and yet people haven't figured it out
You mean I am not Jesus Christ, raising people from the dead? What a let down. Somehow my ego will recover, but it will be difficult.
Sometimes I really think this kind of study is targeted at the providers who haven’t caught on yet. All it does is affirm what has been known in educated professional circles for ages.
Lights and sirens response and transport risks outweigh any benefit.
Measuring effectiveness by response time doesn’t correlate to outcome. Other than the general public, a bunch of dinosaurs running EMS agencies, and the occasional specialty NP that has to take time out to go on a transport, who could possibly think it would?
Think about it. Less than 8 minute response goal is going to do what for a cardiac arrest patient w/o bystander intervention? You are going to meet this outstanding goal 90% of the time? Even if you got there in 6 minutes… Best of luck in your efforts to raise somebody from the dead after 6+ minutes and get them out of the hospital to any place other than a vegetable garden.
Prehospital intubation isn’t showing outstanding success in improving outcomes where a OPA and a BVM would do? Another devastating blow… (pay no attention to the sarcasm)
Immobilization techniques not working? I guess all those posts I spent time typing pointing out basic anatomy characteristics of immobilization weren’t wasted?
“Life saving medications” (the people over in Naples, Florida may want to tune in here) doesn’t matter in cardiac arrest? The AHA has been saying for years they have no evidence it helps and an equal amount that it doesn’t hurt. In layman’s terms, “We can find it does anything one way or another.” In fewer words: “It couldn’t really matter.”
Trauma: This really burns me. EMS providers walk around with utterly stupid statements like “a trauma requires surgery.” What it requires is a trauma expert. (usually a surgeon, but not always EM often does a fine job) Even in surgery low grade liver and splenic lacs don’t automatically mean removal or surgical correction anymore. The very concept of “damage control surgery” is you are going to make some repairs to keep as much viable function as possible. If a patient is not in irreversible shock or has some other condition incompatible with life, chances are they will live to the hospital. There are even accounts of Roman Legion Soldiers in BC surviving open pneumos during battle and returning to fight after recovery. If the patient is in irreversible shock (think about that term) will the surgeon wave his/her magic wand and alter time to prior to that?
With the week spent on teaching paramedics to “load and go” and “we do nothing in trauma care” is it any wonder they don’t help any? Of course what they don’t tell you is that most of the trauma you read about in your paramedic text, and divine being forbid, EMT text is on the decline, and not even the norm most places. Most trauma is muscle skeletal in nature, of which compartment syndrome and myoglobinurea are the life threats. (the later a condition that massive fluid and furosimide actually helps with) Of course with the amount of trauma knowledge in EMS, who in their right mind would allow US EMS to make decisions like that?
I have also written at length here about a public health and prevention role of EMS. Apparently I don’t understand it is about saving lives and “real emergencies.” Even in the hospital most people in the “emergency department” are not. What makes EMS think their patient population would be different and still think they are a part of the same Emergency team?
In response to this article, I see a lot of the same old arguments about pain control, difficulty breathing, allergic reactions, etc. But here is the rub. The easiest way to bring somebody back from the dead is to prevent them from getting to a life threatening state. Those people don’t show up in morbidity studies.
Since our “patients are customers” some say. (which demonstrates the ignorance of modern medicine) Why don’t we ever base our value on what they think helps, or what might actually help instead of feeding them trash like response times? Makes us look like fools or self serving.
Since before I started, EMS has measured its effectiveness on its ability to raise people from the dead and stop time. Those are quite high benchmarks.
Something to think about: “If EMS prevents people from going to the hospital, the amount of people who EMS “helps” but don’t die in the hospital will go down. Maybe more realistic measures like lowering healthcare costs, time of return to function for patients, and a response and education to everyone who calls EMS rather than deciding to refuse people for not being a “true emergency” are much more attainable benchmarks?
Clearly undereducated providers tearing down the street to perform the same mindless treatments on every patient hoping the patient falls into the epidemiology those treatments are designed for doesn’t really “help.” (Analyze what you are doing, no international multicenter trial needed to figure it out. It is amazing what you can figure out thinking about something instead of beating your chest and promoting a big heart and good intentions.)
