Re: MAST pants

[Guest guest]

In a message dated 11/19/03 4:46:09 PM Pacific Standard Time, je.hill@...

writes:

> Dr. Bledsoe, the link went to a " page cannot be found " page...

>

> Jane Hill

>

>

>

I got the " pagae cannot be found " page also.

[Guest guest]

Read the article at http://www.emsmagazine.com/emsmythology/emsmyth1.html.

Mr. Bledson, A.A.S. (candidate)

MAST pants

I would like to know imput on reasons why they shouldn't be used. I

am doing this for a class. Thanks.

[Guest guest]

Dr. Bledsoe, the link went to a " page cannot be found " page...

Jane Hill

[Guest guest]

Try again:

http://www.emsmagazine.com/emsmythology/emsmyth1.html

or

http://www.bryanbledsoe.com/Myth1.pdf

Bledsoe, DO, FACEP

Midlothian, TX

[http://www.bryanbledsoe.com]

RE: MAST pants

Dr. Bledsoe, the link went to a " page cannot be found " page...

Jane Hill

[Guest guest]

Janie;

I used the link and it worked for me try it again and check your privacy

setting

RE: MAST pants

>

>

> > Dr. Bledsoe, the link went to a " page cannot be found " page...

> >

> > Jane Hill

> >

> >

> >

> >

> >

> >

[Guest guest]

Some time ago, perhaps within the last 3-6 years, I recall that NAEMSP came

out with a position paper on MAST which I found interesting. If memory serves

me correctly the position paper took the position that it is contraindicated

in PE, uncontrolled external above the level of the garment, presumed internal

bleeding in the head or thoracic cavity, and pneumothorax. Relative

contraindications (abdominal portion) for pregnancy, impaled objects, and so

forth.

The interesting thing was that it recommended MAST for AAA.

Can Mr. Bledson comment?

GG

[Guest guest]

We know that the Houston study was on the urban patient population with very

short transport times, which really told us nothing about its relation to the

use of MAST in the rural setting with longer transports to a Trauma Center.

What patient population was used in the Cochrane Review and what was the

average transport time to definitive care?

Jane Hill

[Guest guest]

It must have been just something at the time. When I tried the one he

reposted (which looked the same), it went straight to it. Thanks.

Jane Hill

[Guest guest]

The Cochrane review was a meta-analysis of the Houston and Change study. The

Chang study was set in Wichita, Kansas and did involve some rural, but

primarily suburban patients.

PASG: does it help in the management of traumatic shock?

Chang FC, on PB, Beech RR, Helmer SD.

Department of Surgery, University of Kansas School of Medicine, Wichita

67214, USA.

A prospective, randomized study was designed to determine the efficacy of

pneumatic antishock garment (PASG) in the treatment of traumatic shock in a

medium-size urban community. A total of 291 traumatic shock patients were

assigned to either the PASG or No-PASG treatment groups. Of these, data from

248 patients were analyzed in detail. Analysis of demographic factors--such

as age, sex, and mechanism of injury--as well as prehospital evaluative

tools--such as trauma and CRAMS scores, and injury severity scores--revealed

that the two groups were well-matched. This study did not demonstrate

significant differences in hospital stay or mortality between PASG and

No-PASG patients. Similarly, in the subset of patients with blunt trauma,

PASG was not found to be beneficial.

Bledsoe, DO, FACEP

Midlothian, TX

[http://www.bryanbledsoe.com]

RE: MAST pants

We know that the Houston study was on the urban patient population with very

short transport times, which really told us nothing about its relation to

the

use of MAST in the rural setting with longer transports to a Trauma Center.

What patient population was used in the Cochrane Review and what was the

average transport time to definitive care?

Jane Hill

[Guest guest]

Bledsoe wrote:

> The Cochrane review was a meta-analysis of the Houston and Change study. The

> Chang study was set in Wichita, Kansas and did involve some rural, but

> primarily suburban patients.

So is the current conventional wisdom that rural systems with greatly

extended transport times should function identically to their urban

counterparts? That seems to be the implication of your relegation of

MAST to the museums.

I'm not disputing the research. But I would like to know if the

conclusion is applicable to all systems, or if it was simply written

without regard to rural systems.

Rob

[Guest guest]

Points to ponder:

1. There has never been a study that shows MAST improves outcome or

mortality.

2. The mechanism of MAST is now well understood and does not involve any

degree of autotransfusion.

3. Just because there is no research to show that it does not work

specifically in rural patients does not mean that it should be used in rural

patients. This is a cardinal feature of pseudoscience. That is, if somebody

cannot prove that something does not work, then it must work. This is why

magicians do not tell their secrets. If their secrets were known, the magic

could be explained and the trick seen for what it really is.

This is a similar loophole CISMers use, " Well if you cannot specifically

prove that the ICISF multi-component model of CISM does not work, then we

must conclude that it does and must continue doing that. "

Interestingly, I have an article on recognizing pseudoscience in EMS in the

January issue of Best Practices in Emergency Services.

BEB

Bledsoe, DO, FACEP

Midlothian, TX

[http://www.bryanbledsoe.com]

Re: MAST pants

Bledsoe wrote:

> The Cochrane review was a meta-analysis of the Houston and Change study.

The

> Chang study was set in Wichita, Kansas and did involve some rural, but

> primarily suburban patients.

So is the current conventional wisdom that rural systems with greatly

extended transport times should function identically to their urban

counterparts? That seems to be the implication of your relegation of

MAST to the museums.

I'm not disputing the research. But I would like to know if the

conclusion is applicable to all systems, or if it was simply written

without regard to rural systems.

Rob

[Guest guest]

Bledsoe wrote:

> Points to ponder:

I totally agree. But there were two points made in the article which

left the question open:

1. There ARE still several specific indications which are validated by

the article.

2. The same benefits could be achieved by rapid transport.

So, if benefits are acknowleged, that begs the question; What if rapid

transport is not possible? The article did not satisfactorily address that.

Rob

[Guest guest]

So then we are still with the same problem regarding interpretation of MAST

usage studies - there have been no significant studies regarding the efficacy

or lack of in the rural environment. Taking study results with primarily

urban and sububurban type transport times with an intervention like PASG

really tells us nothing in the longer transport setting. You cannot compare

apples to grapes and consider that a responsible interpretation of available

research, in my opinion.

Respectfully yours,

Jane Hill

[Guest guest]

What evidence is there that they work in rural or frontier settings? Just

because they are there does not mean they work. Jane, your response is

emotional rather than scientific. The only evidence is that they work as a

splint. But, you have several other modalities available (back boards) that

are equally or more effective. We all want to help rural patients--but we

need to apply only those devices proven to have benefit. I'll email the

NAEMSP position paper.

Bledsoe, DO, FACEP

Midlothian, TX

[http://www.bryanbledsoe.com]

RE: MAST pants

So then we are still with the same problem regarding interpretation of MAST

usage studies - there have been no significant studies regarding the

efficacy

or lack of in the rural environment. Taking study results with primarily

urban and sububurban type transport times with an intervention like PASG

really tells us nothing in the longer transport setting. You cannot compare

apples to grapes and consider that a responsible interpretation of available

research, in my opinion.

Respectfully yours,

Jane Hill

[Guest guest]

Just for information the Panhandle Emergency Medical Service System does not

use MAST nor are they carried on the trucks. PEMSS has 24 counties associated

with it.

Danny L.

Owner/NREMT-P

Panhandle Emergency Training Services And Response

(PETSAR)

Office

FAX

[Guest guest]

Anecdotally speaking, I have used them on a fem-pop bypass that " popped " .

ugh. looked like a slaughterhouse in this guy's apartment. Anyway, bleeding

was uncontrolled otherwise. PASG applied, rapid transport, IV's and consult

enroute allowed the patient quick access to surgery with the bleeding

controlled and the patient hemodynamically stable. But, how many of those

do you run into in your career?!

Otherwise, I have never seen any added benefit to the PASG/MAST (well,

except for a quick 5 skill points when interning).

Mike

Just fueling the fire.

[Guest guest]

You know science may kill just as many folks as it helps. When MAST first

came out and we used them a bunch, I actually saw them work. That is until the

Dr. at the ER decided to strip the velcro and take them off all at once. Could

this guy have survived the surgery. Heck I don't know. If it had been me I would

have liked to have the chance. If you like I can provide the complete picture of

the call and patient information picture. My point is sometimes science is about

seeing them work. Autotransfuse, maybe not. Create enough pressure to stop the

additional belly bleeding, maybe it did. If folks waited for science all the

time, we wouldn't get anything done. Not say science is bad, just that sometimes

you don't need a study for everything you do. Boy will I get a lot of crap over

this one.

Henry

Bledsoe wrote:

> What evidence is there that they work in rural or frontier settings? Just

> because they are there does not mean they work. Jane, your response is

> emotional rather than scientific. The only evidence is that they work as a

> splint. But, you have several other modalities available (back boards) that

> are equally or more effective. We all want to help rural patients--but we

> need to apply only those devices proven to have benefit. I'll email the

> NAEMSP position paper.

>

> Bledsoe, DO, FACEP

> Midlothian, TX

> [http://www.bryanbledsoe.com]

>

> RE: MAST pants

>

> So then we are still with the same problem regarding interpretation of MAST

> usage studies - there have been no significant studies regarding the

> efficacy

> or lack of in the rural environment. Taking study results with primarily

> urban and sububurban type transport times with an intervention like PASG

> really tells us nothing in the longer transport setting. You cannot compare

>

> apples to grapes and consider that a responsible interpretation of available

>

> research, in my opinion.

>

> Respectfully yours,

> Jane Hill

>

>

>

>

[Guest guest]

How do you know they worked Henry? I would have sworn they worked too when I

used them as a paramedic--but now I know it was the Pygmalian effect--I was

told they worked and tended to believe what I thought I saw. This is where

the Bickell Houston FD is so strong--it eliminates bias. Some things are

common sense and don't need study (i.e., it is necessary to change the

sheets after each call). But if EMS is to be a respected science, we must

base our practices on science.

Bledsoe, DO, FACEP

Midlothian, TX

[http://www.bryanbledsoe.com]

RE: MAST pants

>

> So then we are still with the same problem regarding interpretation of

MAST

> usage studies - there have been no significant studies regarding the

> efficacy

> or lack of in the rural environment. Taking study results with primarily

> urban and sububurban type transport times with an intervention like PASG

> really tells us nothing in the longer transport setting. You cannot

compare

>

> apples to grapes and consider that a responsible interpretation of

available

>

> research, in my opinion.

>

> Respectfully yours,

> Jane Hill

>

>

>

>

[Guest guest]

I didn't mean to sound " emotional " as you put it, cause I am not. I am just

saying that we are just as bad, as a medical community, about throwing out

the baby with the bathwater when research is incomplete or possibly even not

applicable to the setting or situation as we are to adopting medications,

procedures, and treatment without any real justifiable research at ALL. We

are TERRIBLY bad about adopting new protocols and treatments based on

anecdotal medicine in the WHOLE medical community. And we are AWFUL at

taking minimal research and running with it.

The whole point I am trying to make here is that EMS research specific to

each area type is badly needed to justify what we are currently doing as well

as upcoming things we want to do. And we hurt ourselves by jumping to

partial conclusions. We NEED more EMS research. We need urban AND rural

research. And we need to be critical from BOTH sides of this issue and

careful not to jump to conclusions.

Jane Hill

[Guest guest]

Well sometimes I can think for myself. The call that I most remember was a

gentleman that was struck by a car and knocked through a bridge railing into the

water. He had his femur penetrate up through his grion and out his side just

below the diaphragm. His initial BP was in the low 40's palpated. MAST and

Fluids maintained around mind 60's for a 30 minute extrication to shore and 30

minutes a hospital where they had a surgeon. Patient breathing on his own and

color fair. B.P, zero and dead 2 minutes after the surgeon stripped the Mast in

the ER so he could look at the patient's wound. Paramedic pissed of for weeks

afterward. Emotional yes. Can this be explained by science. Maybe. I do know

that it is not similiar to my observation on when to change the sheets. Do we

still carry MAST? Yes. Do we apply them? Never in a number of years. Why?

Because all the new guys on the block have been convinced by heresay (Houston

study that they probably never read) that they don't work. What happens when

someone does another study and supports the MAST. Who knows Calcium may come

back.

Henry

Bledsoe wrote:

> How do you know they worked Henry? I would have sworn they worked too when I

> used them as a paramedic--but now I know it was the Pygmalian effect--I was

> told they worked and tended to believe what I thought I saw. This is where

> the Bickell Houston FD is so strong--it eliminates bias. Some things are

> common sense and don't need study (i.e., it is necessary to change the

> sheets after each call). But if EMS is to be a respected science, we must

> base our practices on science.

>

> Bledsoe, DO, FACEP

> Midlothian, TX

> [http://www.bryanbledsoe.com]

>

> RE: MAST pants

> >

> > So then we are still with the same problem regarding interpretation of

> MAST

> > usage studies - there have been no significant studies regarding the

> > efficacy

> > or lack of in the rural environment. Taking study results with primarily

> > urban and sububurban type transport times with an intervention like PASG

> > really tells us nothing in the longer transport setting. You cannot

> compare

> >

> > apples to grapes and consider that a responsible interpretation of

> available

> >

> > research, in my opinion.

> >

> > Respectfully yours,

> > Jane Hill

> >

> >

> >

> >

[Guest guest]

Doc,

If you have the NAEMS paper available? I sure would like a copy....hint,

hint, hint......

Mike

" Some days you're the dog, and some days you're the hydrant; pretty easy

to figure out which is which. "

Hatfield EMT-P

RE: MAST pants

So then we are still with the same problem regarding interpretation of

MAST

usage studies - there have been no significant studies regarding the

efficacy

or lack of in the rural environment. Taking study results with

primarily

urban and sububurban type transport times with an intervention like PASG

really tells us nothing in the longer transport setting. You cannot

compare

apples to grapes and consider that a responsible interpretation of

available

research, in my opinion.

Respectfully yours,

Jane Hill

[Guest guest]

At the risk of repeating myself (two previous post along this line never

showed up on the listserve), I have to disagree with you about the

conclusion you drew due to the lack of research to prove MAST, CISM, or

anything else works or doesn't work. All a lack of research proves is that

there is a gap in the research...a black hole in the universe of knowledge

if you will where all we're really identified is what we don't know.

Such as the gap of research on the use of MAST pants in rural settings. The

lack of research doesn't prove they don't work, nor does it prove they do

work. It just proves there's a need for study. The Houston study may prove

that in areas where rapid transport to appropriate facilities with short

travel times, the MAST doesn't improve outcomes. But does that same theory

hold up in West Texas where runs are times in hours and not minutes? We

don't know. We know we don't know. Until someone does a rural/frontier

research project we still won't know.

To make the jump that a lack of research proves a point one way or another

is a stretch. As Jane said, our profession needs more research that can

tackle these types of specifics so that we can fill in the gaps of knowledge

so that we can know what we don't know. Anything else would just be an

assumption based on partial knowledge and incomplete research. It may be a

knowledgeable guess, but it is still just a guess.

Barry S.

RE: MAST pants

I didn't mean to sound " emotional " as you put it, cause I am not. I am just

saying that we are just as bad, as a medical community, about throwing out

the baby with the bathwater when research is incomplete or possibly even not

applicable to the setting or situation as we are to adopting medications,

procedures, and treatment without any real justifiable research at ALL. We

are TERRIBLY bad about adopting new protocols and treatments based on

anecdotal medicine in the WHOLE medical community. And we are AWFUL at

taking minimal research and running with it.

The whole point I am trying to make here is that EMS research specific to

each area type is badly needed to justify what we are currently doing as

well

as upcoming things we want to do. And we hurt ourselves by jumping to

partial conclusions. We NEED more EMS research. We need urban AND rural

research. And we need to be critical from BOTH sides of this issue and

careful not to jump to conclusions.

Jane Hill

[Guest guest]

Try again, Jane, I linked without a problem....

Mike

RE: MAST pants

> Dr. Bledsoe, the link went to a " page cannot be found " page...

>

> Jane Hill

>

>

>

>

>

>

[Guest guest]

There have been numerous studies and they have had the same results. How do

you know your patient would not have done just as well without the MAST?

Can't say can you?

BEB

Bledsoe, DO, FACEP

Midlothian, TX

[http://www.bryanbledsoe.com]

RE: MAST pants

> >

> > So then we are still with the same problem regarding interpretation of

> MAST

> > usage studies - there have been no significant studies regarding the

> > efficacy

> > or lack of in the rural environment. Taking study results with

primarily

> > urban and sububurban type transport times with an intervention like PASG

> > really tells us nothing in the longer transport setting. You cannot

> compare

> >

> > apples to grapes and consider that a responsible interpretation of

> available

> >

> > research, in my opinion.

> >

> > Respectfully yours,

> > Jane Hill

> >

> >

> >

> >

[Guest guest]

What's wrong with calcium?! And, where did it go off to this time?

CALCIUM!!! HERE, CALCIUM! COME ON, CALCIUM. HERE BOY!

Hehehe.