the 100% directionless thread

usalsfyre said:
How exactly would prehospital specific data change things? The state of Maine has been applying NEXUS criteria for a decade without a huge outcome issue.

I've read the cited study. The data is pretty weak.
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If we are going to truly to become recognized as profession at not just understood in many circles as being an adjunct to medical care by self-regulated professionals, we need to develop our own body of research (and many other things). If your service has been using NEXUS for that long and it has been successful, it looks as if you have a useful retroactive study staring you in the face! I would love to see the evidence!

With respect....
 
ThirdCareerMedic said:
...we need to develop our own body of research (and many other things).
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Agreed, but at the same time there is no need to reinvent the wheel.

The issue, as I see it, is not whether or not the variables within NEXUS are valid, but if EMS can reliably apply it in a pre-hospital environment.
 
Jon said:
Problem is, it isn't universal. Some of us like iOS better.
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Since I'm typing this on a new 4th gen iPad, I'll rephrase to say that I wish a standard for spine clearance would be adopted. This way adaptations could be made in much the same way local EMS agencies can adapt state protocol to fit an area.
 
Guess who just got a job offer and is once again gainfully employed? I only had to spend about a month unemployed.
 
Someone kill me.

Sitting at my station in the lounge with a bunch of people trying to read my textbook and all I hear is them telling war stories of how good they are and how back in the day the service was so much better and EMTs were held to higher standards and blah blah blah.

If any one of them was standing on a 100' ledge I swear I would push em'.
 
Epi-do said:
Guess who just got a job offer and is once again gainfully employed? I only had to spend about a month unemployed.
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Congrats!
 
Good for you!
 
ThirdCareerMedic said:
Note that NEXUS and the CCS Rule are tools for physicians and there is no evidence-based research on their use in the pre-hospital setting as far as I know. However, that doesn't mean that we shouldn't promote the use good research in a closely related fields in our protocols. (Sounds like a "dah" but it is important to make explicit when advocating for change....)
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Of course the follow up question is "What patient needs c-spine precautions when a x-ray isn't indicated?"
 
JPINFV said:
Of course the follow up question is "What patient needs c-spine precautions when a x-ray isn't indicated?"
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Yep! That is the question, isn't it? LOL!

Think what is really needed is research that clearly shows the level of risks in clearing c-spine in the field using different tools (NEXUS, CCS Rule, etc.) vs immobilization in the field by medics and clearance by a physician in the ED. Immoblization has its own risks as well....

What do you think?
 
Saw this on Facebook took me a minute to figure it out.
ABBEAACC-AB0F-49E7-A8B6-E8C734FF9CD0-4111-0000029CC0F69587.jpg
 
ThirdCareerMedic said:
Yep! That is the question, isn't it? LOL!

Think what is really needed is research that clearly shows the level of risks in clearing c-spine in the field using different tools (NEXUS, CCS Rule, etc.) vs immobilization in the field by medics and clearance by a physician in the ED. Immoblization has its own risks as well....

What do you think?
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Why?
 
ThirdCareerMedic said:
Yep! That is the question, isn't it? LOL!

Think what is really needed is research that clearly shows the level of risks in clearing c-spine in the field using different tools (NEXUS, CCS Rule, etc.) vs immobilization in the field by medics and clearance by a physician in the ED. Immoblization has its own risks as well....

What do you think?
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Do physicians have magic fingers? It's not a drastically difficult assessment...
 
usalsfyre said:
Do physicians have magic fingers? It's not a drastically difficult assessment...
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Hey, I know that paramedics are just as capable of carrying out an assessment algorithm as a physician! I know some paramedics that are more reliable in their assessments than some doctors. We are a VERY capable bunch.

The issue is that since we all still work under the license of physicians (correct me if I am wrong in your case), their a**es are on the line. Some physicians are more enlightened and engaged (your medical director?) in the EMS system. I already know of some REAL sticks in the mud as far as medical director go.... Regardless, we are the ones who need to prove we can take on more skills as part of our scope of practice by producing evidence-based research. And, anyway, isn't doing research into our own practice key in moving paramedicine towards acceptance as a profession in its own right?

What do you think?
 
Luck enough to have a very involved OMD I work very closely with. I see your point, but you risk becoming like nursing who has constructed some poorly designed "studies" to validate parts of their practice that were unlikely to change.

Those medical directors are unlikely to change even when presented with good evidence unfortunately...
 
FDNY has been doing medical evaluations on all EMS promotion to firefighter candidates and has thus far had a 75% failure rate. Primarily due to excessive heartrate on the stairmaster.

The physical fitness standards of EMS never cease to amaze.

Brb eating McDonalds and a giant regular coke every meal and expecting to be a firefighter.
 
NYMedic828 said:
FDNY has been doing medical evaluations on all EMS promotion to firefighter candidates and has thus far had a 75% failure rate. Primarily due to excessive heartrate on the stairmaster.

The physical fitness standards of EMS never cease to amaze.

Brb eating McDonalds and a giant regular coke every meal and expecting to be a firefighter.
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On the other hand, I imagine it's much easier to stay healthy when running a fraction of the runs out of a station with a gym instead of posting on a street corner.
 
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