Are you ready for Evidence Based EMS?

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 as witchcraft 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?

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9 thoughts on “Are you ready for Evidence Based EMS?”

  1. Love the MAST pants line. I have been that same thing when I heard the news of it coming back.

    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.

    1. No, that’s the whole point. Most of what we do has no evidence to support it. Especially everything on that list. AS to the refusal form comment, some in EMS see it as the most dangerous chart they’ll ever write when, in actuality, it is the simplest. Thanks for reading!

      1. Hi, Justin,

        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

  2. “The idea that putting a cardiac monitor on a trauma patient does anything at all (Thanks Ambulance Chaser for the reminder)”

    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. There is extensive evidence for significant ECG findings in nonpenetrating chest trauma.(1) The evidence for ECGs in other traumatic injuries is less extensive, but even extremity trauma can cause conditions associated with signficiant ECG changes.(2) While the standard boilerplate warning about expert-body guidelines being voodoo applies, the guidelines in this case are getting stale, and in this care are based more on expert opinion than anything else, the current AHA recommendations for in-hospital care of serious trauma patients stipulate ECG monitoring.(3)

      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.

      1. Hi,

        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

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