the woods the medics and basics don't include a presumptive diagnosis on their charts, they just include the chief complaint.

I'm not trying to insult the hard working EMS professionals out there, I was an EMT-B and FF for 6 years. I'm just trying to point out that medics and basics are trained to recognize and treat constellations of symptoms and provide symptomatic relief, for the most part.

Yes, someone with a monitor can actually diagnose and begin treatment for a STEMI, but consider the vast majority of other calls out there. Take a 33 y/o female with RLQ stomach pain with nausea and vomiting. Could be physiologic cyst, ovulation pain, ectopic, ovarian torsion, appendicitis, right sided diverticulum, teratoma.... At the end of the day for the medic, does it really matter what her final diagnosis is? No. She's going to get the same prehospital treatment and monitoring no matter what. The medic is just going to monitor her vitals and treat whatever symptoms he or she can. There is no real diagnosing going on the back of the rig.

Sorry I just reread your post and I see what you are saying. But I don't necessary agree. Maybe basics treat only on symptoms, but I think in the medic world it is a little different. I think you definitely have to make some differential diagnoses in order to decide what treatment to pursue. Let's take "respiratory distress." For a basic, it doesn't matter. Its just oxygen. For a medic, however, you have to decide whether the person is having an asthma attack, a COPD exacerbation, congestive heart failure, pneumonia, a cardiac event etc. because the treatments are different. Yes, you are treating the symptoms, but you are still making a differential diagnosis. At least a good medic is doing this. Yes, things are more complicated than these simple differentials, but they are still differentials nonetheless.

You are right that abdominal pain is not really conducive to much differential diagnosis in the field.

There is no way that FDNY is correct 97% of the time. There are a lot of confounding factors there - like listening to what the docs say when they drop of the patient.

 

[mlw47]

No worries.

Tweezing apart the different causes of respiratory distress is a good example of where medics have to think and run a differential diagnosis through their head. That's a good point. I remember that the older medics liked to try to pimp the younger medics on COPD exacerbation vs. pneumonia and why pusing lasix in a pneumonia patient isn't such a good idea.

 

[howelljolly]

No worries.

Tweezing apart the different causes of respiratory distress is a good example of where medics have to think and run a differential diagnosis through their head. That's a good point. I remember that the older medics liked to try to pimp the younger medics on COPD exacerbation vs. pneumonia and why pusing lasix in a pneumonia patient isn't such a good idea.

A buddy of mine in med school was telling me that one of his attendings was pimping the students about pneumonia, and actually asked how the management will change if/when the patient is given a huge dose of lasix on the ambulance.

Seriously though, if medics arent making some sort of a diagnosis, how come every patient with difficulty breathing isnt coming in on lasix, and every chest pain isnt given morphine?

 

[mlw47]

You've got me on that point. Medics do make decisions (i.e. generate a differential diagnosis list and act based on their judgment). Especially for cardiopulmonary stuff. But then again, that's because they basically are treating cardiac signs and symptoms -- whether the patient is hypoxic or not and what the rhythm on the monitor says. So if you consider a pt's ECG a sign and their discomfort a symptom, then this actually folds back into my original point that medics just treat signs and symptoms, and don't make real diagnoses. Was that Afib from insufficient beta-blocker therapy or was their Graves thyrotoxicosis insufficiently managed? It doesn't matter to the medic. They still monitor and care for the pt the same way.

While they certainly can recognize VF from VT from SVT from AFib, for the medic the etiology of the presenting rhythm is less of a concern than the rhythm itself. Perhaps what I'm talking about is of no consequence as medics shouldn't be expected to provide an MD/DO level of working up. At the end of the day it doesn't really affect the patient care that medics provide and I may just be picking on some dumb frivolous point about the definition of "diagnosis"...

 

[howelljolly]

You've got me on that point. Medics do make decisions (i.e. generate a differential diagnosis list and act based on their judgment). Especially for cardiopulmonary stuff. But then again, that's because they basically are treating cardiac signs and symptoms -- whether the patient is hypoxic or not and what the rhythm on the monitor says. So if you consider a pt's ECG a sign and their discomfort a symptom, then this actually folds back into my original point that medics just treat signs and symptoms, and don't make real diagnoses. Was that Afib from insufficient beta-blocker therapy or was their Graves thyrotoxicosis insufficiently managed? It doesn't matter to the medic. They still monitor and care for the pt the same way.

While they certainly can recognize VF from VT from SVT from AFib, for the medic the etiology of the presenting rhythm is less of a concern than the rhythm itself. Perhaps what I'm talking about is of no consequence as medics shouldn't be expected to provide an MD/DO level of working up. At the end of the day it doesn't really affect the patient care that medics provide and I may just be picking on some dumb frivolous point about the definition of "diagnosis"...

Dont you think that most of medicine (the MD kind) is done the same way?....signs and symptoms? Medicine isnt rocket science, as youve seen. Only a small part of medicine entertains ideas of thyrotoxicosis and pheochromocytoma, and thats usually tertiary care and specialists. Even with an SVT, and MD is going to do basically the same thing... treat it like a medic first, and then start thinking about the underlying cause.

I guess my point is that medics do need to think about a medical diagnosis, and they do a pretty stinkin good job of working up and managing the first hour of the most common emergent conditions. Their diagnostic abilities are good enough for common things.

But... maybe this is just my take on it.... when I was in paramedic school, the MD instructors were always driving the point of diagnosis into our heads, and they taught out of Bates.

 

[mlw47]

I see your point.

I think most of my angst for the term "diagnosis" in regards to prehospital professionals comes from my personal experiences. I was a good EMT-B (which nowadays doesn't sound that impressive) and I was great friends with a bunch of EMTs who later went on to become medics, and then they like me went onto become med students. One thing that really hit home for all of us was when we reached med school was that while we previously though that we were hot ****, looking back now we didn't know **** about f()ck. Before we were so content to say that pt X was suffering from condition A. But now when see pts presenting with X I think of A, B, C, D, and E, and I'm often at a loss to put my finger on the right diagnosis. How many syncopes did my medic friends and me right off as "vasovagal" when they really were suffering from something else? I guess that I have a guilty conscience.


...that was way off topic. [/rant]

 

[howelljolly]

I see your point.

I think most of my angst for the term "diagnosis" in regards to prehospital professionals comes from my personal experiences. I was a good EMT-B (which nowadays doesn't sound that impressive) and I was great friends with a bunch of EMTs who later went on to become medics, and then they like me went onto become med students. One thing that really hit home for all of us was when we reached med school was that while we previously though that we were hot ****, looking back now we didn't know **** about f()ck. Before we were so content to say that pt X was suffering from condition A. But now when see pts presenting with X I think of A, B, C, D, and E, and I'm often at a loss to put my finger on the right diagnosis. How many syncopes did my medic friends and me right off as "vasovagal" when they really were suffering from something else? I guess that I have a guilty conscience.


...that was way off topic. [/rant]

Yep, I know the feeling... now you realize that as an EMT you knew just enough to really mess someone up. This too shall pass.

Just recently I was thinking that I used to push meds into patients with so much confidence, and then go to the ER saying "Hey Doc, look what I did, all by myself".... Now I second guess myself on a simple asthma exacerbation.... but at the same time, I REALLY find myself getting complacent (and I dont know what to do about that).

Common things are commonly correct.....

 

[UofM Med]

Therein lies the fundamental fallacy of the entire system. Paramedic arrives on scene, determines patient has respiratory arrest, advanced airway placed, they drop off and feel like the man. No feedback from the ER, no feedback from the ICU. God forbid someone actually apply some science to this.

Hell, most of the time they never even find out if their initial assesment and/or diagnosis was correct. They just walk away thinking they saved a life, but they can't really know, can they?

EMS is worse than the surgeons in terms of "I don't care what the evidence says, in my experience . . . "

You know, as am EMT I thought I knew everything. As a Paramedic I thought EMT's were idiots. As a Med student, I started to feel like I knew everything again. Dangerous, but common way of thinking for ROOKIES.

You ask me who I want to be there when one of my parents is hurt or sick, given the choice between someone with more training and knowledge, versus someone with less, the answer is pretty obvious.

Does every 911 call warrant a Paramedic? No, of course not, but is every 911 call warranted? Nope.

What about nurses? Lets be honest, they push drugs under doctors orders, and can't do much else except for a foley. Should we get rid of them too? You talk about expensive, they make a lot more than a paramedic.

I think you need to get over yourself. You haven't broken any new ground yourself. You are becoming a doctor because you are studying what other researchers have discovered in the past. Standing on the shoulders of giants, so to speak.

Know your role. Youre a little new in the game to be so bitter. Look at your signature line "All dreams die"?

I bet your bedside manner is wonderful.
=)

 

[leviathan]

What about nurses? Lets be honest, they push drugs under doctors orders, and can't do much else except for a foley.

You should express these views in clerkship to your preceptors, and especially to the nursing staff. They will love it.

 

[UofM Med]

You should express these views in clerkship to your preceptors, and especially to the nursing staff. They will love it.

I was trying to make the point that other people besides docs are an important part of the medical field.

 

[howelljolly]

Dont mind him, hes from Canada. English isnt his first language.

 

[gas4all]

Medicine is based on evidence. Well, designed scientific studies that tell people which interventions help the patient, which do nothing, and which harm the patient. We know who is at risk for certain diseases, what treatment is effective, and what is too risky based upon this tangible evidence. What people on this forum are trying to say is that EMS needs to get on board with this. You may feel that you are making a difference or that an intervention is appropriate, but you have no proof of this. Maybe you are, but maybe you aren't. I am a giant advocate of EMS, but if you want respect (like you imply in your post), then you have to earn it. You have to back up what you say with evidence.

You can shout all day long from the highest building about how you saved the lives of 25 hemophiliac children after a school bus accident at the same time having a schizophrenic patient aim a gun at your head. In the rain.

It doesn't matter what you say unless you have proof that your actions changed an outcome. Anecdotes don't count.

Here is the problem: Pre-hospital care efficacy/outcome research is very hard to do, especially if your goal is to compare basic life support with ALS. For example, what study would be approved that rotated BLS and ALS system services, say, every other day. The methodology would be to deny intubation, cardiac meds, breathing treatments, etc. to patients one day, and make them available to citizens the next (and what day would you like grandma to get sick on, scientifically speaking) and see who lives and who lives a bit less or not at all. No, you cannot search out exisitng "all BLS' and "all ALS" systems and compare them. You will have HUGE discrepencies in response and transport times as well as proficiency levels since the BLS systems will almost uniformily be rural/small town/small hospital entities.

What 'science' exactly can we employ to determine the best evidence based care for EMS is the question. Certainly some studies are possible which affect all provider levels....the demise of the MAST grament is a g oood example. But simply because it cannot be shown that procedure X does not affect morbidity or mortality....when no study has been done to determine this...AND procedure X is an 'emergency' procedure (which most of us would prefer was available to family members...AND we supposedly know something about sick people and how to treat them)....NO conclusions can be drawn scientifically regarding any of it.

Rather than dramatic and sweeping statements regarding the expense of EMS in the face of lacking supportive research, Dr. Henry might spend more time proposing research solutions. Otherwise his arguments are pointless. Unfortunately, anecdotal information often is the only information available. Unlike the 'surgeon' who 'does not care what the evidence is' when the research is there, a lack of research produces NO evidence.

DISCLAIMER; Yes, I am a former paramedic from many moons ago so I admit personal bias.

 

[leviathan]

Dont [sic] mind him, hes[sic] from Canada. English isnt [sic] his first language.

What about his statement was showing the importance of other fields in health care by saying that they "can't do much"? I guess they don't teach reading comprehension in American schools. Maybe that's why US students always do so poorly on the VR section of the MCAT.

 

[howelljolly]

What about his statement was showing the importance of other fields in health care by saying that they "can't do much"? I guess they don't teach reading comprehension in American schools. Maybe that's why US students always do so poorly on the VR section of the MCAT.

Someone can't take a joke. Last I checked, they speak English in Canada. If I have to explain it, it isnt funny anymore.

So, while we are in Canada... It just takes one dead celebrity to get everyone jumping up and down about how Med-Evac helicopters save lives.

Doctor: Lack of medical helicopter cost Richardson

http://news.yahoo.com/s/ap/20090321/ap_on_re_us/natasha_richardson

 

[jbar]

that being said I think that a decompensating sub-dural who needs surgery and is over two hours from a hospital with neuro surgery is a pretty good case for a helicopter.

 

[MediumDef]

that being said I think that a decompensating sub-dural who needs surgery and is over two hours from a hospital with neuro surgery is a pretty good case for a helicopter.

I would actually be interested if anyone has ever calculated what the number needed to treat is for medical flights given the relative dangers faced by the crew. (I guess specifically with regard to helicopters).

 

[leviathan]

Someone can't take a joke. Last I checked, they speak English in Canada. If I have to explain it, it isnt funny anymore.

Sorry howelljolly, your joke just didn't make any sense since there was no misinterpretation to begin with.

 

[pseudoknot]

I would actually be interested if anyone has ever calculated what the number needed to treat is for medical flights given the relative dangers faced by the crew. (I guess specifically with regard to helicopters).

Most papers published on medical helicopters show no risk reduction, so the number needed to treat would be infinity. Even if there were no danger to the crews.

 

[leviathan]

Most papers published on medical helicopters show no risk reduction, so the number needed to treat would be infinity. Even if there were no danger to the crews.

NNT would be infinity, but NNH would not. Gotta love it!