Guest guest Posted November 20, 2003 Report Share Posted November 20, 2003 We certainly need more research in rural settings. However, because of decreased call volumes it takes much longer to gather statistically-significant data in rural settings and the logistics of conducting research (IRB approvals, costs, training) sometimes makes such studies impossible or at best difficult. Thus, until such studies are done, we must extrapolate similar data and use clinical judgment to make a determination. Bledsoe, DO, FACEP Midlothian, TX [http://www.bryanbledsoe.com] 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 20, 2003 Report Share Posted November 20, 2003 Guess what? Traction splints have no major role in EMS and are frequently misused with harmful side-effects. See the February issue of JEMS to see how Mr. Bledson addresses this issue. Aw the power of the pen...I mean the Dell Dimension 8250. Bledsoe, DO, FACEP Midlothian, TX [http://www.bryanbledsoe.com] 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 20, 2003 Report Share Posted November 20, 2003 Pt. male black bilateral amputation of both legs from a freight train running over him while he was intoxicated and out cold lying on the tracks. Pt no vitals no respirations not responsive to pain cpr intubated, ambu bag iv not available, as this was under the train in the dark, mast applied pt pulse respirations combative ivs started bilateral ringers in pt to er, er evaluated called surgeon who was knowledgeable about mast mast left in place until surgery. Pt. lived and won a law suit against the rail road. Did mast help this pt. in a rural setting or not? 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 > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 20, 2003 Report Share Posted November 20, 2003 Silsbee EMS wrote: > Did mast help this pt. in a rural setting or not? It didn't help the railroad any, that's for sure. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 20, 2003 Report Share Posted November 20, 2003 I agree I once had an order in an er to assist a dr with reducing a hip dislocation with a traction splint. Talk about damage the dr finally gave up and transferred the pt to some one who knew what he was doing at another facility. 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 > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 21, 2003 Report Share Posted November 21, 2003 extrapolate or compitulate (heck I don't know how to spell or do either) Henry Bledsoe wrote: > We certainly need more research in rural settings. However, because of > decreased call volumes it takes much longer to gather > statistically-significant data in rural settings and the logistics of > conducting research (IRB approvals, costs, training) sometimes makes such > studies impossible or at best difficult. Thus, until such studies are done, > we must extrapolate similar data and use clinical judgment to make a > determination. > > Bledsoe, DO, FACEP > Midlothian, TX > [http://www.bryanbledsoe.com] > > 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 > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 21, 2003 Report Share Posted November 21, 2003 , before it is all over we will be back to funeral home cars and throwing sheets over the patients we want to claim. Henry Bledsoe wrote: > Guess what? Traction splints have no major role in EMS and are frequently > misused with harmful side-effects. See the February issue of JEMS to see how > Mr. Bledson addresses this issue. Aw the power of the pen...I mean the Dell > Dimension 8250. > > Bledsoe, DO, FACEP > Midlothian, TX > [http://www.bryanbledsoe.com] > > 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 > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 21, 2003 Report Share Posted November 21, 2003 , You could have just left him on the tracks and he may have done just as well by himself. Henry By the way , you know I am just jacking with you. Silsbee EMS wrote: > Pt. male black bilateral amputation of both legs from a freight train > running over him while he was intoxicated and out cold lying on the tracks. > Pt no vitals no respirations not responsive to pain cpr intubated, ambu bag > iv not available, as this was under the train in the dark, mast applied pt > pulse respirations combative ivs started bilateral ringers in pt to er, er > evaluated called surgeon who was knowledgeable about mast mast left in place > until surgery. Pt. lived and won a law suit against the rail road. Did mast > help this pt. in a rural setting or not? > > > 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 > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 21, 2003 Report Share Posted November 21, 2003 No, we will be practicing what works (although those were the good old days). Defibrillation, airway management, ALS for medical problems, and similar practices help. But, trauma is a different animal. Unless you can control the bleeding, the best thing is to maintain a pressure between 79-85 and get them somewhere where the bleeding can be controlled. Bledsoe, DO, FACEP Midlothian, TX [http://www.bryanbledsoe.com] 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 > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 21, 2003 Report Share Posted November 21, 2003 Anecdote my boy, anecdote. I once saw a stroke patient regain his speech after being shot in the head. Perhaps we should start shooting all aphasic patients in the head. And, what difference did his race make in this story? Bledsoe, DO, FACEP Midlothian, TX [http://www.bryanbledsoe.com] Re: MAST pants Pt. male black bilateral amputation of both legs from a freight train running over him while he was intoxicated and out cold lying on the tracks. Pt no vitals no respirations not responsive to pain cpr intubated, ambu bag iv not available, as this was under the train in the dark, mast applied pt pulse respirations combative ivs started bilateral ringers in pt to er, er evaluated called surgeon who was knowledgeable about mast mast left in place until surgery. Pt. lived and won a law suit against the rail road. Did mast help this pt. in a rural setting or not? 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 > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 21, 2003 Report Share Posted November 21, 2003 Should have been 70-85 systolic. Fingers aren't working this beautiful AM. Bledsoe, DO, FACEP Midlothian, TX [http://www.bryanbledsoe.com] 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 > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 21, 2003 Report Share Posted November 21, 2003 My partner and I chose not to apply the MAST to our open fx of right femur with extensive soft tissue injury and arterial bleeding from a gaping open wound. After the bleeding was controlled and the patient's pain controlled with morphine, I saw no reason to risk starting the bleeding again by applying a traction splint. There were good dorsalis pedis and posterior tibial pulses, warm and pink toes with intact feeling and movement, and I saw no reason for the TS. We opted for the helo because we faced about 5 miles over ranchland and ranch roads and I did not want to subject the patient to that movement. There was no other reason for the bird. Birdpeople agreed with decision not to traction splint. Birdnurse told me later that the ER doc threw a fit with a purple passion and bobwahr tail because he wasn't splinted; however, the orthopedic surgeon also chose not to apply the TS and he went to surgery without it. So in fact, five of the six people whose opinions mattered chose not to apply the traction splint. First do no harm. The patient is walking around and doing fine without the traction splint. In QAing this call I asked everyone to give me a reason, an argument, why we should have applied the TS. No one could think of a reason. So I opt NOT to do procedures unless I have a definite reason to do them and have a reasonable expectation that the patient will benefit. I have not used MAST on a patient since approximately 1983 or 4. Gene Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 21, 2003 Report Share Posted November 21, 2003 wegandy1938@... wrote: > > So I opt NOT to do procedures unless I have a definite reason to do them > and have a reasonable expectation that the patient will benefit. The first week (at least) of EMT school should be spent doing nothing but reading that statement over and over and over again. This brings us back to the need to get away from training technicians and start educating professionals. Cookbook medicine must go the way of bretylium. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 21, 2003 Report Share Posted November 21, 2003 Amen. However, that would boil down to folks being able to critically think. And, unfortunately, that is a skill that seems to be lacking in many of today's youth - today's younger EMT students. Buuuuuttttt, that is yet another problem and another totally different discussion. LOLOL Jane Hill Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 21, 2003 Report Share Posted November 21, 2003 Yes, Larry, and the is a totally different animal from the Hare. The provides perfect inline traction, while the Hare by its very design causes angulation. GG In a message dated 11/22/2003 12:40:40 AM Central Standard Time, lanelson1@... writes: Concur on not using the TS. You did mention that it was an open fx of the femur, another exclusion criteria. The original use of the Splint (originally a full ring, then Half Splint) was in WW1 when stretcher trips in trenches and long ambulance rides across muddy fields called for an improvement over nothing. Larry RN LP EMSI Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 21, 2003 Report Share Posted November 21, 2003 Concur on not using the TS. You did mention that it was an open fx of the femur, another exclusion criteria. The original use of the Splint (originally a full ring, then Half Splint) was in WW1 when stretcher trips in trenches and long ambulance rides across muddy fields called for an improvement over nothing. Larry RN LP EMSI Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 22, 2003 Report Share Posted November 22, 2003 -- wegandy1938@... wrote: " ...and the is a totally different animal from the Hare. The provides perfect inline traction, while the Hare by its very design causes angulation. " Sometimes newer ISN'T better. Didn't they produce a Half Ring upgrade that included the straps and ratchet device? That would seem to be a better idea. See ya'll in San Antone! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 22, 2003 Report Share Posted November 22, 2003 Not only should that statement be used in EMT school,......That should be the goal of every practicioner out there, regardless of what vehicle they ride in to the call!!! Re: MAST pants > wegandy1938@... wrote: > > > > > So I opt NOT to do procedures unless I have a definite reason to do them > > and have a reasonable expectation that the patient will benefit. > > The first week (at least) of EMT school should be spent doing nothing > but reading that statement over and over and over again. This brings us > back to the need to get away from training technicians and start > educating professionals. Cookbook medicine must go the way of bretylium. > > Rob > > > > > > > Quote Link to comment Share on other sites More sharing options...
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