Bad news for those finally jumping on the Evidence Based bandwagon, most of the things you love about EMS are going out the door.
Don't get me wrong, I'm new on this Evidence Based roller coaster, but we used to call it common sense. How can EMS take ourselves seriously when we demand research for a new toy while defending high dose Epi and backboards aswitchcraft Standard of Care? If something works once it does not guarantee a repeat occurrence. Ask any married man with kids.
Where was I. Ah yes...
Things you have to give up if you truly are "Evidence Based":
Lights and sirens
Backboards
Refusal forms
Amiodarone
Epinepherine 1:10,000
Dopamine
Most of the rest of your drugs except benadryl, albuterol, epi 1:1000, Adenosine and Dextrose
ET tubes
Combitubes
Automatic CPR devices
ACLS recertification
PALS recertification
National Registry
Attitude
ED triage
System Status Management
UhU
The pre-packaged occlusive dressing
MAST (oh, wait...I forgot, are we in a 10 year MAST is good or 10 year MAST is bad time period)
The idea that transporting is the solution
Fee for service
Community Paramedicine (They're calling it Mobile Integrated Healthcare now...you know...to make sure the word Paramedic isn't in there and so nurses can do it and bill more)
The idea that "seconds count" (See no more lights and sirens)
The idea that putting a cardiac monitor on a trauma patient does anything at all (Thanks Ambulance Chaser for the reminder)
The idea that CQI is out to get you (Maybe yours is, but I'm not. Unless you fracked up, then it's on like Donkey Kong)
The idea that your manager was promoted for no reason but when you get the gig it's earned.
The concept that being more like Seattle will save more lives
The idea that a new Medical Director, Chief, Manager or boss will change things for the better
The idea that you are too good for where you are
The idea that EMTs save paramedics
"BLS before ALS saves lives"
The idea that making anything that is red and costs over $200,000 ALS will save lives
The idea that thinking only ambulances can help people
Need I go on?
Don't get me wrong, I'm new on this Evidence Based roller coaster, but we used to call it common sense. How can EMS take ourselves seriously when we demand research for a new toy while defending high dose Epi and backboards as
Where was I. Ah yes...
Things you have to give up if you truly are "Evidence Based":
Lights and sirens
Backboards
Refusal forms
Amiodarone
Epinepherine 1:10,000
Dopamine
Most of the rest of your drugs except benadryl, albuterol, epi 1:1000, Adenosine and Dextrose
ET tubes
Combitubes
Automatic CPR devices
ACLS recertification
PALS recertification
National Registry
Attitude
ED triage
System Status Management
UhU
The pre-packaged occlusive dressing
MAST (oh, wait...I forgot, are we in a 10 year MAST is good or 10 year MAST is bad time period)
The idea that transporting is the solution
Fee for service
Community Paramedicine (They're calling it Mobile Integrated Healthcare now...you know...to make sure the word Paramedic isn't in there and so nurses can do it and bill more)
The idea that "seconds count" (See no more lights and sirens)
The idea that putting a cardiac monitor on a trauma patient does anything at all (Thanks Ambulance Chaser for the reminder)
The idea that CQI is out to get you (Maybe yours is, but I'm not. Unless you fracked up, then it's on like Donkey Kong)
The idea that your manager was promoted for no reason but when you get the gig it's earned.
The concept that being more like Seattle will save more lives
The idea that a new Medical Director, Chief, Manager or boss will change things for the better
The idea that you are too good for where you are
The idea that EMTs save paramedics
"BLS before ALS saves lives"
The idea that making anything that is red and costs over $200,000 ALS will save lives
The idea that thinking only ambulances can help people
Need I go on?
Comments
This is one of my favs too "The idea that your manager was promoted for no reason but when you get the gig it’s earned"
So true and I mentioned that point on a recent podcast.
I think I'm ready to give it all up, except for Fee for service.
My comment above was meant to be more of a wisecrack than anything else, but I think there is an important point here, too. Evidence-based EMS doesn't necessarily mean tossing out everything we're presently doing until high-quality research is done: when the studies haven't been done, or when the evidence is here-to-fore mixed. If we did that, we'd be more-or-less paralyzed, because there's just not enough research out there yet on most of what we do. We'd have to do things like stop using BVMs on patients who are in respiratory arrest.(1) We don't have to let our apneic patients turn blue for lack of bag-mask ventilations, because in the absence of good evidence for or against an intervention the expert consensus still counts.
Don't get me wrong, I'm a true believer in evidence-based EMS, but I think as a profession we're still treating it as more of a buzzword than anything else. We talk about being evidence based and still keep on doing things that we have fairly strong evidence to show we're harming patients with, like blowing high-flow oxygen at basically everybody who looks vaguely uncomfortable.(2)
Jason Merrill
1. See the Canadian PEP Database's evidence based review of BVMs at https://emspep.cdha.nshealth.ca/LOE.aspx?VProtStr=Alternative%20Rescue%20Airway%20Management&VProtID=225#BVM
2. See a fairly comprehensive review article in Respiratory Care, http://www.ncbi.nlm.nih.gov/pubmed/23271821
I was wondering if you could expand on this, I don't quite understand why you wouldn't monitor a trauma patient, or any seriously unwell patient
Tj
@meditude
1. Berk WA. ECG findings in nonpenetrating chest trauma: a review. J Emerg Med. 1987 Jun;5(3):209–15.
2. Guner SI, Oncu MR. Evaluation of crush syndrome patients with extremity injuries in the 2011 Van Earthquake in Turkey. J Clin Nurs. 2014 Jan;23(1-2):243–9.
3. Drew BJ, Califf RM, Funk M, Kaufman ES, Krucoff MW, Laks MM, et al. Practice Standards for Electrocardiographic Monitoring in Hospital Settings An American Heart Association Scientific Statement From the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: Endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses. Circulation. 2004 Oct 26;110(17):2721–46.
I may have missed some irony in this post! Is this a serious list of stuff we shouldn't be doing or a nod at the fact we need more out of hospital research to expand our evidence base?!
Tj
@meditude