Guest guest Posted November 26, 2003 Report Share Posted November 26, 2003 Just out of curiosity....why the distinction with PAID? The patients havent changed, the responsibilties and expectations are tremendous for those who volunteer also. Kathi > If some associations would like some topics to address other than license > plates, feel free to contact your local PAID paramedic. > > If any of you think you have a clue as to what its like to be under paid and > second guessed by an audience that has forgotten that the EMS world has > changed dramatically since you last HAD to work: think again. When you last HAD > to work full time on the truck you probably had LP-5's and never heard of RSI. > The patients haven't changed, the responsibilities & expectations are > tremendous. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 26, 2003 Report Share Posted November 26, 2003 My alligator loafers and boots resemble that remark, sir.... -Wes Ogilvie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 26, 2003 Report Share Posted November 26, 2003 Steve: Your frustration is understandable. I would still be in EMS today if I could have made a decent wage to support my family. I worked for an EMS service many years ago where one of us would make small talk with the nurses while the other would steal the hospital blind just to have enough equipment on the ambulance for patient care. I hope things have changed somewhat. You do not need to read (or believe) all of the research. Former British Prime Minister Disraeli once said, " There are three kinds of lies: lies, damned lies, and statistics. " I have purposefully, on occasion, taken a stand on an issue that I do not necessarily believe in merely to stimulate discourse. I have posted thinly-veiled parodies to get people to read things accurately and think outside the box (and to laugh). EMS is at a critical juncture. It is being driven by a medical technology industry that says " Buy our stuff or you won't be practicing state of the art EMS " and a health care system that is saying " We can't keep paying for extravagant prehospital care. " Thus, we must start asking what works and what doesn't. I personally have felt the MAST somewhat beneficial--but cannot argue with the research. I think traction splints reduce pain and help some, and may hurt others. The skilled paramedic may chose where or when not to apply it. My point is that placing traction splints on ambulances should be a local decision--not mandated by a state or federal entity just because tradition, dogma or financial interest says to do it. I think that medical directors must be paid and be a more active part of the EMS system--not simply used to sign protocols and drug orders. I think protocols should be evidence-based, developed by a committee or providers and physicians (with the medical director having final say). I think each EMS practice should be under some sort of " Sunset Act " whereby it is periodically reviewed (from an evidence-based standpoint) and a determination made as to whether the practice should be dropped, optional, or mandatory. Some things are intuitive and may be above such endeavors. Many of the issues you are dealing with (i.e., MAST, traction splints, CISM) would not cause you distress if we followed this model and addressed these issues continuously or periodically instead of " Dr. Bledsoe going on a tear and shaking our foundations. " Likewise, there should be a way to keep you abreast of the controversies (helicopters, capnography versus oximetry, RSI, permissive hypotension, rural versus urban care) without you having to seek out the journals. JEMS and EMS do a fair-poor job of this, but they do not access every EMS provider. We are starting to do this through JEMS new Grand Rounds series (which always will include a Texan on the panel). Never take anything at face value. Question our practices. Question your medical director. Question Dr. Bledsoe. Question Mr. Gandy. Question your boss. If you do these from a point of improving patient care, improving EMS, or improving yourself--all of those listed should welcome your comments. More is derived from people disagreeing than agreeing. We do not need a bunch of EMS " ditto heads " , we need people to say, " Dr. Bledsoe--please back up your statement with facts " (although I try preemptively). I am far from perfect and have been proved wrong many times, you know what, I learn from it and the whole thing gets better. It's all good...... Mr. Bledson (A.A.S Candidate) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 26, 2003 Report Share Posted November 26, 2003 No need to YELL my friend. Let's keep it civilized here.... Happy Thanksgiving! > I'LL STICK WITH COMMON SENSE, GOOD JUDGEMENT, AND COMPLETE DOCUMENTATION-- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 26, 2003 Report Share Posted November 26, 2003 Rob, Excellent question and point. It would not be good to simply write " c-spine not immobilized because not indicated. " What WOULD be good is to have a selective spinal clearance protocol that has specific evaluations to be done and questions answered. If the protocol points to immobilization, do it. If it shows that immobilization is not indicated, then you don't have to write a conclusion, your documentation already shows the objective criteria that were used in the decision not to immobilize. BTW, we need to think about the term " immobilize. " We all know that a c-collar does NOT immobilize the neck and that a spine board does not immobilize the body. The term " movement restriction " is better. Since I do have the lawyer's perspective and study how lawyers approach their witnesses, let me say that a good plaintiff's lawyer can spend a good hour questioning you about the meaning of " immobilization. " We have to think about what we say and write and what our words mean. Strive for more precise speech and you'll find that your documentations are not so subject to being ripped apart, although the lawyer will try. Best, GG In a message dated 11/26/2003 9:45:27 PM Central Standard Time, rsdrn@... writes: > > I'LL STICK WITH COMMON SENSE, GOOD JUDGEMENT, AND COMPLETE > DOCUMENTATION-- But wouldn't that " COMPLETE DOCUMENTATION " include putting in writing that you chose not to immobilize the c-spine because " I didn't think it was necessary? " Do you really want that in writing? Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 26, 2003 Report Share Posted November 26, 2003 Mike, Interesting that you bring up that case. I testified by deposition in that case as an expert for the plaintiff. BTW, the cardiologist denied in his deposition, under oath, that he had ordered Verapamil. The ER doc had been talking to him on the phone, and SHE ordered the Verapamil. She later contended that the cardiologist has suggested it on the phone, but he denied it vehemently. Both the nurse and the paramedic, who actually pushed the drug, questioned her order but she persisted and the drug was given, with catestrophic results. The patient was unquestionably in ventricular tachycardia. Further, the patient was taking flecainide (Tambocor) which could have complicated things. The total award was $13,140,000. GG In a message dated 11/26/2003 10:09:02 PM Central Standard Time, hatfield@... writes: In line with this conversation......here is an interesting article, a cross post from TEXEMSFACTOR, snipped down for space >>A Fort Worth appeals court upheld a $13 million award for a former North Richland Hills optometrist who was left severely brain damaged after being >>misdiagnosed and injected with the wrong drug. The long and short of it is: >>He received two injections and an intravenous drip, but his accelerated heartbeat continued, court records show. After emergency-room doctors and nurses >>telephoned a cardiologist, Bush was given Verapamil. >>Hospital personnel testified that the Verapamil was given to Bush despite repeated warnings on the label and in literature that giving the drug to a patient with >>ventricular tachycardia " can be a lethal error. " Doing what the " Doctor " ordered or " Because he said so " or " because that is our protocol " is not always your best defense, your best defense is to kow your job, and know it well. Just my opinion though..... Mike Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 26, 2003 Report Share Posted November 26, 2003 > > I'LL STICK WITH COMMON SENSE, GOOD JUDGEMENT, AND COMPLETE > DOCUMENTATION-- But wouldn't that " COMPLETE DOCUMENTATION " include putting in writing that you chose not to immobilize the c-spine because " I didn't think it was necessary? " Do you really want that in writing? Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 26, 2003 Report Share Posted November 26, 2003 With every patient, an appropriate history and assessment should be done. In general, patient care will be based on the information gathered during the history and assessment. If the appropriate patient care decisions are made, then there is no need to be afraid to document any part of the procedure. I don't splint an arm if there is no indication that it needs to be splinted. I don't give a medication if there is no indication that it needs to be given. I don't intubate a patient if there is no indication that the patient needs to be intubated. Why would I backboard a patient if there is no indication that the patient needs to be backboarded? Maxine Pate ---- Original Message ----- From: Rob But wouldn't that " COMPLETE DOCUMENTATION " include putting in writing that you chose not to immobilize the c-spine because " I didn't think it was necessary? " Do you really want that in writing? Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 26, 2003 Report Share Posted November 26, 2003 I would never put that statement in writing. I meant that if the patient refused after several attempts of explaining the need for immobilization such as the " possibility " of an unseen injury. (Maybe I missed something somewhere in previous postings). I was not involved in the treatment, but I know of a situation 20 years ago where someone was thrown from a motorbike (not motorcycle)--- He was walking around--he was not immobilized--transported to the hospital--- and then airlifted to a trauma center due to possible C1/C2 Fx. ---------- Original Message ---------------------------------- Reply-To: Date: Wed, 26 Nov 2003 21:30:55 -0600 >> >> I'LL STICK WITH COMMON SENSE, GOOD JUDGEMENT, AND COMPLETE >> DOCUMENTATION-- > > >But wouldn't that " COMPLETE DOCUMENTATION " include putting in writing >that you chose not to immobilize the c-spine because " I didn't think it >was necessary? " Do you really want that in writing? > >Rob > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 26, 2003 Report Share Posted November 26, 2003 jwservices wrote: > I was not involved in the treatment, but I know of a situation 20 years > ago where someone was thrown from a motorbike (not motorcycle)--- He was > walking around--he was not immobilized--transported to the hospital--- > and then airlifted to a trauma center due to possible C1/C2 Fx. That is my fear. There have been many patients in my career whom I immobilized based strictly on MOI (no other s/sx), who turned out to have cervical fractures. In fact, I myself was immobilized based strictly upon MOI once and turned out to have a cervical fracture of my own. If we lower the bar on that criteria, we are inevitably going to start killing people. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 26, 2003 Report Share Posted November 26, 2003 Why was the helicopter necessary? What did the helicopter offer his C1/C2 fracture that your ambulance could not? Common arguments: 1. Well, he got to the hospital faster. So? The damage was done when he fell off his motorbike. Time makes little difference unless you could not secure an airway and ventilate the patient (if he needed that--but he was walking and talking). 2. The helicopter ride was smoother. Was it? Many helicopters are rougher than ground ambulances when weather and such are factored in. If the patient was properly immobilized he could have been transported by donkey with no adverse outcome. Why was the helicopter necessary? Not trying to be a turd in the punch bowel, just trying to get people to think about WHY they make certain prehospital decisions. Bledsoe, DO, FACEP Midlothian, TX [http://www.bryanbledsoe.com] P.S. The last 2 cervical fractures I saw walked into the ED and said, " My neck hurts. " Re: Perceptions I would never put that statement in writing. I meant that if the patient refused after several attempts of explaining the need for immobilization such as the " possibility " of an unseen injury. (Maybe I missed something somewhere in previous postings). I was not involved in the treatment, but I know of a situation 20 years ago where someone was thrown from a motorbike (not motorcycle)--- He was walking around--he was not immobilized--transported to the hospital--- and then airlifted to a trauma center due to possible C1/C2 Fx. ---------- Original Message ---------------------------------- Reply-To: Date: Wed, 26 Nov 2003 21:30:55 -0600 >> >> I'LL STICK WITH COMMON SENSE, GOOD JUDGEMENT, AND COMPLETE >> DOCUMENTATION-- > > >But wouldn't that " COMPLETE DOCUMENTATION " include putting in writing >that you chose not to immobilize the c-spine because " I didn't think it >was necessary? " Do you really want that in writing? > >Rob > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 26, 2003 Report Share Posted November 26, 2003 I agree 200% !!!!!!!!!!!!!! ---------- Original Message ---------------------------------- Reply-To: Date: Wed, 26 Nov 2003 22:32:06 -0600 >jwservices wrote: > >> I was not involved in the treatment, but I know of a situation 20 years > >> ago where someone was thrown from a motorbike (not motorcycle)--- He was > >> walking around--he was not immobilized--transported to the hospital--- > >> and then airlifted to a trauma center due to possible C1/C2 Fx. > > >That is my fear. There have been many patients in my career whom I >immobilized based strictly on MOI (no other s/sx), who turned out to >have cervical fractures. In fact, I myself was immobilized based >strictly upon MOI once and turned out to have a cervical fracture of my >own. If we lower the bar on that criteria, we are inevitably going to >start killing people. > >Rob > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 26, 2003 Report Share Posted November 26, 2003 Physician's determination--besides, the nearest trauma center is 110 miles away at that time, and the local EMS was volunteer. Also, unfortunately, the paid service was out of a funeral home--- I won't say why they didn't transport OR even be considered for transport. ----- Re: Perceptions > >I would never put that statement in writing. I meant that if the patient >refused after several attempts of explaining the need for immobilization >such as the " possibility " of an unseen injury. >(Maybe I missed something somewhere in previous postings). I was not >involved in the treatment, but I know of a situation 20 years ago where >someone was thrown from a motorbike (not motorcycle)--- He was walking >around--he was not immobilized--transported to the hospital--- and then >airlifted to a trauma center due to possible C1/C2 Fx. > > >---------- Original Message ---------------------------------- > >Reply-To: >Date: Wed, 26 Nov 2003 21:30:55 -0600 > >>> >>> I'LL STICK WITH COMMON SENSE, GOOD JUDGEMENT, AND COMPLETE >>> DOCUMENTATION-- >> >> >>But wouldn't that " COMPLETE DOCUMENTATION " include putting in writing >>that you chose not to immobilize the c-spine because " I didn't think it >>was necessary? " Do you really want that in writing? >> >>Rob >> >> >> >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 26, 2003 Report Share Posted November 26, 2003 Maxine illustrates what I have been saying. EMTs, and especially paramedics, are independent providers and must make decisions themselves about patient care (based on guidelines called protocols). Even as physicians we have guidelines to guide our care (called best-practices, clinical decision models, and so on). You should only do what your educated and experienced mind tells you. An old doctor told me once that the sign of an experienced physician is not knowing when to do a procedure, but knowing when not to. That same admonition applies equally to EMS. Bledsoe, DO, FACEP Midlothian, TX [http://www.bryanbledsoe.com] Re: Perceptions With every patient, an appropriate history and assessment should be done. In general, patient care will be based on the information gathered during the history and assessment. If the appropriate patient care decisions are made, then there is no need to be afraid to document any part of the procedure. I don't splint an arm if there is no indication that it needs to be splinted. I don't give a medication if there is no indication that it needs to be given. I don't intubate a patient if there is no indication that the patient needs to be intubated. Why would I backboard a patient if there is no indication that the patient needs to be backboarded? Maxine Pate ---- Original Message ----- From: Rob But wouldn't that " COMPLETE DOCUMENTATION " include putting in writing that you chose not to immobilize the c-spine because " I didn't think it was necessary? " Do you really want that in writing? Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 26, 2003 Report Share Posted November 26, 2003 Know what I've always thought? In theory, after every play in a football game, every player should be collared and backboarded, flown to a trauma center and c-spine cleared. In my career I have collared and boarded hundreds of people who suffered far less mechanism than a wide out who got hit as he was coming over the middle. A 350 lb lineman hits a 180 lb QB in the chest, you see that head flopping around....and it's got an extra 4 or 5 pounds on. I have to admit, the only c-spine injury I've seen in a patient of mine was from a fall from bed. We collared and boarded her because her neck hurt though. magnetass sends Re: Perceptions > I would never put that statement in writing. I meant that if the patient refused after several attempts of explaining the need for immobilization such as the " possibility " of an unseen injury. > (Maybe I missed something somewhere in previous postings). I was not involved in the treatment, but I know of a situation 20 years ago where someone was thrown from a motorbike (not motorcycle)--- He was walking around--he was not immobilized--transported to the hospital--- and then airlifted to a trauma center due to possible C1/C2 Fx. > > > ---------- Original Message ---------------------------------- > > Reply-To: > Date: Wed, 26 Nov 2003 21:30:55 -0600 > > >> > >> I'LL STICK WITH COMMON SENSE, GOOD JUDGEMENT, AND COMPLETE > >> DOCUMENTATION-- > > > > > >But wouldn't that " COMPLETE DOCUMENTATION " include putting in writing > >that you chose not to immobilize the c-spine because " I didn't think it > >was necessary? " Do you really want that in writing? > > > >Rob > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 26, 2003 Report Share Posted November 26, 2003 None of these are satisfactory arguments: Physician's determination: cop out. Why was it necessary to contact the physician about mode of transport.? Is that not a prehospital decision? Trauma Center 110 miles away: Not unusual in Texas. What if this happened in the Big Bend? Local EMS Volunteer: Volunteers can't immobilize a c-spine and drive an ambulance? Paid service out of a funeral home: Rare in this day and age but I am sure they were TDH licensed and the EMTs and/or paramedics state certified. Bledsoe, DO, FACEP Midlothian, TX [http://www.bryanbledsoe.com] RE: Perceptions Physician's determination--besides, the nearest trauma center is 110 miles away at that time, and the local EMS was volunteer. Also, unfortunately, the paid service was out of a funeral home--- I won't say why they didn't transport OR even be considered for transport. ----- Re: Perceptions > >I would never put that statement in writing. I meant that if the patient >refused after several attempts of explaining the need for immobilization >such as the " possibility " of an unseen injury. >(Maybe I missed something somewhere in previous postings). I was not >involved in the treatment, but I know of a situation 20 years ago where >someone was thrown from a motorbike (not motorcycle)--- He was walking >around--he was not immobilized--transported to the hospital--- and then >airlifted to a trauma center due to possible C1/C2 Fx. > > >---------- Original Message ---------------------------------- > >Reply-To: >Date: Wed, 26 Nov 2003 21:30:55 -0600 > >>> >>> I'LL STICK WITH COMMON SENSE, GOOD JUDGEMENT, AND COMPLETE >>> DOCUMENTATION-- >> >> >>But wouldn't that " COMPLETE DOCUMENTATION " include putting in writing >>that you chose not to immobilize the c-spine because " I didn't think it >>was necessary? " Do you really want that in writing? >> >>Rob >> >> >> >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 27, 2003 Report Share Posted November 27, 2003 To the good doctor: I think you missed something in the first message (left in below) about the patient that was thrown from a motorbike. The patient was first transported to a hospital, and then from that hospital was flown to a trauma center. So, it was a physician that made the decision to fly. Another observation about this particular situation: This took place 20 years ago. My personal experience has been that 15-20 years ago the education regarding patient assessment was woefully lacking, compared to what it is today. The message says nothing about what kind of assessment was done, but suggests that the patient was not backboarded because he was walking around when EMS arrived. " Walking around " is not a thorough assessment, and is not reason enough to skip the c-collar and backboard. Those of us who support and practice selective spinal restriction would not base it only on one factor, such as " walking around " . Maxine Pate ----- Original Message ----- From: Bledsoe None of these are satisfactory arguments: Physician's determination: cop out. Why was it necessary to contact the physician about mode of transport.? Is that not a prehospital decision? Trauma Center 110 miles away: Not unusual in Texas. What if this happened in the Big Bend? Local EMS Volunteer: Volunteers can't immobilize a c-spine and drive an ambulance? Paid service out of a funeral home: Rare in this day and age but I am sure they were TDH licensed and the EMTs and/or paramedics state certified. Bledsoe, DO, FACEP Midlothian, TX [http://www.bryanbledsoe.com] >-----Original Message----- >From: jwservices > >I would never put that statement in writing. I meant that if the patient >refused after several attempts of explaining the need for immobilization >such as the " possibility " of an unseen injury. >(Maybe I missed something somewhere in previous postings). I was not >involved in the treatment, but I know of a situation 20 years ago where >someone was thrown from a motorbike (not motorcycle)--- He was walking >around--he was not immobilized--transported to the hospital--- and then >airlifted to a trauma center due to possible C1/C2 Fx. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 27, 2003 Report Share Posted November 27, 2003 I stand corrected. Thanks. BEB Bledsoe, DO, FACEP Midlothian, TX [http://www.bryanbledsoe.com] Re: Perceptions To the good doctor: I think you missed something in the first message (left in below) about the patient that was thrown from a motorbike. The patient was first transported to a hospital, and then from that hospital was flown to a trauma center. So, it was a physician that made the decision to fly. Another observation about this particular situation: This took place 20 years ago. My personal experience has been that 15-20 years ago the education regarding patient assessment was woefully lacking, compared to what it is today. The message says nothing about what kind of assessment was done, but suggests that the patient was not backboarded because he was walking around when EMS arrived. " Walking around " is not a thorough assessment, and is not reason enough to skip the c-collar and backboard. Those of us who support and practice selective spinal restriction would not base it only on one factor, such as " walking around " . Maxine Pate ----- Original Message ----- From: Bledsoe None of these are satisfactory arguments: Physician's determination: cop out. Why was it necessary to contact the physician about mode of transport.? Is that not a prehospital decision? Trauma Center 110 miles away: Not unusual in Texas. What if this happened in the Big Bend? Local EMS Volunteer: Volunteers can't immobilize a c-spine and drive an ambulance? Paid service out of a funeral home: Rare in this day and age but I am sure they were TDH licensed and the EMTs and/or paramedics state certified. Bledsoe, DO, FACEP Midlothian, TX [http://www.bryanbledsoe.com] >-----Original Message----- >From: jwservices > >I would never put that statement in writing. I meant that if the patient >refused after several attempts of explaining the need for immobilization >such as the " possibility " of an unseen injury. >(Maybe I missed something somewhere in previous postings). I was not >involved in the treatment, but I know of a situation 20 years ago where >someone was thrown from a motorbike (not motorcycle)--- He was walking >around--he was not immobilized--transported to the hospital--- and then >airlifted to a trauma center due to possible C1/C2 Fx. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 27, 2003 Report Share Posted November 27, 2003 Hatfield, I couldn't have worded any of that better if I tried. Good response. Even though I am a Director of an ambulance service now after over 18 years in EMS, I am working shifts regularly on my trucks as both a primary paramedic and as a preceptor. Mr. Gandy works for me too and, by the way, he is a hoot with whom to work on a truck. Jane Hill Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 27, 2003 Report Share Posted November 27, 2003 Anecdote n. A short account of an interesting or humorous incident. Anecdotal Evidence: The description of the occurrence of single unique event, such as a miraculous medical recovery. Even if the occurrence of the event itself is without doubt, the reason that it occurred is often promoted as being due to an unusual therapy applied to the case and thus validating the theory that selection of the therapy was based upon. The probability of apparently unusual events is often considerably higher than we expect by intuition and other unrecognized factors (confounders) may have invalidated the initial prediction of demise, thus making the event not that unusual. As an anecdote is extremely weak evidence in support of a theory, an accumulation of similar anecdotes does not significantly increase support and at best may serve as a justification for a scientific experiment to empirically test the theory. ex. " .I know of a situation 20 years ago where someone was thrown from a motorbike (not motorcycle)--- He was walking around--he was not immobilized--transported to the hospital--- and then airlifted to a trauma center due to possible C1/C2 Fx. " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 27, 2003 Report Share Posted November 27, 2003 Mike: What you are describing is what is called retrospective falsification. That is, an extraordinary event is told and then embellished each time it is re-told. Each time it is re-told the favorable points are emphasized while the unfavorable points are dropped. This phenomenon is also called shoehorning and commonly leads to urban legends. Everybody should be familiar with the: Post hoc fallacy (post hoc ergo propter hoc [ " after this therefore because of this " ]). This is common in pseudoscience. That is, because one thing happens after another, the first event caused the second event. This is used in CISM justification. Proponents will say, " Well, CISM must work because after the session everybody was better. " Science will say " prove it " . With CISM, is it not as likely that people would have gotten better anyway (natural healing), singing Kumbaya, or simply talking with colleagues? Or with MAST, " after we applied the MAST the patient was better " . Was it the MAST, IV fluids, oxygenation, better lighting, improving hypothermia? One does not necessarily lead to the other no matter how intuitive it may seem. Pragmatic fallacy. This is common in pseudoscience and again in CISM. Bascially, someone is saying something is true because " it works. " The term " works " is imprecise. Basically, it means that one person perceives some practical benefit in believing that it is true. Again, this is the principle argument for CISM and MAST: " we know it works! " Regressive fallacy. This is much like the post hoc fallacy, that is the failure to consider natural events when looking at causation. In one CISM study people who were debriefed within 10 hours did better than those debriefed at 24 hours. But, is it just as likely that both groups were better at 24 hours and the group that " got better " after 10 hour debriefing would have gotten " better " had they not been debriefed (natural recovery). That is, there was more room for improvement for the 10 hour when compared to the 24 hour group and they therefore improved more. Thus, this is touted as evidence that CISD works. Positive-outcome bias. This is scientific bias where researchers only provide evidence that supports their hypothesis and do not report evidence that does not support their hypothesis. Confirmation bias. Similar to positive-outcome bias whereby researchers selectively report research that is favorable to their beliefs. This is what the ICISF (CISM) International Journal of Emergency Mental Health is (and to a lesser degree the Air Medical Journal). It has issue after issue of seemingly scientific papers supporting the use of CISM when there is no evidence whatsoever that it is an effective practice. The number of favorable articles in the Air Medical Journal is greater than the number of critical articles. Ad hoc hypothesis. This is trying to change your hypothesis to discount negative findings. This is precisely what and others are doing about CISM. When the research showed single-session CISD was ineffective, they started saying " we never advocated single session CISD " although their earlier writings contradicted this. Likewise, they say studies using individual debriefing are wrong because they always advocated " group debriefing " although their earlier writings contradicted this. Think about it darlin'..... Mr. Bledson RE: Perceptions Anecdote n. A short account of an interesting or humorous incident. Anecdotal Evidence: The description of the occurrence of single unique event, such as a miraculous medical recovery. Even if the occurrence of the event itself is without doubt, the reason that it occurred is often promoted as being due to an unusual therapy applied to the case and thus validating the theory that selection of the therapy was based upon. The probability of apparently unusual events is often considerably higher than we expect by intuition and other unrecognized factors (confounders) may have invalidated the initial prediction of demise, thus making the event not that unusual. As an anecdote is extremely weak evidence in support of a theory, an accumulation of similar anecdotes does not significantly increase support and at best may serve as a justification for a scientific experiment to empirically test the theory. ex. " .I know of a situation 20 years ago where someone was thrown from a motorbike (not motorcycle)--- He was walking around--he was not immobilized--transported to the hospital--- and then airlifted to a trauma center due to possible C1/C2 Fx. " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 27, 2003 Report Share Posted November 27, 2003 , Tonight, I will be sitting at the dinner table corrected (I would stand corrected, but after all, I will be a guest tonight) Thanks for the explanation of positive falsities in research. Have a safe one. Mike Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 27, 2003 Report Share Posted November 27, 2003 Comments inline > I am confused. I thought we were obligated to follow our protocols. I thought if I applied the right protocol to the patient >then I was " covered " . To a degree, that stands true, however, if you have a patient that doesn't quite fit any particular protocol, or fits more than one, then it's time to think outside the box, and actually get into the grey area. Same stands true for making a mistake, even if you are following protocol, any attorney will argue that if you were following protocol, but knew that the patient required something different, you will still suffer the wrath of the alligator in a cheap suit. (No offense to the alligators on the list) > > This blather of " your wrong " , " I'm right " , " Dr Bledsoe says... " , and my favorite, " current research states... " is exhausting. Unfortunately, you have to sort through it all, and decide for yourself what is 'blather' and what is not. That's the true advantage of belonging to a list such as this, you get a wide array of opinions, mind you some are just that, opinions, other posts bring scientific research to the forefront, for all to read, and derive their own thoughts from it. We have some distinguished people on this list, I have learned a lot from many of them, and from the conversations and threads that come across. Depending upon how long you have been in the field, at any particular level, will tell you how much of an opinion you have formed yourself, based upon experience. After a few years, you begin to look upon a long held EMS belief, see eveidence that may not necessarily disprove the theory, but lend credence to the possibilty that it is not all it's cracked up to be. Add that to your knowledge from experience, and POOF!!, now it is *you* who begins to post dissenting ideas, and stir intellignet controversy. All of a sudden, MAST and CISM may or may not be the right choice, regardless of the protocol, or what the 'old timeres' say. > > Noone told me that I was responsible for reading the mass of EMS research going on, and then making my medical director > change our protocol.I never realized that was lawyer bait if I applied a traction splint or MAST. I still won't say that you are responsible for reading the mass of EMS research, you are however responsible to stay abreast of changes that are occuring in the way we approach patient care, transports, and the legalities of such. It's really not that difficult, JEMS and EMS both carry articles designed to stimulate the thought process. That's an aide for steering clear of a loss in the courtroom. Having been deposed once or twice in North Carolina, one question that always came up, was " Aside from your employer, where do you gain information about EMS from? " The source could have been " Barney does EMS " , but my attorney informed me that they were looking to see if you made any effort at all to stay on top of things outside of your basic requirements. Will doing that make the difference between winning and losing? Perhaps not, but the fact that you read the journals, and spend some amount of time learning, and growing, may give you just one piece of knowledge which will help you avoid making a mistake that will lead to a lawsuit. Applying MAST or a traction splint does not immediately make you 'alligator' bait, applying MAST or a traction splint, knowing that research has proven that it could do harm, can certainly lead you closer to the water though. > > There are EMS that are licensed as MICU locally that do not use cordarone, vasopressin or cardizem, and do not have >field c-spine clearance protocols. You may have your opinion, but some medics can only use what they have, and what the >protocol book says to. The crew members of these MICU's still use the good judgement that is available when they are >mentally & physically exhausted. I have placed many comments about the ignored dangers of 24 hour (plus) shifts and >unshared called volume problems. As we all do, if we could create our own EMS service, and put all the goodies on it, it would be great, however, we all have budgets. We have all learned, or are at least in th eprocesss of learning, to do the best we can with what we have. I will not argue the point of working 24 hour shifts in larger metro areas, and the inherent dangers of it, and I believe in the future, (near or not so near) you will see a trend that begins to take us away from them. > The debate on here is more about being pretentious than about crew safety. Of course if your last shift was in a class room >or watching an ambulance pass by your office window, you may think it qualifies you to be an expert, or critic. I'll start by saying that after 14 years, I still work in the field, expert? No. Critic? Yes, of theories which hold no water, and the fa,mous line of " because that's the way it's always been " , my response to the latter is, " Then it's always been done wrong, and it's tiem to change it. " I am a field medic, I am not a 'Dinomedic', but I ain't no spring chicken either. I have seen things work, and fail, I have been the *scoffer*, and at times the *scoffee*, but I have learned from both. > > If some associations would like some topics to address other than license plates, feel free to contact your local PAID > paramedic. I am jsut as vocal and opinionated about this issue as you, but jsut as much as you want them to come to you and ask your opinion, they need you to join them, and give them your opinion, know your organizations, who they represent, what they are trying to accomplish and join them, become a part, and help make the changes that you/I/we so desperately think we need. > If any of you think you have a clue as to what its like to be under paid and second guessed by an audience that has forgotten >that the EMS world has changed dramatically since you last HAD to work: think again. When you last HAD to work full >time on the truck you probably had LP-5's and never heard of RSI. The patients haven't changed, the responsibilities & >expectations are tremendous. You are preaching to the choir on this one, I have long held that those who are in charge of a service, must have an understanding about what it is like in the current world. > I would also ask that my colleauges stop reading my comments and then telling me in person that you like or dislike what I >feel. I encourage everyone to step forward & defend our way of life. I agree. Regards, " Some days you're the dog, and some days you're the hydrant, pretty easy to figure out which is which. " Hatfield EMT-P Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 27, 2003 Report Share Posted November 27, 2003 > I'LL STICK WITH COMMON SENSE, GOOD JUDGEMENT, AND COMPLETE DOCUMENTATION-- > I'll buy that, but where does one get the common sense, and good judgement, if not from staying current with issues? Course, as the saying goes, , " If common sense were common, everyone would have some " . How does one acquire good judgement? Mike " Playing what's-his-names advocate " Hatfield Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 27, 2003 Report Share Posted November 27, 2003 In line with this conversation......here is an interesting article, a cross post from TEXEMSFACTOR, snipped down for space >>A Fort Worth appeals court upheld a $13 million award for a former North Richland Hills optometrist who was left severely brain damaged after being >>misdiagnosed and injected with the wrong drug. The long and short of it is: >>He received two injections and an intravenous drip, but his accelerated heartbeat continued, court records show. After emergency-room doctors and nurses >>telephoned a cardiologist, Bush was given Verapamil. >>Hospital personnel testified that the Verapamil was given to Bush despite repeated warnings on the label and in literature that giving the drug to a patient with >>ventricular tachycardia " can be a lethal error. " Doing what the " Doctor " ordered or " Because he said so " or " because that is our protocol " is not always your best defense, your best defense is to kow your job, and know it well. Just my opinion though..... Mike Quote Link to comment Share on other sites More sharing options...
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