I typed this up as a reply to the ACLS algorythm and drug thread, but after looking it over felt it deserved it's own thread.
It poses no questions, it is more of a statement, but use it how you will.
I think that the major problems with resuscitative science are:
We keep constantly trying to refine what we are doing. Which implies that it does work and therefore just needs to be tweaked a little each time. Which is why some practices that never seem to show benefit despite decades and $ millions if not billions, keep getting wasted on (let me be generous) research.
The fact is, when some of these ideas and concepts were thought up, whole branches of science like molecular biology either didn't exist or were in their infancy.
The treatments were based on expert opinion, because that's all there was. The research is not validating much of it. (no, I am not going to try to link every research article or study I have ever read about it, have some initiative.)
However, like most things that plague EMS treatments today, the expert opinion of yesterday is all but carved in stone, and therefore has been repeated so much it is accepted as fact.
But today's experts who have infinately more understanding and resources are either
a. discounted becase "expert opinion is the lowest form of research." True, it is not very good research or evidence, but it is not given enough weight.
b.There exists the demand to prove beyond all doubt through "research" which ethically and legally cannot be performed theories formed with today's understanding.
So in essence the expert of yesterday has become all powerful when today's experts are all but ignored.
Another problem is that the most educated and experienced resuscitation experts at least in the US, rarely have any contact, much less input on EMS practices or procedures.
Part of it is drawing lines in the sand, but let's face it, the anesthesia intensivists resuscitate more people way more often than EMs do, simply because of the volume of those who need resuscitation in both surgery and the ICU.
I am not picking on EM or anyone else, but the barriers from all sides have to come down if there is going to be progress. All of the Anesthesia docs I know actually ridicule my interest in EMS, and tell me to quit wasting my time. EM needs to realize they do need input from people outside EM. It is almost as bad as field providers telling hospital staff they don't know what it is like outside, as if the science changes. But in fairness, Anesthesia also needs to release some of the tools and procedures they hold as exclusive which interferes with the advancement of resuscitation elsewhere. (like in an ambulance)
If we are to dismiss today's experts as unproven, then we must also dismiss yesterday's experts equally. It seems like there is a barrier to progress we have erected and continue to defend.
When you are in trouble, and your life on the line, to save it, it may take the smartest person you can summon.
In all likelyhood it logistically cannot be a physician. So in order to have people like paramedics fill in, they are going to have to become true experts in the art and science of resuscitative medicine.
Simply knowing the procedures and a basic algorythm isn't going to do. Simpliefied concepts will not work either.
In order to be successful and not just a "feel good" service because they try, EMS providers are going to have to stop clinging to partial understanding. Especially the parts they themselves determine to be important. (As if they know)
They are going to have to learn things like molecular biology, biochemistry, cell biology, etc.
Now I know some say that those mean little in the realtime world. I call BS. I have been taught to use that in my decisions. I do use that in every medical decision I make everyday. If it can be taught to me it can be taught to others.
Here is something interesting to ponder:
The original EMS providers were taught specifically by physicians. There were considerably more demands on them. There was more material covered and more proficency required.
It wasn't until EMS started "training it's trainers" that the downhill slide began. It has evolved into the largely unknowing, teaching those who know nothing.
Well, the educational thread has been beaten to death. So here it is.
The very booklist you need to start becoming a real expert of resuscitative medicine. Forget those nursing manuals, and EMS guides that "boil it down."
Here is what you need, it is applicable to every patient you see. If you don't understand how, the fault is yours, not the material.
Biology, Raven
General chemistry, Hill
Organic Chemistry, Wade
Molecular Biology of the Cell, Alberts
Biochemistry, Garret and Grisham
Physiology, Guyton
Robins Pathological Basis of Disease, Kumar
The developing Human, Moore
Fundamantal Neuroscience, Oswald
Pharmacological basis of theraputics, Goodman and Gillman
Principles of Internal Medicine, Harrison (as if there was another)
(for the ped's folks add Textbook of Pediatrics, Nelson)
Miller's Anesthesia, Miller
(no this is not the booklist required for my degree, infact it is only about 1/2)
But if you truly want to join the major leagues of resuscitation instead of the little league of algorythms and studies, this is in my opinion, where you need to start. The only thing stopping you is your efforts. (and of course your wallet)
It poses no questions, it is more of a statement, but use it how you will.
I think that the major problems with resuscitative science are:
We keep constantly trying to refine what we are doing. Which implies that it does work and therefore just needs to be tweaked a little each time. Which is why some practices that never seem to show benefit despite decades and $ millions if not billions, keep getting wasted on (let me be generous) research.
The fact is, when some of these ideas and concepts were thought up, whole branches of science like molecular biology either didn't exist or were in their infancy.
The treatments were based on expert opinion, because that's all there was. The research is not validating much of it. (no, I am not going to try to link every research article or study I have ever read about it, have some initiative.)
However, like most things that plague EMS treatments today, the expert opinion of yesterday is all but carved in stone, and therefore has been repeated so much it is accepted as fact.
But today's experts who have infinately more understanding and resources are either
a. discounted becase "expert opinion is the lowest form of research." True, it is not very good research or evidence, but it is not given enough weight.
b.There exists the demand to prove beyond all doubt through "research" which ethically and legally cannot be performed theories formed with today's understanding.
So in essence the expert of yesterday has become all powerful when today's experts are all but ignored.
Another problem is that the most educated and experienced resuscitation experts at least in the US, rarely have any contact, much less input on EMS practices or procedures.
Part of it is drawing lines in the sand, but let's face it, the anesthesia intensivists resuscitate more people way more often than EMs do, simply because of the volume of those who need resuscitation in both surgery and the ICU.
I am not picking on EM or anyone else, but the barriers from all sides have to come down if there is going to be progress. All of the Anesthesia docs I know actually ridicule my interest in EMS, and tell me to quit wasting my time. EM needs to realize they do need input from people outside EM. It is almost as bad as field providers telling hospital staff they don't know what it is like outside, as if the science changes. But in fairness, Anesthesia also needs to release some of the tools and procedures they hold as exclusive which interferes with the advancement of resuscitation elsewhere. (like in an ambulance)
If we are to dismiss today's experts as unproven, then we must also dismiss yesterday's experts equally. It seems like there is a barrier to progress we have erected and continue to defend.
When you are in trouble, and your life on the line, to save it, it may take the smartest person you can summon.
In all likelyhood it logistically cannot be a physician. So in order to have people like paramedics fill in, they are going to have to become true experts in the art and science of resuscitative medicine.
Simply knowing the procedures and a basic algorythm isn't going to do. Simpliefied concepts will not work either.
In order to be successful and not just a "feel good" service because they try, EMS providers are going to have to stop clinging to partial understanding. Especially the parts they themselves determine to be important. (As if they know)
They are going to have to learn things like molecular biology, biochemistry, cell biology, etc.
Now I know some say that those mean little in the realtime world. I call BS. I have been taught to use that in my decisions. I do use that in every medical decision I make everyday. If it can be taught to me it can be taught to others.
Here is something interesting to ponder:
The original EMS providers were taught specifically by physicians. There were considerably more demands on them. There was more material covered and more proficency required.
It wasn't until EMS started "training it's trainers" that the downhill slide began. It has evolved into the largely unknowing, teaching those who know nothing.
Well, the educational thread has been beaten to death. So here it is.
The very booklist you need to start becoming a real expert of resuscitative medicine. Forget those nursing manuals, and EMS guides that "boil it down."
Here is what you need, it is applicable to every patient you see. If you don't understand how, the fault is yours, not the material.
Biology, Raven
General chemistry, Hill
Organic Chemistry, Wade
Molecular Biology of the Cell, Alberts
Biochemistry, Garret and Grisham
Physiology, Guyton
Robins Pathological Basis of Disease, Kumar
The developing Human, Moore
Fundamantal Neuroscience, Oswald
Pharmacological basis of theraputics, Goodman and Gillman
Principles of Internal Medicine, Harrison (as if there was another)
(for the ped's folks add Textbook of Pediatrics, Nelson)
Miller's Anesthesia, Miller
(no this is not the booklist required for my degree, infact it is only about 1/2)
But if you truly want to join the major leagues of resuscitation instead of the little league of algorythms and studies, this is in my opinion, where you need to start. The only thing stopping you is your efforts. (and of course your wallet)
h34r:
