Bro.
If you're not confident enough in your knowledge base to differentiate between what's right for the people you take care of, and some flavor-of-the-month speculation and conjectures, it's gonna be a looooong career for you.
Paramedic level care (ALS) of no help, may be harmful
- Thread starter Alan L Serve
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Bro.
If you're not confident enough in your knowledge base to differentiate between what's right for the people you take care of, and some flavor-of-the-month speculation and conjectures, it's gonna be a looooong career for you.
SpecialK
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I don't think such a level of concern is necessary. The current state of resuscitation science seems to be fairly well applied, for example, our current thinking is on doing the basics well (i.e. CPR and defibrillation) and doing the "advanced" things Isuch as gaining intravenous access, administering medications and endotracheal intubation) only if they do not interfere with them.
The biggest area for improvement is probably post-resuscitation care with the only change to the auctual resuscitation likely to be the removal of intravenous adrenaline or at least the removal of fixed boluses of 1 mg in favour of perhaps an infusion or titrated dosing.
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I hadn't even watched the video yet when I first posted to this thread, so I wasn't commenting on anything in it. I was specifically responding to your statement that "every time this debate comes up, I wonder why no one considers that patients who NEED ALS generally carry higher morbidity/mortality rates by default."
Indeed, every time a study comes out that questions the efficacy of ALS interventions, numerous people always say "well, of course ALS patients have worse outcomes - they are sicker to begin with", seemingly without understanding that statistical tools are always used to control for that, to whatever extent is possible.
Not sure what you are talking about here. The guy in the video didn't do that. He cited a bunch of different studies that all show no benefit to ALS care.
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Find a service that focuses on doing the basics really well and has a strong commitment to evidence-based practice.
It's in the middle of the video. Go back and look.
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He cites a handful of studies that indicate ALS is unhelpful. You'll have to be more specific about which one you have an issue with.
I'm not sure if you're purposely being contrary, but I'm not going to run around in circles with you. Listen to what he says. That's all I'm gonna say about it.
Anonymous555
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There's definitely still some progress to be made
Alan L Serve
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He did. Go back and look.
Alan L Serve
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The doctor came out with another video where he shows the studies just don't support using ALS. Watch it in full.
SpecialK
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I find it perplexing and disturbing ambulance personnel refused a randomised control trial. A prospective RCT, while not perfect, is the gold standard in medical research as it removes many of the biases and methodological problems of others, e.g. an observational analysis. While it would be impossible to placebo-control or double-blind such an RCT in the pre-hospital environment, it is still the best type of study to answer these questions. It is more unethical to continue to provide a treatment we know may not work and/or be concerned is actively harmful rather than study it to see if that is the case. The PARAMEDIC-2 trial of adrenaline vs placebo in out-of-hospital cardiac arrest is a good example.
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I've watched the video 3 time now, and I can not find the part where he says anything that could be construed as "extrpolating (the failures of ALS in cardiac arrest) to the efficacy of ALS as a whole".
If it's in there, then be specific about exactly where it is in the video. But I don't see where he even addresses ALS in general at all - the entire video is clearly about BLS vs ALS in cardiac arrest specifically.
ExpatMedic0
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1. As others have said, we are talking about a very specific population group here. He uses bold and sweeping comments about ALS as a whole which are not relevant at all to what the topics really is; out of hospital cardiac arrest.
2:32 mark of the video, he mentions survival from EMS initiated CPR and defib is much worse than bystanders. He again mentions this toward the end of the video to further emphasis his point against ALS. Could it be because bystander CPR and Defib is most likely witnessed, or a short time after a witnessed arrest, thereby reducing the time to defibrillation and the start or CPR? If so, we already know and have known that early dfib and cpr increase survival, so I am not sure how he can turn this argument against EMS. Given, we would have to compare response times to bystander times. Its not possible for EMS to arrive in seconds in most circumstances.
Study that he mentions at 3:16 mark we have been discussing in another area of the forum.
found here http://emtlife.com/threads/study-bls-better-than-als-for-trauma-stroke-respiratory-distress.42485/
This story has been run into the ground and everyone's been talking about. It also looks beyond just cardiac arrest. You can find a lot of rebuttals online. In a nutshell, I dont think the results should be ignored. There maybe something to this and some large scale RCTs should be performed. With that being said the study fails to answer why... which is fine since that is not what was being researched. However, until we solve for Y, we have no idea why these results are they are... In theory they should not be....
I think my biggest beef is the authors of the study above, themselves have demonstrated bias coming up with conclusions from this research in press releases which are subjective and bias and do not accurately portray their findings... which in my opinion is unethical.
At the end of the day, yes I think we need to evaluate aspects of ALS and its interventions and other variables and identify weaknesses so they can be improved. The problem is ALS seems to have friends and foes on both sides that have personal objectives... in my opinion
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SpecialK
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I am not even really sure the hypothesis of this is a sensible one? How can you divide treatment into being either "basic" or "advanced" and who determines it? What is used to make the distinction? Attaching labels of "basic" and "advanced" to treatment and saying one is better than the other seems somewhat arbitrary and pointless. I've never seen a similar hypothesis.
There are aspects of treatment we can (and have) studied; for example the routine administration of supplumental oxygen to the normoxaemic MI patient has been removed, but is that a "basic" treamtment or an "advanced" one? What about permissive hypotension or binding the pelvis in major trauma, is that "basic" or "advanced"? We know salbutamol, ipratropium, some form of steriod and parenatral adrenaline is the general treatment for asthma (depending on how severe) but is that "basic" or "advanced"?
There are aspects of treatment we can (and have) studied; for example the routine administration of supplumental oxygen to the normoxaemic MI patient has been removed, but is that a "basic" treamtment or an "advanced" one? What about permissive hypotension or binding the pelvis in major trauma, is that "basic" or "advanced"? We know salbutamol, ipratropium, some form of steriod and parenatral adrenaline is the general treatment for asthma (depending on how severe) but is that "basic" or "advanced"?
RocketMedic
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Resuscitation is a tiny piece of ALS care. I like how this doctor completely ignores 90% of what we do to quibble about a very small and specific population.
RocketMedic
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People like Remi would take away pain management, airway support, symptom relief and most of our diagnostic tools in favor of rapid transport to hospitals where professionals cold do all of those things. It's the exact opposite of what EMS needs.
Alan L Serve
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The doctor in the videos did a good job of bringing up all the points everyone is making and I think he sufficiently addressed them all.
Now I'm thinking of BLSing every PT after medic eval.
Gosh....Nothing worse than knowing I may have harmed my PTs.
Now I'm thinking of BLSing every PT after medic eval.
Gosh....Nothing worse than knowing I may have harmed my PTs.
Jim37F
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Clearly this whole topic is currently being hotly debated with valid points from both sides. Where the issues will be resolved it seems we need more evidence to sway the answers.
However to the OP if you are that concerned that ALS care will harm your patients, then the answer is simple. Do not become a paramedic and stay an EMT only providing BLS care. Your moral qualms solved. OR go on and become a nurse or a PA or an MD and provide care far more advanced than ALS to definitively treat your patients.......
However to the OP if you are that concerned that ALS care will harm your patients, then the answer is simple. Do not become a paramedic and stay an EMT only providing BLS care. Your moral qualms solved. OR go on and become a nurse or a PA or an MD and provide care far more advanced than ALS to definitively treat your patients.......
And no offense meant, but if your gonna be an EMT masquerading as a paramedic, I hope your not the paramedic who responds to me when I get hurt or sick and then deny's me pain meds after a trauma or anti-emetics, or albuteral if I need it or epi in case of allergic reaction, etc.
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I can't figure out if you are a straight up troll, or really just that bad at reading comprehension. I guess maybe this is the kind of reasoning and discourse that is to be expected from some members of a "profession" whose education comes mostly from 10th-grade level textbooks.
You can disagree with me on any issue you want, of course. But you can't lie about what I've said. I have never once argued for "taking away" any of those things.
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Alan L Serve
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I definitely won't be withholding any meds or treatments from someone who is in pain or puking, gasping or wheezing, etc. But when it comes to someone in a medical or trauma arrest I imagine I'll be discussing this with my PMD and asking if I can BLS everyone.
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