Punisher Posted June 9, 2006 Share Posted June 9, 2006 I'm not saying that it is not totally non-beneficial in all circumstances- I am staying that it is not working as well as we would like to believe. I think this is mainly a function of the way we approach educating and "thinning the herd" when it comes to ALS providers so we wind up with ineffective delivery of the needed interventions. Basically what we have now is a medical example of the idea that no how well you plan something, in the end, unless you keep the idiots away, things will wind up going wrong during the execution. Also you have to remember that I am not some disgruntled BLS provider. I'm an ALS provider myself, and also that I have yet to see anyone with EMT-B behind their name as an author of one of these studies. Link to comment Share on other sites More sharing options...
Ace844 Posted June 9, 2006 Share Posted June 9, 2006 Not at all, I dont really have an opinion on this. There is quite a bit of evidence in both directions on this. Too many to form an opinion. My thought is this. If prehospital ETI is being performed so poorly, and delaying door to door times, blah blah..... ....then why not increase requisite education exponentially to accomidate for the deficiencies? Seems like every study performed that shows a skill being lacking doesnt turn out to require further education being needed, they just want to take the skill away. Seems silly. Just like everyone thinks BLS education sucks, so they want to do away with BLS. Instead of increasing education exponentially to accomidate for the deficiencies....but thats for another thread.... "PRPG," I agree with you. But I will repaeat a statement which I made earlier in another thread. EMS is being forced by medicine to 'jump through study-efficacy hoops' which is interesting because the 'medical community' itself (i.e.: In Hospital) has yet to 'prove' it's own efficacy for most procedures yet we know they help patients and change outcomes anecdotally... SO Let's not have too many knee jerk reactions to 'the studies' doing so is detrimental and dangerous. Food for thought, ACE844 Link to comment Share on other sites More sharing options...
PRPGfirerescuetech Posted June 9, 2006 Share Posted June 9, 2006 "PRPG," I agree with you. But I will repaeat a statement which I made earlier in another thread. EMS is being forced by medicine to 'jump through study-efficacy hoops' which is interesting because the 'medical community' itself (i.e.: In Hospital) has yet to 'prove' it's own efficacy for most procedures yet we know they help patients and change outcomes anecdotally... SO Let's not have too many knee jerk reactions to 'the studies' doing so is detrimental and dangerous. Food for thought, ACE844 Medicine as a whole: Millions of years old EMS: Less than 100 years old Medical community as a whole is well past reevaluating skill based regiments in treatments and provider scopes of practice. Also, I wouldnt describe increasing education in accordance to reports of poor performance as a "knee jerk" reaction. Its responding appropriately to a issue at hand. Research defines medicine, and defines how decisions are made, so making an immediate decision based around recorded issues from medical research is nothing close to "Detrimental or dangerous". IMHO PRPG Link to comment Share on other sites More sharing options...
Ace844 Posted June 9, 2006 Share Posted June 9, 2006 Medicine as a whole: Millions of years old EMS: Less than 100 years old Medical community as a whole is well past reevaluating skill based regiments in treatments and provider scopes of practice. Also, I wouldnt describe increasing education in accordance to reports of poor performance as a "knee jerk" reaction. Its responding appropriately to a issue at hand. Research defines medicine, and defines how decisions are made, so making an immediate decision based around recorded issues from medical research is nothing close to "Detrimental or dangerous". IMHO PRPG "PRPG," I agreed with you about the education bit and the need for change. I have advocated for that here ad nauseaum, as you have. Next, medicine is indeed 'changing and evaluating it's practices'. Hence the advent of 'EVIDENCED BASED MEDICINE'! Next, as far as knee jerk reactions I seem to recall a similar instinacnce like what we are discussing here, The lidocaine vs Amiodarone debate and changes brought about based on some flawed studies. Just to name one example off the top of my head. So, YES, making a decision or changing established practices because of ONE study is very dangerous, ABSOLUTELY KNEE JERK, and Detrimental to the profession at large. This was a statement made generally not necessarily about the 'intubation' debate we are having. Food for thought, ACE844 Link to comment Share on other sites More sharing options...
ERDoc Posted June 9, 2006 Author Share Posted June 9, 2006 "PRPG," I agreed with you about the education bit and the need for change. I have advocated for that here ad nauseaum, as you have. Next, medicine is indeed 'changing and evaluating it's practices'. Hence the advent of 'EVIDENCED BASED MEDICINE'! Next, as far as knee jerk reactions I seem to recall a similar instinacnce like what we are discussing here, The lidocaine vs Amiodarone debate and changes brought about based on some flawed studies. Just to name one example off the top of my head. So, YES, making a decision or changing established practices because of ONE study is very dangerous, ABSOLUTELY KNEE JERK, and Detrimental to the profession at large. This was a statement made generally not necessarily about the 'intubation' debate we are having. Food for thought, ACE844 This would be true if it weren't for the fact that there are A LOT MORE than one paper. We recently had a journal club where we discussed this topic and there were three papers that showed prehospital intubation decreased survival in head trauma pts (and those are just the three that we reviewed). Take a look through pubmed, there are a lot more than one. Saying that this is a knee jerk reaction is a little off the mark. Link to comment Share on other sites More sharing options...
Ace844 Posted June 9, 2006 Share Posted June 9, 2006 This would be true if it weren't for the fact that there are A LOT MORE than one paper. We recently had a journal club where we discussed this topic and there were three papers that showed prehospital intubation decreased survival in head trauma pts (and those are just the three that we reviewed). Take a look through pubmed, there are a lot more than one. Saying that this is a knee jerk reaction is a little off the mark. "ERDoc," With all due respect I'd like to bring to your attention the sentance which follows the one you originally put in 'bold'. I have done the same so it is easier to see. Thanks for the info. Thanks, ACE Link to comment Share on other sites More sharing options...
ERDoc Posted June 9, 2006 Author Share Posted June 9, 2006 "ERDoc," With all due respect I'd like to bring to your attention the sentance which follows the one you originally put in 'bold'. I have done the same so it is easier to see. Thanks for the info. Thanks, ACE I humbly apologise. Link to comment Share on other sites More sharing options...
Ace844 Posted June 9, 2006 Share Posted June 9, 2006 I humbly apologise. No worries my friend. Although I am curious about something, do you have any links to data showing the efficacy of RSI and ETI in the ER? Just curious as I have only seen a few older studies. Thanks, ACE844 Link to comment Share on other sites More sharing options...
ERDoc Posted June 9, 2006 Author Share Posted June 9, 2006 No worries my friend. Although I am curious about something, do you have any links to data showing the efficacy of RSI and ETI in the ER? Just curious as I have only seen a few older studies. Thanks, ACE844 Check out pubmed and do a search, there is a wealth of info. There was also another thread here somewhere that I gave links to several studies. Link to comment Share on other sites More sharing options...
Ace844 Posted June 9, 2006 Share Posted June 9, 2006 Check out pubmed and do a search, there is a wealth of info. There was also another thread here somewhere that I gave links to several studies. Touche'...I am in the process of doing this and I regularly try to make a habit of searching on my own first. I was asking to see if you knew of any recent ones off the top of your head is all...since you mentioned you do the 'journal club thing' most probably for a residency program, I figured you may have something in mind. ACE Link to comment Share on other sites More sharing options...
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