Accreditation and success paper

November 29, 2007

>>> Further, I would question the bias of the authors, since one of

them is an official of NREMT and another is famous for his other

biased studies. <<<

Gene,

Every paper ever written is influenced by a bias inherently present

in all authors. Everyone on this list with an opinion has a bias.

Are you implying that the authors of that paper were involved

in " data torturing " by misrepresenting beyond a reasonable

interpretation of the facts?

Are you also suggesting that a National Registry employee (who

actually is no longer affiliated with the NR) has a conflict

regarding studies involving accredited programs?

I'm your student, so educate me like I'm a five-year-old.

Kenny Navarro

Dallas

November 29, 2007

Kenny. Your first sentence explains it.

I have not evaluated the study in depth, but some of the ways that bias can

be inserted are in who one chooses as the subjects of the study.

For example, one study showed that paramedics in a certain system could not

intubate well. Some applied that study across the board as meaning that all

paramedics cannot intubate well, when all it really showed was that the

paramedics in that system couldn't do it well.

So I will go with the Texas statistics and what they show. Anyone can see

how each program does, and whether it is accredited or not. It appears to me

that the Texas stats do not show that the accredited programs have any

advantage in preparing folks to pass NR.

BTW, I did not know that Phil was no longer with NR. Now I do. I am not

suggesting that one would consciously skew, but a study can be skewed for any

number of reasons. Often one starts a study in order to prove a theory.

That's all.

Let's look at ALL the accredited programs and ALL the non-accredited programs

and then we might see a trend.

GG

In a message dated 11/29/07 7:08:22 AM, kenneth.navarro@...

writes:

>

> >>> Further, I would question the bias of the authors, since one of

> them is an official of NREMT and another is famous for his other

> biased studies. <<<

>

> Gene,

>

> Every paper ever written is influenced by a bias inherently present

> in all authors. Everyone on this list with an opinion has a bias.

>

> Are you implying that the authors of that paper were involved

> in " data torturing " by misrepresenting beyond a reasonable

> interpretation of the facts?

>

> Are you also suggesting that a National Registry employee (who

> actually is no longer affiliated with the NR) has a conflict

> regarding studies involving accredited programs?

>

> I'm your student, so educate me like I'm a five-year-old.

>

> Kenny Navarro

> Dallas

>

**************************************

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November 29, 2007

Well, for one thing, Kenny, I am a suspicious person. I guess law taught me

that.

I am skeptical of all studies.

I read something just the other day suggesting that a large percentage of

research is invalid balderdash. There are many, many hidden factors that can

influence a study.

I think one must always take an individual study with a grain of salt. When

studies can be repeated by independent researchers in divergent areas, then I

tend to believe them.

If says Henry Wang is a good guy and a good researcher, then I believe

him. I don't have the opportunity to know him, but I do not question his

motives. Rather, I question just what exactly we should gather from his

research.

One can have the best motives and still produce a biased study. My wife is

a researcher who has done research for over 30 years, been published numerous

times, and she is the first to say that one must know a lot about a study

before accepting it as meaningful.

After reflection, I see that my problem is not so much with Henry Wang but

with those who read his study and glean more from it than is warranted.

As I have said before, one study is a snapshot.

When we have a whole bunch of studies done in many parts of the country that

all say the same thing about paramedic intubation, then I'll take notice.

In the meantime, I believe that paramedics can be taught to intubate as well

as physicians, do it every day in various places, and there are numerous

factors in training, practice, application, availability of adjuncts, and so

forth

that can change the results of a study.

For example, did the paramedics in the studies have a bougie and use it?

Did they change blades for the second attempt? Did they assess the airway

prior to the attempt and adapt their technique to the patient's anatomy?

So I am the skeptic. If I have unfairly characterized Henry Wang, I go on

record as apologizing. But I still question the results of his study and am

not willing to concede that it gives anyone a basis to make a change in

procedures. It is what it is, but it is ONLY what it is.

GG

In a message dated 11/29/07 11:15:33 PM, kenneth.navarro@...

writes:

>

> >>> . . . some of the ways that bias can be inserted are in who one

> chooses as the subjects of the study. For example, one study showed

> that paramedics in a certain system could not intubate well. Some

> applied that study across the board as meaning that all paramedics

> cannot intubate well, when all it really showed was that the

> paramedics in that system couldn't do it well. <<<

>

> Gene,

>

> If any study suggested the intubation skills of paramedics within a

> certain system were poor . . . then some third party told you that

> (based on that study) the intubation skills of ALL paramedics are

> poor, it seems that the individual you should be suspicious of is the

> third party, NOT the original researcher.

>

> If the methodology used by Dr. Wang in any of his published work were

> sloppy or unethical, it should cast a shadow over anything to which

> he attaches his name. However, as pointed out, that is not the

> case.

>

> Therefore, what is confusing to me is why one would automatically be

> suspicious of Dr Wang's work when his methodology appears to be

> sound. If we are discounting his work because we don't agree with

> it, it seems that the more harmful bias does not belong to Dr. Wang.

>

> Kenny Navarro

> Dallas

>

**************************************

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November 29, 2007

>>> . . . some of the ways that bias can be inserted are in who one

chooses as the subjects of the study. For example, one study showed

that paramedics in a certain system could not intubate well. Some

applied that study across the board as meaning that all paramedics

cannot intubate well, when all it really showed was that the

paramedics in that system couldn't do it well. <<<

Gene,

If any study suggested the intubation skills of paramedics within a

certain system were poor . . . then some third party told you that

(based on that study) the intubation skills of ALL paramedics are

poor, it seems that the individual you should be suspicious of is the

third party, NOT the original researcher.

If the methodology used by Dr. Wang in any of his published work were

sloppy or unethical, it should cast a shadow over anything to which

he attaches his name. However, as pointed out, that is not the

case.

Therefore, what is confusing to me is why one would automatically be

suspicious of Dr Wang's work when his methodology appears to be

sound. If we are discounting his work because we don't agree with

it, it seems that the more harmful bias does not belong to Dr. Wang.

Kenny Navarro

Dallas

November 30, 2007

In a message dated 11/30/2007 1:28:10 P.M. Central Standard Time,

ExLngHrn@... writes:

Wait.... I'll give you the phone number for the State Bar. ;-)

Wes, you better hope you Mom isn't on this list!

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Owner and President of LNM Emergency Services Consulting Services (LNMECS)

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

(IFW/TFW/FSS Office)

(IFW/TFW/FSS Fax)

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

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November 30, 2007

Is it possible that Dr. Wang's prehospital intubation study is actually good

science, but that some reads of the study, with their own agenda, have

over-generalized the study to use it as ammunition against prehospital

intubation?

-Wes Ogilvie, MPA, JD, LP

-Attorney/Licensed Paramedic

-Licensed and Sanitized for your protection

Re: Re: Accreditation and success paper

Well, for one thing, Kenny, I am a suspicious person. I guess law taught me

that.

I am skeptical of all studies.

I read something just the other day suggesting that a large percentage of

research is invalid balderdash. There are many, many hidden factors that can

influence a study.

I think one must always take an individual study with a grain of salt. When

studies can be repeated by independent researchers in divergent areas, then I

tend to believe them.

If says Henry Wang is a good guy and a good researcher, then I believe

him. I don't have the opportunity to know him, but I do not question his

motives. Rather, I question just what exactly we should gather from his

research.

One can have the best motives and still produce a biased study. My wife is

a researcher who has done research for over 30 years, been published numerous

times, and she is the first to say that one must know a lot about a study

before accepting it as meaningful.

After reflection, I see that my problem is not so much with Henry Wang but

with those who read his study and glean more from it than is warranted.

As I have said before, one study is a snapshot.

When we have a whole bunch of studies done in many parts of the country that

all say the same thing about paramedic intubation, then I'll take notice.

In the meantime, I believe that paramedics can be taught to intubate as well

as physicians, do it every day in various places, and there are numerous

factors in training, practice, application, availability of adjuncts, and so

forth

that can change the results of a study.

For example, did the paramedics in the studies have a bougie and use it?

Did they change blades for the second attempt? Did they assess the airway

prior to the attempt and adapt their technique to the patient's anatomy?

So I am the skeptic. If I have unfairly characterized Henry Wang, I go on

record as apologizing. But I still question the results of his study and am

not willing to concede that it gives anyone a basis to make a change in

procedures. It is what it is, but it is ONLY what it is.

GG

In a message dated 11/29/07 11:15:33 PM, kenneth.navarro@...

writes:

>

> >>> . . . some of the ways that bias can be inserted are in who one

> chooses as the subjects of the study. For example, one study showed

> that paramedics in a certain system could not intubate well. Some

> applied that study across the board as meaning that all paramedics

> cannot intubate well, when all it really showed was that the

> paramedics in that system couldn't do it well. <<<

>

> Gene,

>

> If any study suggested the intubation skills of paramedics within a

> certain system were poor . . . then some third party told you that

> (based on that study) the intubation skills of ALL paramedics are

> poor, it seems that the individual you should be suspicious of is the

> third party, NOT the original researcher.

>

> If the methodology used by Dr. Wang in any of his published work were

> sloppy or unethical, it should cast a shadow over anything to which

> he attaches his name. However, as pointed out, that is not the

> case.

>

> Therefore, what is confusing to me is why one would automatically be

> suspicious of Dr Wang's work when his methodology appears to be

> sound. If we are discounting his work because we don't agree with

> it, it seems that the more harmful bias does not belong to Dr. Wang.

>

> Kenny Navarro

> Dallas

>

**************************************

Check out AOL's list of 2007's hottest

products.

(http://money.aol.com/special/hot-products-2007?NCID=aoltop00030000000001)

November 30, 2007

The interesting thing about numbers and data is that I can make it say anything

I want or need it to say from either the authors perspective or from those

reading it.

>>> Wes Ogilvie 11/30/2007 10:41 AM >>>

Is it possible that Dr. Wang's prehospital intubation study is actually good

science, but that some reads of the study, with their own agenda, have

over-generalized the study to use it as ammunition against prehospital

intubation?

-Wes Ogilvie, MPA, JD, LP

-Attorney/Licensed Paramedic

-Licensed and Sanitized for your protection

Re: Re: Accreditation and success paper

Well, for one thing, Kenny, I am a suspicious person. I guess law taught me

that.

I am skeptical of all studies.

I read something just the other day suggesting that a large percentage of

research is invalid balderdash. There are many, many hidden factors that can

influence a study.

I think one must always take an individual study with a grain of salt. When

studies can be repeated by independent researchers in divergent areas, then I

tend to believe them.

If says Henry Wang is a good guy and a good researcher, then I believe

him. I don't have the opportunity to know him, but I do not question his

motives. Rather, I question just what exactly we should gather from his

research.

One can have the best motives and still produce a biased study. My wife is

a researcher who has done research for over 30 years, been published numerous

times, and she is the first to say that one must know a lot about a study

before accepting it as meaningful.

After reflection, I see that my problem is not so much with Henry Wang but

with those who read his study and glean more from it than is warranted.

As I have said before, one study is a snapshot.

When we have a whole bunch of studies done in many parts of the country that

all say the same thing about paramedic intubation, then I'll take notice.

In the meantime, I believe that paramedics can be taught to intubate as well

as physicians, do it every day in various places, and there are numerous

factors in training, practice, application, availability of adjuncts, and so

forth

that can change the results of a study.

For example, did the paramedics in the studies have a bougie and use it?

Did they change blades for the second attempt? Did they assess the airway

prior to the attempt and adapt their technique to the patient's anatomy?

So I am the skeptic. If I have unfairly characterized Henry Wang, I go on

record as apologizing. But I still question the results of his study and am

not willing to concede that it gives anyone a basis to make a change in

procedures. It is what it is, but it is ONLY what it is.

GG

In a message dated 11/29/07 11:15:33 PM, kenneth.navarro@...

writes:

>

> >>> . . . some of the ways that bias can be inserted are in who one

> chooses as the subjects of the study. For example, one study showed

> that paramedics in a certain system could not intubate well. Some

> applied that study across the board as meaning that all paramedics

> cannot intubate well, when all it really showed was that the

> paramedics in that system couldn't do it well. <<<

>

> Gene,

>

> If any study suggested the intubation skills of paramedics within a

> certain system were poor . . . then some third party told you that

> (based on that study) the intubation skills of ALL paramedics are

> poor, it seems that the individual you should be suspicious of is the

> third party, NOT the original researcher.

>

> If the methodology used by Dr. Wang in any of his published work were

> sloppy or unethical, it should cast a shadow over anything to which

> he attaches his name. However, as pointed out, that is not the

> case.

>

> Therefore, what is confusing to me is why one would automatically be

> suspicious of Dr Wang's work when his methodology appears to be

> sound. If we are discounting his work because we don't agree with

> it, it seems that the more harmful bias does not belong to Dr. Wang.

>

> Kenny Navarro

> Dallas

>

**************************************

Check out AOL's list of 2007's hottest

products.

(http://money.aol.com/special/hot-products-2007?NCID=aoltop00030000000001)

November 30, 2007

>>> Is it possible that Dr. Wang's prehospital intubation study is

actually good science, but that some reads of the study, with their

own agenda, have over-generalized the study to use it as ammunition

against prehospital intubation? <<<

Wes,

Anything is possible. There may indeed be individuals who will over-

generalize in order to further an agenda of halting prehospital

endotracheal intubation (ETI.) Just as it is possible that some

individuals armed with limited data may be overly dismissive in order

to promote prehospital ETI.

I have had several spirituous discussions with people who have

discredited a conclusion by saying something nebulous like, " the data

is flawed " or " the author has a hidden agenda. " When pressed for a

further explanation, I hear either an elaborate convoluted conspiracy

theory or stammering.

In my limited experience, after reading a study whose conclusions

differ from my opinion, I find it very easy to dismiss it with the

above-mentioned nebulous statements. I can even get other people to

dismiss the studies by saying things like, " The pediatric intubation

study in Los Angeles was severely flawed. " or " The San Diego RSI

study had some major methodology limitations. " Many people

(especially my students) do not require any additional supporting

data.

Instead, I should be pointing out that those same negative

consequences could be occurring in other systems if changes are not

made to the airway control approach. (Didn't you listen to my

portion of our Houston lecture - or were you too focused on rubbing

that new paramedic patch?)

By the way, if Dr. Wang was the only one out there with data pointing

out the hazards of prehospital intubation (or at best - the lack of

efficacy) it might be easy to dismiss the data as an anomaly.

However, the preponderance of the evidence supports Dr. Wang's

position. (Did I use that term appropriately, counselor?)

***GENERALIZATION ALERT - individual applicability may vary***

I agree with Gene's assertion that we CAN teach a paramedic to

intubate with the same accuracy as a physician. However, we don't.

We CAN reduce the risks to our patients by making changes to our

airway control approach. However, we don't.

We COULD make paramedic school six months longer and focus more on

airway techniques while spending more time as an intubating intern

under the watchful eye of an experienced anesthesiologist. However,

we don't.

In addition, if we tried, would that be the REAL end of EMS that

we've been hearing about for some time?

Kenny Navarro

Dallas

November 30, 2007

Actually, I've read the Wang study.? In my opinion (which there are plenty of on

this list), the Wang study leads to many possible conclusions.? One is to

limit/curtail prehospital intubations.? Another is to reeducate medics about

airway management.? Intubation is just a psychomotor skill in the plethora of

airway management options.? We need to be teaching students to THINK about

airway management, not merely apply a skill because it's an option.

The real end of EMS as a trade and the emergence of prehospital medicine as a

profession will occur when we stop teaching skills and interventions in a vacuum

and start teaching them in context of clinical judgement.

Kenny, we're probably agreeing -- just disagreeing over semantics.? In short,

the real test of a paramedic is having the judgement to know when NOT to do

something.

-Wes Ogilvie, MPA, JD, LP

Re: Accreditation and success paper

>>> Is it possible that Dr. Wang's prehospital intubation study is

actually good science, but that some reads of the study, with their

own agenda, have over-generalized the study to use it as ammunition

against prehospital intubation? <<<

Wes,

Anything is possible. There may indeed be individuals who will over-

generalize in order to further an agenda of halting prehospital

endotracheal intubation (ETI.) Just as it is possible that some

individuals armed with limited data may be overly dismissive in order

to promote prehospital ETI.

I have had several spirituous discussions with people who have

discredited a conclusion by saying something nebulous like, " the data

is flawed " or " the author has a hidden agenda. " When pressed for a

further explanation, I hear either an elaborate convoluted conspiracy

theory or stammering.

In my limited experience, after reading a study whose conclusions

differ from my opinion, I find it very easy to dismiss it with the

above-mentioned nebulous statements. I can even get other people to

dismiss the studies by saying things like, " The pediatric intubation

study in Los Angeles was severely flawed. " or " The San Diego RSI

study had some major methodology limitations. " Many people

(especially my students) do not require any additional supporting

data.

Instead, I should be pointing out that those same negative

consequences could be occurring in other systems if changes are not

made to the airway control approach. (Didn't you listen to my

portion of our Houston lecture - or were you too focused on rubbing

that new paramedic patch?)

By the way, if Dr. Wang was the only one out there with data pointing

out the hazards of prehospital intubation (or at best - the lack of

efficacy) it might be easy to dismiss the data as an anomaly.

However, the preponderance of the evidence supports Dr. Wang's

position. (Did I use that term appropriately, counselor?)

***GENERALIZATION ALERT - individual applicability may vary***

I agree with Gene's assertion that we CAN teach a paramedic to

intubate with the same accuracy as a physician. However, we don't.

We CAN reduce the risks to our patients by making changes to our

airway control approach. However, we don't.

We COULD make paramedic school six months longer and focus more on

airway techniques while spending more time as an intubating intern

under the watchful eye of an experienced anesthesiologist. However,

we don't.

In addition, if we tried, would that be the REAL end of EMS that

we've been hearing about for some time?

Kenny Navarro

Dallas

________________________________________________________________________

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November 30, 2007

Would anyone have thought that a lawyer could make so much sense?

________________________________

From: texasems-l [mailto:texasems-l ] On Behalf

Of Wes Ogilvie

Sent: Friday, November 30, 2007 12:41 PM

To: texasems-l

Subject: Re: Re: Accreditation and success paper