Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 " academic elite " - Now there's a phrase that's never been associated with me before! Maxine ---- Original message ---- >Date: Fri, 18 Feb 2005 10:23:20 -0600 > > Yet it is being embraced by the academic elite with the > same zeal that CISM was. > > Rob > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 " academic elite " - Now there's a phrase that's never been associated with me before! Maxine ---- Original message ---- >Date: Fri, 18 Feb 2005 10:23:20 -0600 > > Yet it is being embraced by the academic elite with the > same zeal that CISM was. > > Rob > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 " academic elite " - Now there's a phrase that's never been associated with me before! Maxine ---- Original message ---- >Date: Fri, 18 Feb 2005 10:23:20 -0600 > > Yet it is being embraced by the academic elite with the > same zeal that CISM was. > > Rob > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 -- " " wrote: Well when you get that pocket CT scanner send it my way LOL I'm sure I could find a dozen uses for it. Meantime I'll continue using the ole exray vision goggles. Although I'm thinking the new up and coming special, strong flashlights might be even better than the exray vision goggles. Too Funny!!! Careful how you pack that thing, amidst the MOPP gear, socks and books! I'm waiting for my tricorder; Bones McCoy supposedly left it to me in his will. " Dogs are not our whole lives, but they make our lives whole. " Larry RN LP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 -- " " wrote: Well when you get that pocket CT scanner send it my way LOL I'm sure I could find a dozen uses for it. Meantime I'll continue using the ole exray vision goggles. Although I'm thinking the new up and coming special, strong flashlights might be even better than the exray vision goggles. Too Funny!!! Careful how you pack that thing, amidst the MOPP gear, socks and books! I'm waiting for my tricorder; Bones McCoy supposedly left it to me in his will. " Dogs are not our whole lives, but they make our lives whole. " Larry RN LP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2005 Report Share Posted February 18, 2005 -- " " wrote: Well when you get that pocket CT scanner send it my way LOL I'm sure I could find a dozen uses for it. Meantime I'll continue using the ole exray vision goggles. Although I'm thinking the new up and coming special, strong flashlights might be even better than the exray vision goggles. Too Funny!!! Careful how you pack that thing, amidst the MOPP gear, socks and books! I'm waiting for my tricorder; Bones McCoy supposedly left it to me in his will. " Dogs are not our whole lives, but they make our lives whole. " Larry RN LP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2005 Report Share Posted February 19, 2005 Rob, I must reply. I'll put my comments into your previous text. Read down, please. Gene > > > And Rob,  the standard is CHANGING.  Read the literature, please. > > I read it. It's crap. It's an excuse for laziness. It's like a union > voting for a strike because, " they can't fire us all if we all do it! "  Yet > it is being embraced by the academic elite with the same zeal that CISM was. > > What literature are you saying is CRAP? To me, simply immobilizing eve rybody according to a mindless MOI protocol is the ultimate laziness. It doesn't require that you assess your patient. Just put them all on the board. > And I suspect it will turn out to be as valid as CISM was too. > You're saying that selective spinal immobilization is on the same level as CISM as being a valid concept? This just does not make sense. Am I misunderstanding you? > > And it will result in unnecessary morbidity and mortality. > The unnecessary morbidity and mortality will come from unnecessarily putting people on the board when they don't need it. Trust me. > > And as someone else rightfully stated, injuries from prolonged > immobilization (for lack of a better term) is the problem of the hospital, > not > the medic. > Here you're saying that the medic has no responsibility for assessing a patient properly and placing on a long board unnecessarily. When the hospital gets them, they're on the board, and they're going to remain there until somebody there performs a proper assessment and gets them off it. If you place the patient on the board, the patient is there until taken off at the hospital. You can say that it's the hospital's problem, but it wasn't the hospital that placed the patient on the board. You did. So it's your problem. You're responsible. We have the absolute duty to use the best information available, which is contained in those studies that you say are " crap " and if we don't we are not serving our patients well. We have the duty to do no harm to our patients. ly, I'm appalled by your statements and surprised by them because I haven't known you to be reckless and callous in the past. Am I misreading your post? If so, please explain. Otherwise, I must say that I'm disappointed that you have taken the position that you have. If I have misinterpreted your post, please let me know. I do not want to wrongfully criticize. If I have misunderstood you, please tell me. Gene > > Rob > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2005 Report Share Posted February 19, 2005 Rob, I must reply. I'll put my comments into your previous text. Read down, please. Gene > > > And Rob,  the standard is CHANGING.  Read the literature, please. > > I read it. It's crap. It's an excuse for laziness. It's like a union > voting for a strike because, " they can't fire us all if we all do it! "  Yet > it is being embraced by the academic elite with the same zeal that CISM was. > > What literature are you saying is CRAP? To me, simply immobilizing eve rybody according to a mindless MOI protocol is the ultimate laziness. It doesn't require that you assess your patient. Just put them all on the board. > And I suspect it will turn out to be as valid as CISM was too. > You're saying that selective spinal immobilization is on the same level as CISM as being a valid concept? This just does not make sense. Am I misunderstanding you? > > And it will result in unnecessary morbidity and mortality. > The unnecessary morbidity and mortality will come from unnecessarily putting people on the board when they don't need it. Trust me. > > And as someone else rightfully stated, injuries from prolonged > immobilization (for lack of a better term) is the problem of the hospital, > not > the medic. > Here you're saying that the medic has no responsibility for assessing a patient properly and placing on a long board unnecessarily. When the hospital gets them, they're on the board, and they're going to remain there until somebody there performs a proper assessment and gets them off it. If you place the patient on the board, the patient is there until taken off at the hospital. You can say that it's the hospital's problem, but it wasn't the hospital that placed the patient on the board. You did. So it's your problem. You're responsible. We have the absolute duty to use the best information available, which is contained in those studies that you say are " crap " and if we don't we are not serving our patients well. We have the duty to do no harm to our patients. ly, I'm appalled by your statements and surprised by them because I haven't known you to be reckless and callous in the past. Am I misreading your post? If so, please explain. Otherwise, I must say that I'm disappointed that you have taken the position that you have. If I have misinterpreted your post, please let me know. I do not want to wrongfully criticize. If I have misunderstood you, please tell me. Gene > > Rob > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2005 Report Share Posted February 19, 2005 Rob, I must reply. I'll put my comments into your previous text. Read down, please. Gene > > > And Rob,  the standard is CHANGING.  Read the literature, please. > > I read it. It's crap. It's an excuse for laziness. It's like a union > voting for a strike because, " they can't fire us all if we all do it! "  Yet > it is being embraced by the academic elite with the same zeal that CISM was. > > What literature are you saying is CRAP? To me, simply immobilizing eve rybody according to a mindless MOI protocol is the ultimate laziness. It doesn't require that you assess your patient. Just put them all on the board. > And I suspect it will turn out to be as valid as CISM was too. > You're saying that selective spinal immobilization is on the same level as CISM as being a valid concept? This just does not make sense. Am I misunderstanding you? > > And it will result in unnecessary morbidity and mortality. > The unnecessary morbidity and mortality will come from unnecessarily putting people on the board when they don't need it. Trust me. > > And as someone else rightfully stated, injuries from prolonged > immobilization (for lack of a better term) is the problem of the hospital, > not > the medic. > Here you're saying that the medic has no responsibility for assessing a patient properly and placing on a long board unnecessarily. When the hospital gets them, they're on the board, and they're going to remain there until somebody there performs a proper assessment and gets them off it. If you place the patient on the board, the patient is there until taken off at the hospital. You can say that it's the hospital's problem, but it wasn't the hospital that placed the patient on the board. You did. So it's your problem. You're responsible. We have the absolute duty to use the best information available, which is contained in those studies that you say are " crap " and if we don't we are not serving our patients well. We have the duty to do no harm to our patients. ly, I'm appalled by your statements and surprised by them because I haven't known you to be reckless and callous in the past. Am I misreading your post? If so, please explain. Otherwise, I must say that I'm disappointed that you have taken the position that you have. If I have misinterpreted your post, please let me know. I do not want to wrongfully criticize. If I have misunderstood you, please tell me. Gene > > Rob > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2005 Report Share Posted February 21, 2005 asks: > > What literature are you saying is CRAP? The Maine Protocol. > To me, simply immobilizing everybody according to a mindless MOI > protocol is the ultimate laziness. I don't recall espousing a mindless MOI protocol. > You're saying that selective spinal immobilization is on the same level as > CISM as being a valid concept? I am saying that in the bandwagon zeal to embrace " the next big thing, " certain potentially dangerous pitfalls are obviously being overlooked. That is very much the same thing that happened with CISM. Psychological counseling for PTSD victims is a valid concept. CISM is not. Selective spinal immobilization is a valid concept. The Maine Protocol is not. >The unnecessary morbidity and mortality will come from unnecessarily >putting > people on the board when they don't need it. Trust me. I would prefer to trust the numbers. Show me the numbers. For every patient you can document for me who suffered morbidity or mortality due to a couple hours of immobilization, I will show you more who suffered an asymptomatic c-spinal injury. You tell me which is more serious. > Here you're saying that the medic has no responsibility for assessing a > patient properly and placing on a long board unnecessarily. You are going to dangerously dishonest lengths to put words into my mouth, Gene. I never said any such thing. > When the hospital gets them, they're on the board, and they're going to > remain > there until somebody there performs a proper assessment and gets them off > it. Ahhh... now we're getting somewhere! You're glossing over a very key point, Gene. What exactly is this " proper assessment " that the ER is going to perform? Radiology! I don't have it. They do. How many ER physicians out there are taking patients out of immobilization without x-ray clearance? > If you place the patient on the board, the patient is there until taken > off at the hospital. > You can say that it's the hospital's problem, but it wasn't the hospital > that > placed the patient on the board. You did. So it's your problem. > You're > responsible. You know what Gene? Some medical procedures are uncomfortable but necessary for the safety of the patient. That's life. You just gotta deal with it. I have been the patient on that backboard for those few hours more than once, and I have yet to develop a pressure sore. And you know what else? I have also been the patient with an asymptomatic c-spinal injury who the medics immobilized strictly because of MOI. You, Gene, would not have caught that injury. Explain that. > We have the absolute duty to use the best information available, which is > contained in those studies that you say are " crap " and if we don't we are > not > serving our patients well. I guess I just believe in a higher standard than you, Gene. I refuse to accept a study that dismisses asymptomatic c-spine injuries because they don't think they are " significant " as " the best information available. " > ly, I'm appalled by your statements and surprised by them because I > haven't known you to be reckless and callous in the past. Am I > misreading your post? Apparently so. There have been many criticisms levelled against me in my career. Perfectionist. Stickler for the rules. Slavedriver. Some have even called me an a-hole that they couldn't work with. But I have never been accused of being lazy, reckless, or callous. The irony here is that I -- and obviously other respected medics here -- see the Maine Protocol as reckless and callous. Another irony is that after hearing Dr. Bledsoe rail against " cookbook medicine " in the past, he now appears to be espousing just that by endorsing the Maine Protocol. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2005 Report Share Posted February 21, 2005 asks: > > What literature are you saying is CRAP? The Maine Protocol. > To me, simply immobilizing everybody according to a mindless MOI > protocol is the ultimate laziness. I don't recall espousing a mindless MOI protocol. > You're saying that selective spinal immobilization is on the same level as > CISM as being a valid concept? I am saying that in the bandwagon zeal to embrace " the next big thing, " certain potentially dangerous pitfalls are obviously being overlooked. That is very much the same thing that happened with CISM. Psychological counseling for PTSD victims is a valid concept. CISM is not. Selective spinal immobilization is a valid concept. The Maine Protocol is not. >The unnecessary morbidity and mortality will come from unnecessarily >putting > people on the board when they don't need it. Trust me. I would prefer to trust the numbers. Show me the numbers. For every patient you can document for me who suffered morbidity or mortality due to a couple hours of immobilization, I will show you more who suffered an asymptomatic c-spinal injury. You tell me which is more serious. > Here you're saying that the medic has no responsibility for assessing a > patient properly and placing on a long board unnecessarily. You are going to dangerously dishonest lengths to put words into my mouth, Gene. I never said any such thing. > When the hospital gets them, they're on the board, and they're going to > remain > there until somebody there performs a proper assessment and gets them off > it. Ahhh... now we're getting somewhere! You're glossing over a very key point, Gene. What exactly is this " proper assessment " that the ER is going to perform? Radiology! I don't have it. They do. How many ER physicians out there are taking patients out of immobilization without x-ray clearance? > If you place the patient on the board, the patient is there until taken > off at the hospital. > You can say that it's the hospital's problem, but it wasn't the hospital > that > placed the patient on the board. You did. So it's your problem. > You're > responsible. You know what Gene? Some medical procedures are uncomfortable but necessary for the safety of the patient. That's life. You just gotta deal with it. I have been the patient on that backboard for those few hours more than once, and I have yet to develop a pressure sore. And you know what else? I have also been the patient with an asymptomatic c-spinal injury who the medics immobilized strictly because of MOI. You, Gene, would not have caught that injury. Explain that. > We have the absolute duty to use the best information available, which is > contained in those studies that you say are " crap " and if we don't we are > not > serving our patients well. I guess I just believe in a higher standard than you, Gene. I refuse to accept a study that dismisses asymptomatic c-spine injuries because they don't think they are " significant " as " the best information available. " > ly, I'm appalled by your statements and surprised by them because I > haven't known you to be reckless and callous in the past. Am I > misreading your post? Apparently so. There have been many criticisms levelled against me in my career. Perfectionist. Stickler for the rules. Slavedriver. Some have even called me an a-hole that they couldn't work with. But I have never been accused of being lazy, reckless, or callous. The irony here is that I -- and obviously other respected medics here -- see the Maine Protocol as reckless and callous. Another irony is that after hearing Dr. Bledsoe rail against " cookbook medicine " in the past, he now appears to be espousing just that by endorsing the Maine Protocol. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2005 Report Share Posted February 21, 2005 In a message dated 2/21/2005 10:21:03 AM Eastern Standard Time, " Rob " writes: > > asks: >> >> What literature are you saying is CRAP? > >The Maine Protocol. Rob, that's a pretty big stretch. Your opinion, OK. You have the right to it. No problem . > >> To me, simply immobilizing everybody according to a mindless MOI >> protocol is the ultimate laziness. > >I don't recall espousing a mindless MOI protocol. Then what do you mean by " crap? " > >> You're saying that selective spinal immobilization is on the same level as >> CISM as being a valid concept? > >I am saying that in the bandwagon zeal to embrace " the next big thing, " >certain potentially dangerous pitfalls are obviously being overlooked. Â That >is very much the same thing that happened with CISM. Â Psychological >counseling for PTSD victims is a valid concept. Â CISM is not. Â Selective >spinal immobilization is a valid concept. Â The Maine Protocol is not. Do you have a protocol that you believe is superior to the Maine protocols? Please share it. I'm serious. If you've figured out improvements, that's great. I'd love to see them. > >>The unnecessary morbidity and mortality will come from unnecessarily >>putting >> people on the board when they don't need it. Â Trust me. > >I would prefer to trust the numbers. Â Show me the numbers. Â For every >patient you can document for me who suffered morbidity or mortality due to a >couple hours of immobilization, I will show you more who suffered an >asymptomatic c-spinal injury. Â You tell me which is more serious. I don't have numbers on that. Do you have numbers on asymptomatic c-spine injuries? Can you zap me the references so I can read the articles? > >> Here you're saying that the medic has no responsibility for assessing a >> patient properly and placing on a long board unnecessarily. > >You are going to dangerously dishonest lengths to put words into my mouth, >Gene. Â I never said any such thing. That was what I gathered from your comments. That's what you said meant to me. Was taking your words and telling you what I gathered from them. Not putting words into your mouth, telling you my interpretation of your remarks. > >> When the hospital gets them, they're on the board, and they're going to >> remain >> there until somebody there performs a proper assessment and gets them off >> it. > >Ahhh... now we're getting somewhere! Â You're glossing over a very key point, >Gene. Â What exactly is this " proper assessment " that the ER is going to >perform? Â Radiology! Â I don't have it. Â They do. Â How many ER physicians out >there are taking patients out of immobilization without x-ray clearance? Many, because they figure out that the patient is not at risk for a spinal injury from physical examination. Potential for mistakes? Sure. How many have happened? I frankly do not know. If you have studies and reports, I'd like to know about them. > >> If you place the patient on the board, the patient is there until taken >> off at the hospital. >> You can say that it's the hospital's problem, but it wasn't the hospital >> that >> placed the patient on the board. Â You did. Â So it's your problem. >> You're >> responsible. > >You know what Gene? Â Some medical procedures are uncomfortable but necessary >for the safety of the patient. Â That's life. Â You just gotta deal with it. >I have been the patient on that backboard for those few hours more than >once, and I have yet to develop a pressure sore. Â And you know what else? Â I >have also been the patient with an asymptomatic c-spinal injury who the >medics immobilized strictly because of MOI. Â You, Gene, would not have But Rob, you're not a 69 year old skinny lil ole lady with no padding over her sacrum and shoulders. I cannot comment upon whether or not I would have caught your " asymptomatic " injury since I wasn't there. If you'd care to tell me more, privately, I'd be interested. I'd like to know if you were " asymptomatic " simply because a competent physical exam wasn't done, or for some other reason. >caught that injury. Â Explain that. > >> We have the absolute duty to use the best information available, which is >> contained in those studies that you say are " crap " and if we don't we are >> not >> serving our patients well. > >I guess I just believe in a higher standard than you, Gene. Â I refuse to >accept a study that dismisses asymptomatic c-spine injuries because they >don't think they are " significant " as " the best information available. " We can argue all night about what's the higher standard. I am also not understanding your comments about " asymptomatic c-spine injuries. " I don't understand that. > >> ly, I'm appalled by your statements and surprised by them because I >> haven't known you to be reckless and callous in the past. Â Am I >> misreading your post? > >Apparently so. Â There have been many criticisms levelled against me in my >career. Â Perfectionist. Â Stickler for the rules. Â Slavedriver. Â Some have >even called me an a-hole that they couldn't work with. Â But I have never >been accused of being lazy, reckless, or callous. Â The irony here is that >I -- and obviously other respected medics here -- see the Maine Protocol as >reckless and callous. Â Another irony is that after hearing Dr. Bledsoe rail >against " cookbook medicine " in the past, he now appears to be espousing just >that by endorsing the Maine Protocol. I can agree with you that " cookbook medicine " isn't good for anybody. I certainly don't think Bledsoe advocates cookbook medicine. To me the Maine protocols are a tool to use to apply a reasoned approach to spinal clearance in the field. One must always use his knowledge, experience, and common sense when applying any tool. That's why I can't understand your relegation of the Maine Protocols to the crap pile. I think this is an important subject and ought to be subject to more debate. Between you and me, this is just a debate. I don't ever mean anything I say personally. I guess I'm used to the intense debate that takes place between lawers, then we all go have a beer together. I hope our debate will make others think about all aspects of spinal immobilization and reflect upon what the best practices actually are. Let us seek the truth. Let us do no harm to our patients. Let us thoughtfully think and plan how to handle them in the best way. Gene > >Rob > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2005 Report Share Posted February 21, 2005 In a message dated 2/21/2005 10:21:03 AM Eastern Standard Time, " Rob " writes: > > asks: >> >> What literature are you saying is CRAP? > >The Maine Protocol. Rob, that's a pretty big stretch. Your opinion, OK. You have the right to it. No problem . > >> To me, simply immobilizing everybody according to a mindless MOI >> protocol is the ultimate laziness. > >I don't recall espousing a mindless MOI protocol. Then what do you mean by " crap? " > >> You're saying that selective spinal immobilization is on the same level as >> CISM as being a valid concept? > >I am saying that in the bandwagon zeal to embrace " the next big thing, " >certain potentially dangerous pitfalls are obviously being overlooked. Â That >is very much the same thing that happened with CISM. Â Psychological >counseling for PTSD victims is a valid concept. Â CISM is not. Â Selective >spinal immobilization is a valid concept. Â The Maine Protocol is not. Do you have a protocol that you believe is superior to the Maine protocols? Please share it. I'm serious. If you've figured out improvements, that's great. I'd love to see them. > >>The unnecessary morbidity and mortality will come from unnecessarily >>putting >> people on the board when they don't need it. Â Trust me. > >I would prefer to trust the numbers. Â Show me the numbers. Â For every >patient you can document for me who suffered morbidity or mortality due to a >couple hours of immobilization, I will show you more who suffered an >asymptomatic c-spinal injury. Â You tell me which is more serious. I don't have numbers on that. Do you have numbers on asymptomatic c-spine injuries? Can you zap me the references so I can read the articles? > >> Here you're saying that the medic has no responsibility for assessing a >> patient properly and placing on a long board unnecessarily. > >You are going to dangerously dishonest lengths to put words into my mouth, >Gene. Â I never said any such thing. That was what I gathered from your comments. That's what you said meant to me. Was taking your words and telling you what I gathered from them. Not putting words into your mouth, telling you my interpretation of your remarks. > >> When the hospital gets them, they're on the board, and they're going to >> remain >> there until somebody there performs a proper assessment and gets them off >> it. > >Ahhh... now we're getting somewhere! Â You're glossing over a very key point, >Gene. Â What exactly is this " proper assessment " that the ER is going to >perform? Â Radiology! Â I don't have it. Â They do. Â How many ER physicians out >there are taking patients out of immobilization without x-ray clearance? Many, because they figure out that the patient is not at risk for a spinal injury from physical examination. Potential for mistakes? Sure. How many have happened? I frankly do not know. If you have studies and reports, I'd like to know about them. > >> If you place the patient on the board, the patient is there until taken >> off at the hospital. >> You can say that it's the hospital's problem, but it wasn't the hospital >> that >> placed the patient on the board. Â You did. Â So it's your problem. >> You're >> responsible. > >You know what Gene? Â Some medical procedures are uncomfortable but necessary >for the safety of the patient. Â That's life. Â You just gotta deal with it. >I have been the patient on that backboard for those few hours more than >once, and I have yet to develop a pressure sore. Â And you know what else? Â I >have also been the patient with an asymptomatic c-spinal injury who the >medics immobilized strictly because of MOI. Â You, Gene, would not have But Rob, you're not a 69 year old skinny lil ole lady with no padding over her sacrum and shoulders. I cannot comment upon whether or not I would have caught your " asymptomatic " injury since I wasn't there. If you'd care to tell me more, privately, I'd be interested. I'd like to know if you were " asymptomatic " simply because a competent physical exam wasn't done, or for some other reason. >caught that injury. Â Explain that. > >> We have the absolute duty to use the best information available, which is >> contained in those studies that you say are " crap " and if we don't we are >> not >> serving our patients well. > >I guess I just believe in a higher standard than you, Gene. Â I refuse to >accept a study that dismisses asymptomatic c-spine injuries because they >don't think they are " significant " as " the best information available. " We can argue all night about what's the higher standard. I am also not understanding your comments about " asymptomatic c-spine injuries. " I don't understand that. > >> ly, I'm appalled by your statements and surprised by them because I >> haven't known you to be reckless and callous in the past. Â Am I >> misreading your post? > >Apparently so. Â There have been many criticisms levelled against me in my >career. Â Perfectionist. Â Stickler for the rules. Â Slavedriver. Â Some have >even called me an a-hole that they couldn't work with. Â But I have never >been accused of being lazy, reckless, or callous. Â The irony here is that >I -- and obviously other respected medics here -- see the Maine Protocol as >reckless and callous. Â Another irony is that after hearing Dr. Bledsoe rail >against " cookbook medicine " in the past, he now appears to be espousing just >that by endorsing the Maine Protocol. I can agree with you that " cookbook medicine " isn't good for anybody. I certainly don't think Bledsoe advocates cookbook medicine. To me the Maine protocols are a tool to use to apply a reasoned approach to spinal clearance in the field. One must always use his knowledge, experience, and common sense when applying any tool. That's why I can't understand your relegation of the Maine Protocols to the crap pile. I think this is an important subject and ought to be subject to more debate. Between you and me, this is just a debate. I don't ever mean anything I say personally. I guess I'm used to the intense debate that takes place between lawers, then we all go have a beer together. I hope our debate will make others think about all aspects of spinal immobilization and reflect upon what the best practices actually are. Let us seek the truth. Let us do no harm to our patients. Let us thoughtfully think and plan how to handle them in the best way. Gene > >Rob > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2005 Report Share Posted February 22, 2005 FYI. The spinal restriction protocol used by PEMSS is as good a protocol as I have seen. It allows the EMT,EMT-I, and Paramedic to make the determination as to whether to package a patient or not. Even in discussing the need for spinal restriction with a physician they will err on the side of at least a C-collar for those walking into the ER with neck pain from an accident until an x-ray is available. There are backboards out now that have padding for just the purpose as discussed thus far. I can't place where they come from but PEMSS allowed one to be passed around about two months ago. I would say this as a final precaution. Since none of us have the x-ray vision( that I know of), then we must err on the side of caution and as Gene made comment on; WE MUST DO NO HARM. Needless spinal immobilization/restriction is something that, as a progressing profession; we need to be concerned with but even physicians will tell you they don't have eyes to see an injury inside the body. Danny L. Owner/NREMT-P Panhandle Emergency Training Services And Response (PETSAR) Office FAX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2005 Report Share Posted February 22, 2005 FYI. The spinal restriction protocol used by PEMSS is as good a protocol as I have seen. It allows the EMT,EMT-I, and Paramedic to make the determination as to whether to package a patient or not. Even in discussing the need for spinal restriction with a physician they will err on the side of at least a C-collar for those walking into the ER with neck pain from an accident until an x-ray is available. There are backboards out now that have padding for just the purpose as discussed thus far. I can't place where they come from but PEMSS allowed one to be passed around about two months ago. I would say this as a final precaution. Since none of us have the x-ray vision( that I know of), then we must err on the side of caution and as Gene made comment on; WE MUST DO NO HARM. Needless spinal immobilization/restriction is something that, as a progressing profession; we need to be concerned with but even physicians will tell you they don't have eyes to see an injury inside the body. Danny L. Owner/NREMT-P Panhandle Emergency Training Services And Response (PETSAR) Office FAX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2005 Report Share Posted February 22, 2005 FYI. The spinal restriction protocol used by PEMSS is as good a protocol as I have seen. It allows the EMT,EMT-I, and Paramedic to make the determination as to whether to package a patient or not. Even in discussing the need for spinal restriction with a physician they will err on the side of at least a C-collar for those walking into the ER with neck pain from an accident until an x-ray is available. There are backboards out now that have padding for just the purpose as discussed thus far. I can't place where they come from but PEMSS allowed one to be passed around about two months ago. I would say this as a final precaution. Since none of us have the x-ray vision( that I know of), then we must err on the side of caution and as Gene made comment on; WE MUST DO NO HARM. Needless spinal immobilization/restriction is something that, as a progressing profession; we need to be concerned with but even physicians will tell you they don't have eyes to see an injury inside the body. Danny L. Owner/NREMT-P Panhandle Emergency Training Services And Response (PETSAR) Office FAX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2005 Report Share Posted February 22, 2005 > > wegandy1938@a... wrote: > > > > I don't have numbers on that [morbidity and mortality due to spinal > > immobilization]. Do you have numbers on asymptomatic c-spine injuries? > > I don't need numbers, Gene. And neither should you. We both know it > happens. And we both know that under the Maine Protocol, those patients > will not receive proper treatment from EMS. > I do not know that at all. I do not know about the incidence of " asymptomatic " spinal injuries, and I do not know that under the Maine Protocols those patients will not receive proper treatment from EMS. I challenge you to support both those statements with facts, if you would kindly do so. > > > Potential for mistakes? Sure. How many have happened? I > > frankly do not know. If you have studies and reports, I'd like to > > know about them. > > So, you admit that you are buying into the Maine Protocol even though the > data is -- by your own admission -- incomplete. THAT is exactly what I mean > when I refer to the myopic zeal of people who rush to jump on the bandwagon > of " the next big thing. "  And yes, that is exactly how CISM got wings. > I asked you for data supporting your statements concerning the number of " asymptomatic " injuries. There is data supporting the Maine Protocols. Where is your data, please? > > > I cannot comment upon whether or not I would have caught your > > " asymptomatic " injury since I wasn't there. > > That right there should be enough to have you seriously questioning whether > or not the Maine Protocol is as good as you claim, shouldn't it? > Not at all. I said I wasn't there and didn't know your signs and symptoms. I don't know whether or not the Maine Protocol was followed correctly. I don't know any facts except what you've chosen to relate; therefore, I couldn't say with any degree of reliability whether or not the Maine Protocols, if properly followed, would have resulted in your being immobilized or not. > > > We can argue all night about what's the higher standard. I am also > > not understanding your comments about " asymptomatic c-spine > > injuries. "  I don't understand that. > > I don't know how I can make the concept any simpler, but I will try: > > 1. The Maine Protocol uses a checklist approach to spinal assessment. > > 2. Those patients who exhibit none of the signs or symptoms on that > checklist are automatically deemed to be non-candidates for immobilization. > > 3. Some patients with significant spinal injury requiring immobilization do > not exhibit any of the signs and symptoms listed in the Maine Protocol. > > 4. Those patients will either be transported without proper treatment and > precautions, or worse yet, encouraged to " refuse transport " (wink wink) by > medics who are now convinced there is nothing wrong with the patient. > Your statements assume that the medics applying the protocols apply no personal experience and judgment to the situation. You still have not supported the comment that " some patients with significant spinal injury requiring immobilization do not exhibit any of the signs and symptoms listed in the Main Protocol. " Is that your conclusion or are you basing that statement upon published evidence? I'm asking you once again for evidence according too scientific studies published in peer reviewed publications, sir. > > How many patients will this happen to? It doesn't matter! It is a travesty > for it to happen to ONE patient when it simply does not have to! Quibbling > over numbers is nice and sterile in the statistical arena, but what we are > really talking about here are not just numbers; they are PEOPLE! To dismiss > those people is as unconscionable as dismissing the Holocaust because of all > the 'good things' Hitler did for Germany. > Have you now crossed the line from objective commentary to emotionalism? > > I don't recall who it was that commented that by not taking the Maine > Protocol hook, line, and sinker, that I was somehow a " God of self, " but > that is the very opposite of what I am. It is those who contend that > letting a few people die or end up quadriplegics is a statistically > acceptable loss if it saves us the time and effort of immobilizing them who > are playing God. > > Do I have a better protocol? Nope. Never claimed to. I don't have to have > a better protocol to know that this one is dangerously flawed, just like I > don't have to be a helicopter pilot to know they crash too much. > I accept your conclusions as being your own. > > I am not against progress or improvement. But so far I have yet to see ANY > studies which show this to be an improvement in patient care. I have yet to > see ANY statistics on the plague of " pressure sores " that we are supposedly > battling. All it does is cut down on unnecessary field procedures. It does > nothing to improve morbidity or mortality. Shouldn't that be our ultimate > goal? > > I support further research into this matter. And if a protocol is developed > which cuts down unnecessary immobilization while not simultaneously > jeopardizing the lives of a significant segment of our patient population, I > am all for it. Maine just ain't it. And utilizing it simply because it is > " all we have so far, " full well knowing that it needs improvement, is > reckless. > > Back to the CISM analogy, the comparison seems very clear to me. A lot of > people leaping without looking. At least with CISM we can claim that we > were really trying to provide the best possible care for people. With the > Maine Protocol, the only thing we can claim is that we are trying to GET OUT > of providing the best possible care for people. Is that the bandwagon YOU > want to be on? > I want to do what's best for all my patients. Current data shows that some patients with a MOI previously thought to require immobilization can be safely field cleared. We have the duty not to inflict pain and injury when unwarranted. I'll stick with my views, as I expect will you. Each of us wants to do what's right, but we see differing pathways. Rational discussion is the way to resolve these issues. Emotional retorts are not helpful (he told himself as a reminder, also). Respectfully, GG > > Rob > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2005 Report Share Posted February 22, 2005 > > wegandy1938@a... wrote: > > > > I don't have numbers on that [morbidity and mortality due to spinal > > immobilization]. Do you have numbers on asymptomatic c-spine injuries? > > I don't need numbers, Gene. And neither should you. We both know it > happens. And we both know that under the Maine Protocol, those patients > will not receive proper treatment from EMS. > I do not know that at all. I do not know about the incidence of " asymptomatic " spinal injuries, and I do not know that under the Maine Protocols those patients will not receive proper treatment from EMS. I challenge you to support both those statements with facts, if you would kindly do so. > > > Potential for mistakes? Sure. How many have happened? I > > frankly do not know. If you have studies and reports, I'd like to > > know about them. > > So, you admit that you are buying into the Maine Protocol even though the > data is -- by your own admission -- incomplete. THAT is exactly what I mean > when I refer to the myopic zeal of people who rush to jump on the bandwagon > of " the next big thing. "  And yes, that is exactly how CISM got wings. > I asked you for data supporting your statements concerning the number of " asymptomatic " injuries. There is data supporting the Maine Protocols. Where is your data, please? > > > I cannot comment upon whether or not I would have caught your > > " asymptomatic " injury since I wasn't there. > > That right there should be enough to have you seriously questioning whether > or not the Maine Protocol is as good as you claim, shouldn't it? > Not at all. I said I wasn't there and didn't know your signs and symptoms. I don't know whether or not the Maine Protocol was followed correctly. I don't know any facts except what you've chosen to relate; therefore, I couldn't say with any degree of reliability whether or not the Maine Protocols, if properly followed, would have resulted in your being immobilized or not. > > > We can argue all night about what's the higher standard. I am also > > not understanding your comments about " asymptomatic c-spine > > injuries. "  I don't understand that. > > I don't know how I can make the concept any simpler, but I will try: > > 1. The Maine Protocol uses a checklist approach to spinal assessment. > > 2. Those patients who exhibit none of the signs or symptoms on that > checklist are automatically deemed to be non-candidates for immobilization. > > 3. Some patients with significant spinal injury requiring immobilization do > not exhibit any of the signs and symptoms listed in the Maine Protocol. > > 4. Those patients will either be transported without proper treatment and > precautions, or worse yet, encouraged to " refuse transport " (wink wink) by > medics who are now convinced there is nothing wrong with the patient. > Your statements assume that the medics applying the protocols apply no personal experience and judgment to the situation. You still have not supported the comment that " some patients with significant spinal injury requiring immobilization do not exhibit any of the signs and symptoms listed in the Main Protocol. " Is that your conclusion or are you basing that statement upon published evidence? I'm asking you once again for evidence according too scientific studies published in peer reviewed publications, sir. > > How many patients will this happen to? It doesn't matter! It is a travesty > for it to happen to ONE patient when it simply does not have to! Quibbling > over numbers is nice and sterile in the statistical arena, but what we are > really talking about here are not just numbers; they are PEOPLE! To dismiss > those people is as unconscionable as dismissing the Holocaust because of all > the 'good things' Hitler did for Germany. > Have you now crossed the line from objective commentary to emotionalism? > > I don't recall who it was that commented that by not taking the Maine > Protocol hook, line, and sinker, that I was somehow a " God of self, " but > that is the very opposite of what I am. It is those who contend that > letting a few people die or end up quadriplegics is a statistically > acceptable loss if it saves us the time and effort of immobilizing them who > are playing God. > > Do I have a better protocol? Nope. Never claimed to. I don't have to have > a better protocol to know that this one is dangerously flawed, just like I > don't have to be a helicopter pilot to know they crash too much. > I accept your conclusions as being your own. > > I am not against progress or improvement. But so far I have yet to see ANY > studies which show this to be an improvement in patient care. I have yet to > see ANY statistics on the plague of " pressure sores " that we are supposedly > battling. All it does is cut down on unnecessary field procedures. It does > nothing to improve morbidity or mortality. Shouldn't that be our ultimate > goal? > > I support further research into this matter. And if a protocol is developed > which cuts down unnecessary immobilization while not simultaneously > jeopardizing the lives of a significant segment of our patient population, I > am all for it. Maine just ain't it. And utilizing it simply because it is > " all we have so far, " full well knowing that it needs improvement, is > reckless. > > Back to the CISM analogy, the comparison seems very clear to me. A lot of > people leaping without looking. At least with CISM we can claim that we > were really trying to provide the best possible care for people. With the > Maine Protocol, the only thing we can claim is that we are trying to GET OUT > of providing the best possible care for people. Is that the bandwagon YOU > want to be on? > I want to do what's best for all my patients. Current data shows that some patients with a MOI previously thought to require immobilization can be safely field cleared. We have the duty not to inflict pain and injury when unwarranted. I'll stick with my views, as I expect will you. Each of us wants to do what's right, but we see differing pathways. Rational discussion is the way to resolve these issues. Emotional retorts are not helpful (he told himself as a reminder, also). Respectfully, GG > > Rob > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2005 Report Share Posted February 22, 2005 > > wegandy1938@a... wrote: > > > > I don't have numbers on that [morbidity and mortality due to spinal > > immobilization]. Do you have numbers on asymptomatic c-spine injuries? > > I don't need numbers, Gene. And neither should you. We both know it > happens. And we both know that under the Maine Protocol, those patients > will not receive proper treatment from EMS. > I do not know that at all. I do not know about the incidence of " asymptomatic " spinal injuries, and I do not know that under the Maine Protocols those patients will not receive proper treatment from EMS. I challenge you to support both those statements with facts, if you would kindly do so. > > > Potential for mistakes? Sure. How many have happened? I > > frankly do not know. If you have studies and reports, I'd like to > > know about them. > > So, you admit that you are buying into the Maine Protocol even though the > data is -- by your own admission -- incomplete. THAT is exactly what I mean > when I refer to the myopic zeal of people who rush to jump on the bandwagon > of " the next big thing. "  And yes, that is exactly how CISM got wings. > I asked you for data supporting your statements concerning the number of " asymptomatic " injuries. There is data supporting the Maine Protocols. Where is your data, please? > > > I cannot comment upon whether or not I would have caught your > > " asymptomatic " injury since I wasn't there. > > That right there should be enough to have you seriously questioning whether > or not the Maine Protocol is as good as you claim, shouldn't it? > Not at all. I said I wasn't there and didn't know your signs and symptoms. I don't know whether or not the Maine Protocol was followed correctly. I don't know any facts except what you've chosen to relate; therefore, I couldn't say with any degree of reliability whether or not the Maine Protocols, if properly followed, would have resulted in your being immobilized or not. > > > We can argue all night about what's the higher standard. I am also > > not understanding your comments about " asymptomatic c-spine > > injuries. "  I don't understand that. > > I don't know how I can make the concept any simpler, but I will try: > > 1. The Maine Protocol uses a checklist approach to spinal assessment. > > 2. Those patients who exhibit none of the signs or symptoms on that > checklist are automatically deemed to be non-candidates for immobilization. > > 3. Some patients with significant spinal injury requiring immobilization do > not exhibit any of the signs and symptoms listed in the Maine Protocol. > > 4. Those patients will either be transported without proper treatment and > precautions, or worse yet, encouraged to " refuse transport " (wink wink) by > medics who are now convinced there is nothing wrong with the patient. > Your statements assume that the medics applying the protocols apply no personal experience and judgment to the situation. You still have not supported the comment that " some patients with significant spinal injury requiring immobilization do not exhibit any of the signs and symptoms listed in the Main Protocol. " Is that your conclusion or are you basing that statement upon published evidence? I'm asking you once again for evidence according too scientific studies published in peer reviewed publications, sir. > > How many patients will this happen to? It doesn't matter! It is a travesty > for it to happen to ONE patient when it simply does not have to! Quibbling > over numbers is nice and sterile in the statistical arena, but what we are > really talking about here are not just numbers; they are PEOPLE! To dismiss > those people is as unconscionable as dismissing the Holocaust because of all > the 'good things' Hitler did for Germany. > Have you now crossed the line from objective commentary to emotionalism? > > I don't recall who it was that commented that by not taking the Maine > Protocol hook, line, and sinker, that I was somehow a " God of self, " but > that is the very opposite of what I am. It is those who contend that > letting a few people die or end up quadriplegics is a statistically > acceptable loss if it saves us the time and effort of immobilizing them who > are playing God. > > Do I have a better protocol? Nope. Never claimed to. I don't have to have > a better protocol to know that this one is dangerously flawed, just like I > don't have to be a helicopter pilot to know they crash too much. > I accept your conclusions as being your own. > > I am not against progress or improvement. But so far I have yet to see ANY > studies which show this to be an improvement in patient care. I have yet to > see ANY statistics on the plague of " pressure sores " that we are supposedly > battling. All it does is cut down on unnecessary field procedures. It does > nothing to improve morbidity or mortality. Shouldn't that be our ultimate > goal? > > I support further research into this matter. And if a protocol is developed > which cuts down unnecessary immobilization while not simultaneously > jeopardizing the lives of a significant segment of our patient population, I > am all for it. Maine just ain't it. And utilizing it simply because it is > " all we have so far, " full well knowing that it needs improvement, is > reckless. > > Back to the CISM analogy, the comparison seems very clear to me. A lot of > people leaping without looking. At least with CISM we can claim that we > were really trying to provide the best possible care for people. With the > Maine Protocol, the only thing we can claim is that we are trying to GET OUT > of providing the best possible care for people. Is that the bandwagon YOU > want to be on? > I want to do what's best for all my patients. Current data shows that some patients with a MOI previously thought to require immobilization can be safely field cleared. We have the duty not to inflict pain and injury when unwarranted. I'll stick with my views, as I expect will you. Each of us wants to do what's right, but we see differing pathways. Rational discussion is the way to resolve these issues. Emotional retorts are not helpful (he told himself as a reminder, also). Respectfully, GG > > Rob > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2005 Report Share Posted February 22, 2005 Hi Folks, The most comprehensive information thus far about spinal immobilization can be found at the following web site: http://www.naemsp.org/Position%20Papers/ClinGdeSpine.html This is the official guideline of the National Association of EMS Physicians (NAEMSP) and is backed by over 40 research articles. You can read them all if you like. After reading the position paper you will both have a better understanding about the issues and the science that backs our practice. While we are not perfect we are making a concerted effort to use evidence based research for our rationale. There are good reasons to immobilize some patients spines and there are equally good reasons not to immobilize others. We need to always practice our skills with judgment to meet the specific needs of each patient and not just respond like mindless robots to all accidents. Thank you for your concern about doing what is best for our patients. Best regards, Larry MD Medical director AMR San & Austin, Blanco, Bulverde, Spring Branch, Devine > > > > >> > >> > wegandy1938@a... wrote: >>> > > >>> > > I don't have numbers on that [morbidity and mortality due to spinal >>> > > immobilization]. Do you have numbers on asymptomatic c-spine injuries? >> > >> > I don't need numbers, Gene. And neither should you. We both know it >> > happens. And we both know that under the Maine Protocol, those patients >> > will not receive proper treatment from EMS. >> > > I do not know that at all. I do not know about the incidence of > " asymptomatic " spinal injuries, and I do not know that under the Maine > Protocols those > patients will not receive proper treatment from EMS. I challenge you to > support both those statements with facts, if you would kindly do so. >> > >>> > > Potential for mistakes? Sure. How many have happened? I >>> > > frankly do not know. If you have studies and reports, I'd like to >>> > > know about them. >> > >> > So, you admit that you are buying into the Maine Protocol even though the >> > data is -- by your own admission -- incomplete. THAT is exactly what I >> mean >> > when I refer to the myopic zeal of people who rush to jump on the bandwagon >> > of " the next big thing. "  And yes, that is exactly how CISM got wings. >> > > I asked you for data supporting your statements concerning the number of > " asymptomatic " injuries. There is data supporting the Maine Protocols. > Where > is your data, please? > >> > >>> > > I cannot comment upon whether or not I would have caught your >>> > > " asymptomatic " injury since I wasn't there. >> > >> > That right there should be enough to have you seriously questioning whether >> > or not the Maine Protocol is as good as you claim, shouldn't it? >> > > Not at all. I said I wasn't there and didn't know your signs and symptoms. > I don't know whether or not the Maine Protocol was followed correctly. I > don't know any facts except what you've chosen to relate; therefore, I > couldn't > say with any degree of reliability whether or not the Maine Protocols, if > properly followed, would have resulted in your being immobilized or not. >> > >>> > > We can argue all night about what's the higher standard. I am also >>> > > not understanding your comments about " asymptomatic c-spine >>> > > injuries. "  I don't understand that. >> > >> > I don't know how I can make the concept any simpler, but I will try: >> > >> > 1. The Maine Protocol uses a checklist approach to spinal assessment. >> > >> > 2. Those patients who exhibit none of the signs or symptoms on that >> > checklist are automatically deemed to be non-candidates for immobilization. >> > >> > 3. Some patients with significant spinal injury requiring immobilization >> do >> > not exhibit any of the signs and symptoms listed in the Maine Protocol. >> > >> > 4. Those patients will either be transported without proper treatment and >> > precautions, or worse yet, encouraged to " refuse transport " (wink wink) by >> > medics who are now convinced there is nothing wrong with the patient. >> > > Your statements assume that the medics applying the protocols apply no > personal experience and judgment to the situation. You still have not > supported > the comment that " some patients with significant spinal injury requiring > immobilization do not exhibit any of the signs and symptoms listed in the Main > Protocol. " Is that your conclusion or are you basing that statement upon > published > evidence? I'm asking you once again for evidence according too scientific > studies published in peer reviewed publications, sir. >> > >> > How many patients will this happen to? It doesn't matter! It is a >> travesty >> > for it to happen to ONE patient when it simply does not have to! Quibbling >> > over numbers is nice and sterile in the statistical arena, but what we are >> > really talking about here are not just numbers; they are PEOPLE! To >> dismiss >> > those people is as unconscionable as dismissing the Holocaust because of >> all >> > the 'good things' Hitler did for Germany. >> > > Have you now crossed the line from objective commentary to emotionalism? >> > >> > I don't recall who it was that commented that by not taking the Maine >> > Protocol hook, line, and sinker, that I was somehow a " God of self, " but >> > that is the very opposite of what I am. It is those who contend that >> > letting a few people die or end up quadriplegics is a statistically >> > acceptable loss if it saves us the time and effort of immobilizing them who >> > are playing God. >> > >> > Do I have a better protocol? Nope. Never claimed to. I don't have to >> have >> > a better protocol to know that this one is dangerously flawed, just like I >> > don't have to be a helicopter pilot to know they crash too much. >> > > I accept your conclusions as being your own. >> > >> > I am not against progress or improvement. But so far I have yet to see ANY >> > studies which show this to be an improvement in patient care. I have yet >> to >> > see ANY statistics on the plague of " pressure sores " that we are supposedly >> > battling. All it does is cut down on unnecessary field procedures. It does >> > nothing to improve morbidity or mortality. Shouldn't that be our ultimate >> > goal? >> > >> > I support further research into this matter. And if a protocol is >> developed >> > which cuts down unnecessary immobilization while not simultaneously >> > jeopardizing the lives of a significant segment of our patient population, I >> > am all for it. Maine just ain't it. And utilizing it simply because it is >> > " all we have so far, " full well knowing that it needs improvement, is >> > reckless. >> > >> > Back to the CISM analogy, the comparison seems very clear to me. A lot of >> > people leaping without looking. At least with CISM we can claim that we >> > were really trying to provide the best possible care for people. With the >> > Maine Protocol, the only thing we can claim is that we are trying to GET >> OUT >> > of providing the best possible care for people. Is that the bandwagon YOU >> > want to be on? >> > > I want to do what's best for all my patients. Current data shows that some > patients with a MOI previously thought to require immobilization can be safely > field cleared. We have the duty not to inflict pain and injury when > unwarranted. > > I'll stick with my views, as I expect will you. Each of us wants to do > what's right, but we see differing pathways. Rational discussion is the way > to > resolve these issues. Emotional retorts are not helpful (he told himself as > a > reminder, also). > > Respectfully, > > GG >> > >> > Rob >> > >> > >> > >> > >> > >> > >> > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2005 Report Share Posted February 22, 2005 Hi Folks, The most comprehensive information thus far about spinal immobilization can be found at the following web site: http://www.naemsp.org/Position%20Papers/ClinGdeSpine.html This is the official guideline of the National Association of EMS Physicians (NAEMSP) and is backed by over 40 research articles. You can read them all if you like. After reading the position paper you will both have a better understanding about the issues and the science that backs our practice. While we are not perfect we are making a concerted effort to use evidence based research for our rationale. There are good reasons to immobilize some patients spines and there are equally good reasons not to immobilize others. We need to always practice our skills with judgment to meet the specific needs of each patient and not just respond like mindless robots to all accidents. Thank you for your concern about doing what is best for our patients. Best regards, Larry MD Medical director AMR San & Austin, Blanco, Bulverde, Spring Branch, Devine > > > > >> > >> > wegandy1938@a... wrote: >>> > > >>> > > I don't have numbers on that [morbidity and mortality due to spinal >>> > > immobilization]. Do you have numbers on asymptomatic c-spine injuries? >> > >> > I don't need numbers, Gene. And neither should you. We both know it >> > happens. And we both know that under the Maine Protocol, those patients >> > will not receive proper treatment from EMS. >> > > I do not know that at all. I do not know about the incidence of > " asymptomatic " spinal injuries, and I do not know that under the Maine > Protocols those > patients will not receive proper treatment from EMS. I challenge you to > support both those statements with facts, if you would kindly do so. >> > >>> > > Potential for mistakes? Sure. How many have happened? I >>> > > frankly do not know. If you have studies and reports, I'd like to >>> > > know about them. >> > >> > So, you admit that you are buying into the Maine Protocol even though the >> > data is -- by your own admission -- incomplete. THAT is exactly what I >> mean >> > when I refer to the myopic zeal of people who rush to jump on the bandwagon >> > of " the next big thing. "  And yes, that is exactly how CISM got wings. >> > > I asked you for data supporting your statements concerning the number of > " asymptomatic " injuries. There is data supporting the Maine Protocols. > Where > is your data, please? > >> > >>> > > I cannot comment upon whether or not I would have caught your >>> > > " asymptomatic " injury since I wasn't there. >> > >> > That right there should be enough to have you seriously questioning whether >> > or not the Maine Protocol is as good as you claim, shouldn't it? >> > > Not at all. I said I wasn't there and didn't know your signs and symptoms. > I don't know whether or not the Maine Protocol was followed correctly. I > don't know any facts except what you've chosen to relate; therefore, I > couldn't > say with any degree of reliability whether or not the Maine Protocols, if > properly followed, would have resulted in your being immobilized or not. >> > >>> > > We can argue all night about what's the higher standard. I am also >>> > > not understanding your comments about " asymptomatic c-spine >>> > > injuries. "  I don't understand that. >> > >> > I don't know how I can make the concept any simpler, but I will try: >> > >> > 1. The Maine Protocol uses a checklist approach to spinal assessment. >> > >> > 2. Those patients who exhibit none of the signs or symptoms on that >> > checklist are automatically deemed to be non-candidates for immobilization. >> > >> > 3. Some patients with significant spinal injury requiring immobilization >> do >> > not exhibit any of the signs and symptoms listed in the Maine Protocol. >> > >> > 4. Those patients will either be transported without proper treatment and >> > precautions, or worse yet, encouraged to " refuse transport " (wink wink) by >> > medics who are now convinced there is nothing wrong with the patient. >> > > Your statements assume that the medics applying the protocols apply no > personal experience and judgment to the situation. You still have not > supported > the comment that " some patients with significant spinal injury requiring > immobilization do not exhibit any of the signs and symptoms listed in the Main > Protocol. " Is that your conclusion or are you basing that statement upon > published > evidence? I'm asking you once again for evidence according too scientific > studies published in peer reviewed publications, sir. >> > >> > How many patients will this happen to? It doesn't matter! It is a >> travesty >> > for it to happen to ONE patient when it simply does not have to! Quibbling >> > over numbers is nice and sterile in the statistical arena, but what we are >> > really talking about here are not just numbers; they are PEOPLE! To >> dismiss >> > those people is as unconscionable as dismissing the Holocaust because of >> all >> > the 'good things' Hitler did for Germany. >> > > Have you now crossed the line from objective commentary to emotionalism? >> > >> > I don't recall who it was that commented that by not taking the Maine >> > Protocol hook, line, and sinker, that I was somehow a " God of self, " but >> > that is the very opposite of what I am. It is those who contend that >> > letting a few people die or end up quadriplegics is a statistically >> > acceptable loss if it saves us the time and effort of immobilizing them who >> > are playing God. >> > >> > Do I have a better protocol? Nope. Never claimed to. I don't have to >> have >> > a better protocol to know that this one is dangerously flawed, just like I >> > don't have to be a helicopter pilot to know they crash too much. >> > > I accept your conclusions as being your own. >> > >> > I am not against progress or improvement. But so far I have yet to see ANY >> > studies which show this to be an improvement in patient care. I have yet >> to >> > see ANY statistics on the plague of " pressure sores " that we are supposedly >> > battling. All it does is cut down on unnecessary field procedures. It does >> > nothing to improve morbidity or mortality. Shouldn't that be our ultimate >> > goal? >> > >> > I support further research into this matter. And if a protocol is >> developed >> > which cuts down unnecessary immobilization while not simultaneously >> > jeopardizing the lives of a significant segment of our patient population, I >> > am all for it. Maine just ain't it. And utilizing it simply because it is >> > " all we have so far, " full well knowing that it needs improvement, is >> > reckless. >> > >> > Back to the CISM analogy, the comparison seems very clear to me. A lot of >> > people leaping without looking. At least with CISM we can claim that we >> > were really trying to provide the best possible care for people. With the >> > Maine Protocol, the only thing we can claim is that we are trying to GET >> OUT >> > of providing the best possible care for people. Is that the bandwagon YOU >> > want to be on? >> > > I want to do what's best for all my patients. Current data shows that some > patients with a MOI previously thought to require immobilization can be safely > field cleared. We have the duty not to inflict pain and injury when > unwarranted. > > I'll stick with my views, as I expect will you. Each of us wants to do > what's right, but we see differing pathways. Rational discussion is the way > to > resolve these issues. Emotional retorts are not helpful (he told himself as > a > reminder, also). > > Respectfully, > > GG >> > >> > Rob >> > >> > >> > >> > >> > >> > >> > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2005 Report Share Posted February 22, 2005 Hi Folks, The most comprehensive information thus far about spinal immobilization can be found at the following web site: http://www.naemsp.org/Position%20Papers/ClinGdeSpine.html This is the official guideline of the National Association of EMS Physicians (NAEMSP) and is backed by over 40 research articles. You can read them all if you like. After reading the position paper you will both have a better understanding about the issues and the science that backs our practice. While we are not perfect we are making a concerted effort to use evidence based research for our rationale. There are good reasons to immobilize some patients spines and there are equally good reasons not to immobilize others. We need to always practice our skills with judgment to meet the specific needs of each patient and not just respond like mindless robots to all accidents. Thank you for your concern about doing what is best for our patients. Best regards, Larry MD Medical director AMR San & Austin, Blanco, Bulverde, Spring Branch, Devine > > > > >> > >> > wegandy1938@a... wrote: >>> > > >>> > > I don't have numbers on that [morbidity and mortality due to spinal >>> > > immobilization]. Do you have numbers on asymptomatic c-spine injuries? >> > >> > I don't need numbers, Gene. And neither should you. We both know it >> > happens. And we both know that under the Maine Protocol, those patients >> > will not receive proper treatment from EMS. >> > > I do not know that at all. I do not know about the incidence of > " asymptomatic " spinal injuries, and I do not know that under the Maine > Protocols those > patients will not receive proper treatment from EMS. I challenge you to > support both those statements with facts, if you would kindly do so. >> > >>> > > Potential for mistakes? Sure. How many have happened? I >>> > > frankly do not know. If you have studies and reports, I'd like to >>> > > know about them. >> > >> > So, you admit that you are buying into the Maine Protocol even though the >> > data is -- by your own admission -- incomplete. THAT is exactly what I >> mean >> > when I refer to the myopic zeal of people who rush to jump on the bandwagon >> > of " the next big thing. "  And yes, that is exactly how CISM got wings. >> > > I asked you for data supporting your statements concerning the number of > " asymptomatic " injuries. There is data supporting the Maine Protocols. > Where > is your data, please? > >> > >>> > > I cannot comment upon whether or not I would have caught your >>> > > " asymptomatic " injury since I wasn't there. >> > >> > That right there should be enough to have you seriously questioning whether >> > or not the Maine Protocol is as good as you claim, shouldn't it? >> > > Not at all. I said I wasn't there and didn't know your signs and symptoms. > I don't know whether or not the Maine Protocol was followed correctly. I > don't know any facts except what you've chosen to relate; therefore, I > couldn't > say with any degree of reliability whether or not the Maine Protocols, if > properly followed, would have resulted in your being immobilized or not. >> > >>> > > We can argue all night about what's the higher standard. I am also >>> > > not understanding your comments about " asymptomatic c-spine >>> > > injuries. "  I don't understand that. >> > >> > I don't know how I can make the concept any simpler, but I will try: >> > >> > 1. The Maine Protocol uses a checklist approach to spinal assessment. >> > >> > 2. Those patients who exhibit none of the signs or symptoms on that >> > checklist are automatically deemed to be non-candidates for immobilization. >> > >> > 3. Some patients with significant spinal injury requiring immobilization >> do >> > not exhibit any of the signs and symptoms listed in the Maine Protocol. >> > >> > 4. Those patients will either be transported without proper treatment and >> > precautions, or worse yet, encouraged to " refuse transport " (wink wink) by >> > medics who are now convinced there is nothing wrong with the patient. >> > > Your statements assume that the medics applying the protocols apply no > personal experience and judgment to the situation. You still have not > supported > the comment that " some patients with significant spinal injury requiring > immobilization do not exhibit any of the signs and symptoms listed in the Main > Protocol. " Is that your conclusion or are you basing that statement upon > published > evidence? I'm asking you once again for evidence according too scientific > studies published in peer reviewed publications, sir. >> > >> > How many patients will this happen to? It doesn't matter! It is a >> travesty >> > for it to happen to ONE patient when it simply does not have to! Quibbling >> > over numbers is nice and sterile in the statistical arena, but what we are >> > really talking about here are not just numbers; they are PEOPLE! To >> dismiss >> > those people is as unconscionable as dismissing the Holocaust because of >> all >> > the 'good things' Hitler did for Germany. >> > > Have you now crossed the line from objective commentary to emotionalism? >> > >> > I don't recall who it was that commented that by not taking the Maine >> > Protocol hook, line, and sinker, that I was somehow a " God of self, " but >> > that is the very opposite of what I am. It is those who contend that >> > letting a few people die or end up quadriplegics is a statistically >> > acceptable loss if it saves us the time and effort of immobilizing them who >> > are playing God. >> > >> > Do I have a better protocol? Nope. Never claimed to. I don't have to >> have >> > a better protocol to know that this one is dangerously flawed, just like I >> > don't have to be a helicopter pilot to know they crash too much. >> > > I accept your conclusions as being your own. >> > >> > I am not against progress or improvement. But so far I have yet to see ANY >> > studies which show this to be an improvement in patient care. I have yet >> to >> > see ANY statistics on the plague of " pressure sores " that we are supposedly >> > battling. All it does is cut down on unnecessary field procedures. It does >> > nothing to improve morbidity or mortality. Shouldn't that be our ultimate >> > goal? >> > >> > I support further research into this matter. And if a protocol is >> developed >> > which cuts down unnecessary immobilization while not simultaneously >> > jeopardizing the lives of a significant segment of our patient population, I >> > am all for it. Maine just ain't it. And utilizing it simply because it is >> > " all we have so far, " full well knowing that it needs improvement, is >> > reckless. >> > >> > Back to the CISM analogy, the comparison seems very clear to me. A lot of >> > people leaping without looking. At least with CISM we can claim that we >> > were really trying to provide the best possible care for people. With the >> > Maine Protocol, the only thing we can claim is that we are trying to GET >> OUT >> > of providing the best possible care for people. Is that the bandwagon YOU >> > want to be on? >> > > I want to do what's best for all my patients. Current data shows that some > patients with a MOI previously thought to require immobilization can be safely > field cleared. We have the duty not to inflict pain and injury when > unwarranted. > > I'll stick with my views, as I expect will you. Each of us wants to do > what's right, but we see differing pathways. Rational discussion is the way > to > resolve these issues. Emotional retorts are not helpful (he told himself as > a > reminder, also). > > Respectfully, > > GG >> > >> > Rob >> > >> > >> > >> > >> > >> > >> > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2005 Report Share Posted February 23, 2005 Thank you VERY much, Dr. . You say it better than any of us have. Gene > > > Hi Folks, > > The most comprehensive information thus far about spinal immobilization can > be found at the following web site: > > http://www.naemsp.org/Position%20Papers/ClinGdeSpine.html > > This is the official guideline of the National Association of EMS Physicians > (NAEMSP) and is backed by over 40 research articles. You can read them all > if you like. > > After reading the position paper you will both have a better understanding > about the issues and the science that backs our practice. While we are not > perfect we are making a concerted effort to use evidence based research for > our rationale. There are good reasons to immobilize some patients spines > and there are equally good reasons not to immobilize others. We need to > always practice our skills with judgment to meet the specific needs of each > patient and not just respond like mindless robots to all accidents. > > Thank you for your concern about doing what is best for our patients. > > Best regards, > > Larry MD > Medical director AMR San & Austin, Blanco, Bulverde, Spring Branch, > Devine > > > > > > > > > > >> > > >> > wegandy1938@a... wrote: > >>> > > > >>> > > I don't have numbers on that [morbidity and mortality due to spinal > >>> > > immobilization]. Do you have numbers on asymptomatic c-spine > injuries? > >> > > >> > I don't need numbers, Gene. And neither should you. We both know it > >> > happens. And we both know that under the Maine Protocol, those > patients > >> > will not receive proper treatment from EMS. > >> > > > I do not know that at all.  I do not know about the incidence of > > " asymptomatic " spinal injuries, and I do not know that under the Maine > > Protocols those > > patients will not receive proper treatment from EMS.  I challenge you to > > support both those statements with facts, if you would kindly do so. > >> > > >>> > > Potential for mistakes? Sure. How many have happened? I > >>> > > frankly do not know. If you have studies and reports, I'd like to > >>> > > know about them. > >> > > >> > So, you admit that you are buying into the Maine Protocol even though > the > >> > data is -- by your own admission -- incomplete. THAT is exactly what I > >> mean > >> > when I refer to the myopic zeal of people who rush to jump on the > bandwagon > >> > of " the next big thing. "  And yes, that is exactly how CISM got wings. > >> > > > I asked you for data supporting your statements concerning the number of > > " asymptomatic " injuries.  There is data supporting the Maine Protocols. > > Where > > is your data, please? > > > >> > > >>> > > I cannot comment upon whether or not I would have caught your > >>> > > " asymptomatic " injury since I wasn't there. > >> > > >> > That right there should be enough to have you seriously questioning > whether > >> > or not the Maine Protocol is as good as you claim, shouldn't it? > >> > > > Not at all.  I said I wasn't there and didn't know your signs and > symptoms. > > I don't know whether or not the Maine Protocol was followed correctly.  > I > > don't know any facts except what you've chosen to relate; therefore, I > > couldn't > > say with any degree of reliability whether or not the Maine Protocols, if > > properly followed, would have resulted in your being immobilized or not. > >> > > >>> > > We can argue all night about what's the higher standard. I am also > >>> > > not understanding your comments about " asymptomatic c-spine > >>> > > injuries. "  I don't understand that. > >> > > >> > I don't know how I can make the concept any simpler, but I will try: > >> > > >> > 1. The Maine Protocol uses a checklist approach to spinal assessment. > >> > > >> > 2. Those patients who exhibit none of the signs or symptoms on that > >> > checklist are automatically deemed to be non-candidates for > immobilization. > >> > > >> > 3. Some patients with significant spinal injury requiring > immobilization > >> do > >> > not exhibit any of the signs and symptoms listed in the Maine Protocol. > >> > > >> > 4. Those patients will either be transported without proper treatment > and > >> > precautions, or worse yet, encouraged to " refuse transport " (wink wink) > by > >> > medics who are now convinced there is nothing wrong with the patient. > >> > > > Your statements assume that the medics applying the protocols apply no > > personal experience and judgment to the situation.  You still have not > > supported > > the comment that " some patients with significant spinal injury requiring > > immobilization do not exhibit any of the signs and symptoms listed in the > Main > > Protocol. "   Is that your conclusion or are you basing that statement upon > > published > > evidence?  I'm asking you once again for evidence according too > scientific > > studies published in peer reviewed publications, sir. > >> > > >> > How many patients will this happen to? It doesn't matter! It is a > >> travesty > >> > for it to happen to ONE patient when it simply does not have to! > Quibbling > >> > over numbers is nice and sterile in the statistical arena, but what we > are > >> > really talking about here are not just numbers; they are PEOPLE! To > >> dismiss > >> > those people is as unconscionable as dismissing the Holocaust because > of >> > all > >> > the 'good things' Hitler did for Germany. > >> > > > Have you now crossed the line from objective commentary to emotionalism? > >> > > >> > I don't recall who it was that commented that by not taking the Maine > >> > Protocol hook, line, and sinker, that I was somehow a " God of self, " > but > >> > that is the very opposite of what I am. It is those who contend that > >> > letting a few people die or end up quadriplegics is a statistically > >> > acceptable loss if it saves us the time and effort of immobilizing them > who > >> > are playing God. > >> > > >> > Do I have a better protocol? Nope. Never claimed to. I don't have to > >> have > >> > a better protocol to know that this one is dangerously flawed, just > like I > >> > don't have to be a helicopter pilot to know they crash too much. > >> > > > I accept your conclusions as being your own. > >> > > >> > I am not against progress or improvement. But so far I have yet to see > ANY > >> > studies which show this to be an improvement in patient care. I have > yet > >> to > >> > see ANY statistics on the plague of " pressure sores " that we are > supposedly > >> > battling. All it does is cut down on unnecessary field procedures. It > does > >> > nothing to improve morbidity or mortality. Shouldn't that be our > ultimate > >> > goal? > >> > > >> > I support further research into this matter. And if a protocol is > >> developed > >> > which cuts down unnecessary immobilization while not simultaneously > >> > jeopardizing the lives of a significant segment of our patient > population, > I > >> > am all for it. Maine just ain't it. And utilizing it simply because > it is > >> > " all we have so far, " full well knowing that it needs improvement, is > >> > reckless. > >> > > >> > Back to the CISM analogy, the comparison seems very clear to me. A lot > of > >> > people leaping without looking. At least with CISM we can claim that > we > >> > were really trying to provide the best possible care for people. With > the > >> > Maine Protocol, the only thing we can claim is that we are trying to > GET >> > OUT > >> > of providing the best possible care for people. Is that the bandwagon > YOU > >> > want to be on? > >> > > > I want to do what's best for all my patients.  Current data shows that > some > > patients with a MOI previously thought to require immobilization can be > safely > > field cleared.  We have the duty not to inflict pain and injury when > > unwarranted. > > > > I'll stick with my views, as I expect will you.  Each of us wants to do > > what's right, but we see differing pathways.  Rational discussion is the > way > > to > > resolve these issues.  Emotional retorts are not helpful (he told himself > as > > a > > reminder, also). > > > > Respectfully, > > > > GG > >> > > >> > Rob > >> > > >> > > >> > > >> > > >> > > >> > > >> > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2005 Report Share Posted February 23, 2005 Thank you VERY much, Dr. . You say it better than any of us have. Gene > > > Hi Folks, > > The most comprehensive information thus far about spinal immobilization can > be found at the following web site: > > http://www.naemsp.org/Position%20Papers/ClinGdeSpine.html > > This is the official guideline of the National Association of EMS Physicians > (NAEMSP) and is backed by over 40 research articles. You can read them all > if you like. > > After reading the position paper you will both have a better understanding > about the issues and the science that backs our practice. While we are not > perfect we are making a concerted effort to use evidence based research for > our rationale. There are good reasons to immobilize some patients spines > and there are equally good reasons not to immobilize others. We need to > always practice our skills with judgment to meet the specific needs of each > patient and not just respond like mindless robots to all accidents. > > Thank you for your concern about doing what is best for our patients. > > Best regards, > > Larry MD > Medical director AMR San & Austin, Blanco, Bulverde, Spring Branch, > Devine > > > > > > > > > > >> > > >> > wegandy1938@a... wrote: > >>> > > > >>> > > I don't have numbers on that [morbidity and mortality due to spinal > >>> > > immobilization]. Do you have numbers on asymptomatic c-spine > injuries? > >> > > >> > I don't need numbers, Gene. And neither should you. We both know it > >> > happens. And we both know that under the Maine Protocol, those > patients > >> > will not receive proper treatment from EMS. > >> > > > I do not know that at all.  I do not know about the incidence of > > " asymptomatic " spinal injuries, and I do not know that under the Maine > > Protocols those > > patients will not receive proper treatment from EMS.  I challenge you to > > support both those statements with facts, if you would kindly do so. > >> > > >>> > > Potential for mistakes? Sure. How many have happened? I > >>> > > frankly do not know. If you have studies and reports, I'd like to > >>> > > know about them. > >> > > >> > So, you admit that you are buying into the Maine Protocol even though > the > >> > data is -- by your own admission -- incomplete. THAT is exactly what I > >> mean > >> > when I refer to the myopic zeal of people who rush to jump on the > bandwagon > >> > of " the next big thing. "  And yes, that is exactly how CISM got wings. > >> > > > I asked you for data supporting your statements concerning the number of > > " asymptomatic " injuries.  There is data supporting the Maine Protocols. > > Where > > is your data, please? > > > >> > > >>> > > I cannot comment upon whether or not I would have caught your > >>> > > " asymptomatic " injury since I wasn't there. > >> > > >> > That right there should be enough to have you seriously questioning > whether > >> > or not the Maine Protocol is as good as you claim, shouldn't it? > >> > > > Not at all.  I said I wasn't there and didn't know your signs and > symptoms. > > I don't know whether or not the Maine Protocol was followed correctly.  > I > > don't know any facts except what you've chosen to relate; therefore, I > > couldn't > > say with any degree of reliability whether or not the Maine Protocols, if > > properly followed, would have resulted in your being immobilized or not. > >> > > >>> > > We can argue all night about what's the higher standard. I am also > >>> > > not understanding your comments about " asymptomatic c-spine > >>> > > injuries. "  I don't understand that. > >> > > >> > I don't know how I can make the concept any simpler, but I will try: > >> > > >> > 1. The Maine Protocol uses a checklist approach to spinal assessment. > >> > > >> > 2. Those patients who exhibit none of the signs or symptoms on that > >> > checklist are automatically deemed to be non-candidates for > immobilization. > >> > > >> > 3. Some patients with significant spinal injury requiring > immobilization > >> do > >> > not exhibit any of the signs and symptoms listed in the Maine Protocol. > >> > > >> > 4. Those patients will either be transported without proper treatment > and > >> > precautions, or worse yet, encouraged to " refuse transport " (wink wink) > by > >> > medics who are now convinced there is nothing wrong with the patient. > >> > > > Your statements assume that the medics applying the protocols apply no > > personal experience and judgment to the situation.  You still have not > > supported > > the comment that " some patients with significant spinal injury requiring > > immobilization do not exhibit any of the signs and symptoms listed in the > Main > > Protocol. "   Is that your conclusion or are you basing that statement upon > > published > > evidence?  I'm asking you once again for evidence according too > scientific > > studies published in peer reviewed publications, sir. > >> > > >> > How many patients will this happen to? It doesn't matter! It is a > >> travesty > >> > for it to happen to ONE patient when it simply does not have to! > Quibbling > >> > over numbers is nice and sterile in the statistical arena, but what we > are > >> > really talking about here are not just numbers; they are PEOPLE! To > >> dismiss > >> > those people is as unconscionable as dismissing the Holocaust because > of >> > all > >> > the 'good things' Hitler did for Germany. > >> > > > Have you now crossed the line from objective commentary to emotionalism? > >> > > >> > I don't recall who it was that commented that by not taking the Maine > >> > Protocol hook, line, and sinker, that I was somehow a " God of self, " > but > >> > that is the very opposite of what I am. It is those who contend that > >> > letting a few people die or end up quadriplegics is a statistically > >> > acceptable loss if it saves us the time and effort of immobilizing them > who > >> > are playing God. > >> > > >> > Do I have a better protocol? Nope. Never claimed to. I don't have to > >> have > >> > a better protocol to know that this one is dangerously flawed, just > like I > >> > don't have to be a helicopter pilot to know they crash too much. > >> > > > I accept your conclusions as being your own. > >> > > >> > I am not against progress or improvement. But so far I have yet to see > ANY > >> > studies which show this to be an improvement in patient care. I have > yet > >> to > >> > see ANY statistics on the plague of " pressure sores " that we are > supposedly > >> > battling. All it does is cut down on unnecessary field procedures. It > does > >> > nothing to improve morbidity or mortality. Shouldn't that be our > ultimate > >> > goal? > >> > > >> > I support further research into this matter. And if a protocol is > >> developed > >> > which cuts down unnecessary immobilization while not simultaneously > >> > jeopardizing the lives of a significant segment of our patient > population, > I > >> > am all for it. Maine just ain't it. And utilizing it simply because > it is > >> > " all we have so far, " full well knowing that it needs improvement, is > >> > reckless. > >> > > >> > Back to the CISM analogy, the comparison seems very clear to me. A lot > of > >> > people leaping without looking. At least with CISM we can claim that > we > >> > were really trying to provide the best possible care for people. With > the > >> > Maine Protocol, the only thing we can claim is that we are trying to > GET >> > OUT > >> > of providing the best possible care for people. Is that the bandwagon > YOU > >> > want to be on? > >> > > > I want to do what's best for all my patients.  Current data shows that > some > > patients with a MOI previously thought to require immobilization can be > safely > > field cleared.  We have the duty not to inflict pain and injury when > > unwarranted. > > > > I'll stick with my views, as I expect will you.  Each of us wants to do > > what's right, but we see differing pathways.  Rational discussion is the > way > > to > > resolve these issues.  Emotional retorts are not helpful (he told himself > as > > a > > reminder, also). > > > > Respectfully, > > > > GG > >> > > >> > Rob > >> > > >> > > >> > > >> > > >> > > >> > > >> > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2005 Report Share Posted February 23, 2005 Thank you VERY much, Dr. . You say it better than any of us have. Gene > > > Hi Folks, > > The most comprehensive information thus far about spinal immobilization can > be found at the following web site: > > http://www.naemsp.org/Position%20Papers/ClinGdeSpine.html > > This is the official guideline of the National Association of EMS Physicians > (NAEMSP) and is backed by over 40 research articles. You can read them all > if you like. > > After reading the position paper you will both have a better understanding > about the issues and the science that backs our practice. While we are not > perfect we are making a concerted effort to use evidence based research for > our rationale. There are good reasons to immobilize some patients spines > and there are equally good reasons not to immobilize others. We need to > always practice our skills with judgment to meet the specific needs of each > patient and not just respond like mindless robots to all accidents. > > Thank you for your concern about doing what is best for our patients. > > Best regards, > > Larry MD > Medical director AMR San & Austin, Blanco, Bulverde, Spring Branch, > Devine > > > > > > > > > > >> > > >> > wegandy1938@a... wrote: > >>> > > > >>> > > I don't have numbers on that [morbidity and mortality due to spinal > >>> > > immobilization]. Do you have numbers on asymptomatic c-spine > injuries? > >> > > >> > I don't need numbers, Gene. And neither should you. We both know it > >> > happens. And we both know that under the Maine Protocol, those > patients > >> > will not receive proper treatment from EMS. > >> > > > I do not know that at all.  I do not know about the incidence of > > " asymptomatic " spinal injuries, and I do not know that under the Maine > > Protocols those > > patients will not receive proper treatment from EMS.  I challenge you to > > support both those statements with facts, if you would kindly do so. > >> > > >>> > > Potential for mistakes? Sure. How many have happened? I > >>> > > frankly do not know. If you have studies and reports, I'd like to > >>> > > know about them. > >> > > >> > So, you admit that you are buying into the Maine Protocol even though > the > >> > data is -- by your own admission -- incomplete. THAT is exactly what I > >> mean > >> > when I refer to the myopic zeal of people who rush to jump on the > bandwagon > >> > of " the next big thing. "  And yes, that is exactly how CISM got wings. > >> > > > I asked you for data supporting your statements concerning the number of > > " asymptomatic " injuries.  There is data supporting the Maine Protocols. > > Where > > is your data, please? > > > >> > > >>> > > I cannot comment upon whether or not I would have caught your > >>> > > " asymptomatic " injury since I wasn't there. > >> > > >> > That right there should be enough to have you seriously questioning > whether > >> > or not the Maine Protocol is as good as you claim, shouldn't it? > >> > > > Not at all.  I said I wasn't there and didn't know your signs and > symptoms. > > I don't know whether or not the Maine Protocol was followed correctly.  > I > > don't know any facts except what you've chosen to relate; therefore, I > > couldn't > > say with any degree of reliability whether or not the Maine Protocols, if > > properly followed, would have resulted in your being immobilized or not. > >> > > >>> > > We can argue all night about what's the higher standard. I am also > >>> > > not understanding your comments about " asymptomatic c-spine > >>> > > injuries. "  I don't understand that. > >> > > >> > I don't know how I can make the concept any simpler, but I will try: > >> > > >> > 1. The Maine Protocol uses a checklist approach to spinal assessment. > >> > > >> > 2. Those patients who exhibit none of the signs or symptoms on that > >> > checklist are automatically deemed to be non-candidates for > immobilization. > >> > > >> > 3. Some patients with significant spinal injury requiring > immobilization > >> do > >> > not exhibit any of the signs and symptoms listed in the Maine Protocol. > >> > > >> > 4. Those patients will either be transported without proper treatment > and > >> > precautions, or worse yet, encouraged to " refuse transport " (wink wink) > by > >> > medics who are now convinced there is nothing wrong with the patient. > >> > > > Your statements assume that the medics applying the protocols apply no > > personal experience and judgment to the situation.  You still have not > > supported > > the comment that " some patients with significant spinal injury requiring > > immobilization do not exhibit any of the signs and symptoms listed in the > Main > > Protocol. "   Is that your conclusion or are you basing that statement upon > > published > > evidence?  I'm asking you once again for evidence according too > scientific > > studies published in peer reviewed publications, sir. > >> > > >> > How many patients will this happen to? It doesn't matter! It is a > >> travesty > >> > for it to happen to ONE patient when it simply does not have to! > Quibbling > >> > over numbers is nice and sterile in the statistical arena, but what we > are > >> > really talking about here are not just numbers; they are PEOPLE! To > >> dismiss > >> > those people is as unconscionable as dismissing the Holocaust because > of >> > all > >> > the 'good things' Hitler did for Germany. > >> > > > Have you now crossed the line from objective commentary to emotionalism? > >> > > >> > I don't recall who it was that commented that by not taking the Maine > >> > Protocol hook, line, and sinker, that I was somehow a " God of self, " > but > >> > that is the very opposite of what I am. It is those who contend that > >> > letting a few people die or end up quadriplegics is a statistically > >> > acceptable loss if it saves us the time and effort of immobilizing them > who > >> > are playing God. > >> > > >> > Do I have a better protocol? Nope. Never claimed to. I don't have to > >> have > >> > a better protocol to know that this one is dangerously flawed, just > like I > >> > don't have to be a helicopter pilot to know they crash too much. > >> > > > I accept your conclusions as being your own. > >> > > >> > I am not against progress or improvement. But so far I have yet to see > ANY > >> > studies which show this to be an improvement in patient care. I have > yet > >> to > >> > see ANY statistics on the plague of " pressure sores " that we are > supposedly > >> > battling. All it does is cut down on unnecessary field procedures. It > does > >> > nothing to improve morbidity or mortality. Shouldn't that be our > ultimate > >> > goal? > >> > > >> > I support further research into this matter. And if a protocol is > >> developed > >> > which cuts down unnecessary immobilization while not simultaneously > >> > jeopardizing the lives of a significant segment of our patient > population, > I > >> > am all for it. Maine just ain't it. And utilizing it simply because > it is > >> > " all we have so far, " full well knowing that it needs improvement, is > >> > reckless. > >> > > >> > Back to the CISM analogy, the comparison seems very clear to me. A lot > of > >> > people leaping without looking. At least with CISM we can claim that > we > >> > were really trying to provide the best possible care for people. With > the > >> > Maine Protocol, the only thing we can claim is that we are trying to > GET >> > OUT > >> > of providing the best possible care for people. Is that the bandwagon > YOU > >> > want to be on? > >> > > > I want to do what's best for all my patients.  Current data shows that > some > > patients with a MOI previously thought to require immobilization can be > safely > > field cleared.  We have the duty not to inflict pain and injury when > > unwarranted. > > > > I'll stick with my views, as I expect will you.  Each of us wants to do > > what's right, but we see differing pathways.  Rational discussion is the > way > > to > > resolve these issues.  Emotional retorts are not helpful (he told himself > as > > a > > reminder, also). > > > > Respectfully, > > > > GG > >> > > >> > Rob > >> > > >> > > >> > > >> > > >> > > >> > > >> > Quote Link to comment Share on other sites More sharing options...
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