Re: [EMS-L] Common sense is uncommon

[Guest guest]

Wonderfully stated Wes!

Jules

[EMS-L] Common sense is uncommon

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I just wanted to share this thought with y'all, especially since the

EBM

types and others with an agenda that often involves limiting EMS

practices

because of " statistical evidence. "

People who die after receiving advanced interventions don't die from

the

advanced intervention. They die because they're sick enough to need

the

advanced intervention. (Remember the study a few years ago about chest

pain

patients

who receive morphine experiencing worse outcomes? It's obvious -- if

you're

in enough pain that nitroglycerin isn't providing symptom relief

through

vasodilation, you're having the BIG ONE.)

Additionally, how do the " experts " propose measuring if someone

would've

died without receiving the advanced intervention in the prehospital

setting?

Finally, do the statisticians have a way to eliminate deaths that

weren't

directly related to prehospital intervention? (e.g., a trauma code

returned to

the ER with ROSC, but who dies of a post-op infection).

So, the next time your medical director wants to eliminate endotracheal

intubation because " intubations have bad outcomes, " ask him to explain

himself.

As Mark Twain so eloquently said, " There are three kinds of lies: lies,

damned lies, and statistics. " Let's not let advanced prehospital care

be

killed

or dumbed down in the name of statistics. In other words, what we do

isn't

always complete science. The ART of medicine may have a scientific

basis, but

it's still about people. If we forget this, we lose our own humanity.

-Wes Ogilvie, MPA, JD, EMT

Austin, Texas

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[Guest guest]

Sounds like just had a run in with an EBM person!

Yes, I would agree that one can usually manipulate statistics to show whatever

one wants

(think...amiodarone is " far superior " to lidocaine). All of the studies have to

have funding

from someone, the trick is trying to discover which bias is present and then

re-reading

with that in mind.

Pharmaceuticals are BIG business! They have no interest in just making

generics. Who

gets a big payoff from that. I am a firm believer in the principle of, " Don't

be the first to

use a new drug, or the last to use an old one. " (think...Autopulse, amiodarone,

vioxx, etc)

Just because the rep is sexy doesn't make it the best.

There is a place for EBM though. The trick is reminding how something didn't

work that

we believed in for ages. Hmm, leeches? Tried and true for decades, they still

have a

limited place in medicine, but not like they did in Washington's day.

Anyone

remember laying apneic victims prone and pushing on the back (give a massage)

and

lifting the arms? How about bretylium?

I'm sure that some doctor eons ago said, " Hippocrates would be rolling in his

grave to hear

someone say that the feces poltice doesn't work for a cannonball through the

chest! How

dare you! " There are going to be large egos on each side of a debate. The art

of

medicine, in my humble opinion, is to be able to see through the BS and slick

advertising,

slow everyone down so that the data can be really evaluated, and make a calm

rational

decision.

That said, there will be some things that are obvious (i.e. the feces politice

for the

cannonbal through the chest). In my estimation, romazicon for an unknown

substance

overdose. Some EMS medical directors have been sucked into this. If one gives

romazicon

and any BZ on board may be PREVENTING the patient from seizing due to say an

ultram

overdose, how are you going to stop the seizure? You just blocked the BZ

receptors.

Better to stay with the old protocol...SNOT. If you look at the company

literature and

extrapolate the endoscopy suite findings to the street, we will all be changing

to SNORT

from SNOT.

The old ACLS said it best. " It may be a cookbook approach, but it takes a

thinking cook! "

So, everyone...especially the medical directors, but EVERYONE, we have to start

thinking

critically.

Stay safe!

Don

> I just wanted to share this thought with y'all, especially since the

> EBM

> types and others with an agenda that often involves limiting EMS

> practices

> because of " statistical evidence. "

>

> People who die after receiving advanced interventions don't die from

> the

> advanced intervention. They die because they're sick enough to need

> the

> advanced intervention. (Remember the study a few years ago about chest

> pain

> patients

> who receive morphine experiencing worse outcomes? It's obvious -- if

> you're

> in enough pain that nitroglycerin isn't providing symptom relief

> through

> vasodilation, you're having the BIG ONE.)

>

> Additionally, how do the " experts " propose measuring if someone

> would've

> died without receiving the advanced intervention in the prehospital

> setting?

> Finally, do the statisticians have a way to eliminate deaths that

> weren't

> directly related to prehospital intervention? (e.g., a trauma code

> returned to

>

> the ER with ROSC, but who dies of a post-op infection).

>

> So, the next time your medical director wants to eliminate endotracheal

>

> intubation because " intubations have bad outcomes, " ask him to explain

> himself.

>

>

> As Mark Twain so eloquently said, " There are three kinds of lies: lies,

>

> damned lies, and statistics. " Let's not let advanced prehospital care

> be

> killed

> or dumbed down in the name of statistics. In other words, what we do

> isn't

> always complete science. The ART of medicine may have a scientific

> basis, but

> it's still about people. If we forget this, we lose our own humanity.

>

> -Wes Ogilvie, MPA, JD, EMT

> Austin, Texas

>

>

> --

>

> EMS-L (Public Mailing List):

>

> List FAQ: HTTP://EMS-L.ORG

> Unsubscribe: EMS-L-UNSUBSCRIBE@...

> Manage: HTTP://EMS-L.ORG/MAN-EMS-L.HTM

> Post to list: EMS-L@...

> List Manager: LISTADMIN@...

> Moderator: MODERATOR@...

>

>

>

>

> ________________________________________________________________________

> Check Out the new free AIM® Mail -- 2 GB of storage and

> industry-leading spam and email virus protection.

>

[Guest guest]

Exactly Dr. . Blind adherence to anecdote or blind adherence to EBM

doesn't serve our patients or our profession. Critical thinking is ultimately

what's going to help us to help our patients.

-Wes Ogilvie, MPA, JD, EMT

Austin, Texas

Re: [EMS-L] Common sense is uncommon

Sounds like just had a run in with an EBM person!

Yes, I would agree that one can usually manipulate statistics to show whatever

one wants

(think...amiodarone is " far superior " to lidocaine). All of the studies have to

have funding

from someone, the trick is trying to discover which bias is present and then

re-reading

with that in mind.

Pharmaceuticals are BIG business! They have no interest in just making generics.

Who

gets a big payoff from that. I am a firm believer in the principle of, " Don't be

the first to

use a new drug, or the last to use an old one. " (think...Autopulse, amiodarone,

vioxx, etc)

Just because the rep is sexy doesn't make it the best.

There is a place for EBM though. The trick is reminding how something didn't

work that

we believed in for ages. Hmm, leeches? Tried and true for decades, they still

have a

limited place in medicine, but not like they did in Washington's day.

Anyone

remember laying apneic victims prone and pushing on the back (give a massage)

and

lifting the arms? How about bretylium?

I'm sure that some doctor eons ago said, " Hippocrates would be rolling in his

grave to hear

someone say that the feces poltice doesn't work for a cannonball through the

chest! How

dare you! " There are going to be large egos on each side of a debate. The art of

medicine, in my humble opinion, is to be able to see through the BS and slick

advertising,

slow everyone down so that the data can be really evaluated, and make a calm

rational

decision.

That said, there will be some things that are obvious (i.e. the feces politice

for the

cannonbal through the chest). In my estimation, romazicon for an unknown

substance

overdose. Some EMS medical directors have been sucked into this. If one gives

romazicon

and any BZ on board may be PREVENTING the patient from seizing due to say an

ultram

overdose, how are you going to stop the seizure? You just blocked the BZ

receptors.

Better to stay with the old protocol...SNOT. If you look at the company

literature and

extrapolate the endoscopy suite findings to the street, we will all be changing

to SNORT

from SNOT.

The old ACLS said it best. " It may be a cookbook approach, but it takes a

thinking cook! "

So, everyone...especially the medical directors, but EVERYONE, we have to start

thinking

critically.

Stay safe!

Don

> I just wanted to share this thought with y'all, especially since the

> EBM

> types and others with an agenda that often involves limiting EMS

> practices

> because of " statistical evidence. "

>

> People who die after receiving advanced interventions don't die from

> the

> advanced intervention. They die because they're sick enough to need

> the

> advanced intervention. (Remember the study a few years ago about chest

> pain

> patients

> who receive morphine experiencing worse outcomes? It's obvious -- if

> you're

> in enough pain that nitroglycerin isn't providing symptom relief

> through

> vasodilation, you're having the BIG ONE.)

>

> Additionally, how do the " experts " propose measuring if someone

> would've

> died without receiving the advanced intervention in the prehospital

> setting?

> Finally, do the statisticians have a way to eliminate deaths that

> weren't

> directly related to prehospital intervention? (e.g., a trauma code

> returned to

>

> the ER with ROSC, but who dies of a post-op infection).

>

> So, the next time your medical director wants to eliminate endotracheal

>

> intubation because " intubations have bad outcomes, " ask him to explain

> himself.

>

>

> As Mark Twain so eloquently said, " There are three kinds of lies: lies,

>

> damned lies, and statistics. " Let's not let advanced prehospital care

> be

> killed

> or dumbed down in the name of statistics. In other words, what we do

> isn't

> always complete science. The ART of medicine may have a scientific

> basis, but

> it's still about people. If we forget this, we lose our own humanity.

>

> -Wes Ogilvie, MPA, JD, EMT

> Austin, Texas

>

>

> --

>

> EMS-L (Public Mailing List):

>

> List FAQ: HTTP://EMS-L.ORG

> Unsubscribe: EMS-L-UNSUBSCRIBE@...

> Manage: HTTP://EMS-L.ORG/MAN-EMS-L.HTM

> Post to list: EMS-L@...

> List Manager: LISTADMIN@...

> Moderator: MODERATOR@...

>

>

>

>

> __________________________________________________________

> Check Out the new free AIM® Mail -- 2 GB of storage and

> industry-leading spam and email virus protection.

>

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