Paramedic level care (ALS) of no help, may be harmful

[Doczilla]

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

Amen. That's what I was getting at.

 

[RocketMedic]

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.

That's completely idiotic, but let me know how it works out, especially for your asthmatics, your N/V/D, traumatic injuries and AMI patients.

"Sorry, that albuterol might not be what you need."

"Ooohhhh....I dunno about decompressing that chest, it might not be directly correlated to survival!"

"This Versed might cause RESPIRATORY DEPRESSION!"

"Hey, can I just run the Lifepack in AED mode? I'm afraid I might manually defibrillate inappropriately."

 

[Doczilla]

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.

This is the last I'm going to contribute to this banter; at 6:28-6:32, the entire thing is wrapped up (smugly, by the way) with the questionas to why ALS is used so "widely" when it's demonstrated (in this very specific topic) to possibly have no positive effect, or a deleterious effect on outcomes.

The problem that I have with this notion is the undertone it comes with, and what people glean from it. I mean, look at the original post. Poor guy essentially labeled himself as the grim reaper.

Sure, most people don't/won't do that, but my stance on taking studies and drawing concrete (or highly suggestive) conclusions is this: there's always two sides to the research.

For a few years now, my system has been pushing aggressive resuscitation for cardiac arrest on scene, using the pit crew model more recently. The mantra is, "give them the best 10 minutes of your life". The rationale is (aside from special situations like trauma etc) is that

A: the BLS/ACLS provided on scene is (read: should be) as proficient as what the ED is going to provide for salvageable patients, and is certainly higher quality than the sub-optimal conditions of the back of the truck. Anyone ever seen someone riding the undercarriage of the stretcher doing "CPR" on the way into the E.D? In a vacuum, rushing to get out of there (as in, without scene or other considerations) sacrifices the quality of effective, uninterrupted chest compressions.

B: Patients who are ROSCed on scene should receive consistent, high quality post arrest care (see: pit crew ROSC checklist) and transported to a PCI facility if a cardiac etiology is suspected as the underlying cause. That way, they're stable enough to be packaged and transported, and they get the life-saving PCI they need to improve outcomes.

Yeah, yeah. We get it. Scoop and run trumps stay and play in many situations. What I'm driving at however, is it isn't as black and white as a few studies point to.

Some people live no matter what we do for them, and some people die no matter what we do for them.

Pointing out how intubation in cardiac arrest (that train has left the station for most by the way) and drugs don't help people who are essentially doomed to begin with is like pointing out that band aids don't affect outcomes in cardiothoracic trauma. These people live or die based on their downtime, comorbid factors, and the timely implementation of doing the right thing at the right time.

I just feel like this video is very "fox news" when it comes to a subject that should be approached without bias. And before you spout the rhetoric about the stringent processes these studies go through, it's not the studies that I'm opposed to (there's plenty of data suporting the model i outlined). It's the way this dude is spinning them.

 

[RocketMedic]

....not to mention the entire caveat that ALS care exists precisely to keep patients from deteriorating to the point of cardiac arrest...

 

[Alan L Serve]

That's completely idiotic, but let me know how it works out, especially for your asthmatics, your N/V/D, traumatic injuries and AMI patients.

"Sorry, that albuterol might not be what you need."

"Ooohhhh....I dunno about decompressing that chest, it might not be directly correlated to survival!"

"This Versed might cause RESPIRATORY DEPRESSION!"

"Hey, can I just run the Lifepack in AED mode? I'm afraid I might manually defibrillate inappropriately."

Read my previous post where I say I would not withhold ALS interventions from people struggling to breathe or in pain but rather would have a chat with my PMD about medical and trauma arrests.

I will treat you and your opinions with respect. Please do the same for me and never refer to what I say as "idiotic"

 

[RocketMedic]

Read my previous post where I say I would not withhold ALS interventions from people struggling to breathe or in pain but rather would have a chat with my PMD about medical and trauma arrests.

I will treat you and your opinions with respect. Please do the same for me and never refer to what I say as "idiotic"

No, I will not pay dumb suggestions the courtesy that you request, because they are just that. Frankly, I don't care about your opinions or your feelings- what you are promoting is poor medicine, it's unprofessional, and it's negligent. And if you really do feel and practice this way, I don't respect you as a fellow paramedic, because you suck at your job.

It's one thing to debate the efficacy, effectiveness, quality and outcome of our care and specific portions thereof; it's how we improve it. It's entirely another thing to ignore the entire toolkit that we have because you're afraid that it's not perfect.

You claim that you'll never withhold other ALS treatment, and yet you're afraid of some of the most important treatments that we offer. Are you afraid of benzodiazepines and opiates too? What about cardioversion? That's pretty risky, are you willing to do it?

 

[Doczilla]

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.

Yeah, mr. Rocketmedic was a little abrasive. You can blame the Army for that. I doubt it's anything personal though, no need for the passive agressiveness, man.

While we're on the topic of passive aggressiveness though, did you not study those same text books while you were in school? Sure, some of us (hopefully most) spread our wings, and seek more knowledge from "meatier" texts, and you have no way of knowing who did/didn't.

I'll crack open The Pharmacological Basis of Therapeutics when I want to know why coke differs in its affects to other sodium channel blockers. It's all supplimentary, and in no way sets two medics apart from a practical standpoint.

I get it that you don't like having words put in your mouth. No one does. Perhaps a way to rectify that is to contribute more to the discussion than sniping people's comments. It comes off a little smug.

 

[Doczilla]

You need not be abrasive or uncivil.

Here, I'll attempt to translate for you.

You're in critical care, no? CCEMT-P is a very intensive endeavor, which most medics gave to spend months preparing for. You've undoubtedly spent a lot of time studying, practicing, and refining the foundation that you started with. It's a pretty high acuity world.

That being said, you need to lean on that foundation like a rock. You're going to need to advocate for the well-being of your patients, sometimes against the judgement of peers, nurses, PAs, and M.Ds. it happens all the time out here. You simply can't be swayed by something as simple as a video that takes something we already know, and attaches a strong bias to it.

Agree or disagree with this dude in the video, you need to be able to sift through the dregs of the internet, the trendy "flavor of the month" stuff, and the general bullsh1t thats gonna be stuffed down your gullet. Use that noodle that got you this far: is BLSing every patient really the answer?

Cmon man, you're better than that.

 

[Chimpie]

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DO NOT reopen this topic in another thread.