EMS might be a detriment to surviving trauma

[tniuqs]

Nice Ride =D>

[AnthonyM83]

Just so we're clear, the OPALS study being criticized is different from the one I posted above.

That's the one you guys are criticizing, right, the OPALS?

The one I posted accounts for similar severity indexes and several other similar factors. It's not simply that less life-threatening traumas are more likely to go by private vehicle. The article might cause homies to rush to the hospital, but 1) Homies usually aren't too educated and 2) You can't stop research like this just for fear of that. It can lean to pinpointing what needs to be done to change it to decrease the ambulance transport death rate. It's a great study...and like all studies need follow-up studies.

[JPINFV]

We didn't go wrong at all!

Scenario #3:

*Headline News*

Homeboy shot in a drug deal gone wrong is Rushed to Hospital by Homies.

Kills an Entirely Family of 5, in Intersection Collision.

Investgators file lawsuit for "stupidity" for publishers and researchers of a Study that "Driver" homeboy reads in magazine.

Do you think that all studies are well researched....this study proves the point that some studies are simply a waste of breath.

Because, you know, ambulances transporting code 3 never get in any accidents. Nope, never. Unheard of. At least homeboy's homies probably aren't driving a heavy converted van AND the provider/local government isn't going to get sued when they get in an accident. Ambulance with any sort of government employee on board [cough fire based EMS] will.

[AnthonyM83]

We didn't go wrong at all!

Scenario #3:

*Headline News*

Homeboy shot in a drug deal gone wrong is Rushed to Hospital by Homies.

Kills an Entirely Family of 5, in Intersection Collision.

Investgators file lawsuit for "stupidity" for publishers and researchers of a Study that "Driver" homeboy reads in magazine.

Do you think that all studies are well researched....this study proves the point that some studies are simply a waste of breath.

How exactly does it prove that? Explain the flaws with this study?

[tniuqs]

Ok stop the insanity, just quote the parts you are wishing to debate...I am getting dizzy!

JPINFV

Because, you know, ambulances transporting code 3 never get in any accidents. Nope, never. Unheard of. At least homeboy's homies probably aren't driving a heavy converted van AND the provider/local government isn't going to get sued when they get in an accident. Ambulance with any sort of government employee on board [cough fire based EMS] will.

So your point is what then? Solve the problem with a new improved homeboy/fire/government/driver?

Please read Rids comments again, they do make good sence, your's are without any clearity unless your headed down the fire based service crap AGAIN.

AnthonyM83: I don't fear good research I fear bad research, and penny pincing polititians that twist the values.

The Opals Study I was responding too was due to AZCEP comment it was another "out of hospital arrest survival rates study" done in Ontario, it basically boils down to "in an arrest situation" the TIME to recieve ALS care is a determining factor, a system of Advanced Life Support System it should not be judged on this criteria alone, and I think very well stated by the author.

cheers

[Ridryder 911]

Just because the numbers and outcome base adds up to quantity does make one a good study. Please refer to L.A. political underlying problems of keeping and maintaining Level I trauma services. The proportion of the number of Level I closings in the past ten years is astronomical, as well as the abuse of EMS units in L.A.

I did not see where in the study of identifying factors of why EMS transport caused death or why p.o.v. transport increased survival. The main emphasis of the outcome of the study is non directional, so really this is a poor study when they addressed a outcome change without addressing the reason and etiology of such. You just have a poor quantitative study. When you have identifying markers or make such claims, one needs to investigate the reasons and the etiology, not just the outcome numbers. As well review the numbers and make up...

....RESULTS: The two groups were similar with regard to mechanism of injury and the need for surgery or intensive care unit admission. The crude mortality rate was 9.3% in the EMS group and 4.0% in the non-EMS group (relative risk, 2.32; P < .001). After adjustment for ISS, the relative risk was 1.60 (P = .002). Subgroup analysis showed that among patients with ISS greater than 15, those in the EMS group had a mortality rate twice that of those in the non-EMS group (28.8% vs 14.1%). After controlling for confounding factors, the adjusted mortality among patients with ISS greater than 15 was 28.2% for the EMS group and 17.9% for the non-EMS group (P < .001

Now, one has to read that the ISS was almost 10% more than the non-EMS group. No mention of appropriate triage occurred, or if there was a delay in care at either markers. Was there peak and slow times included in the variables ? As well as turn around time at the TC ? Was the severity of type of wounds was the cause of change in the outcomes even though the ISS was near the same? (i.e. penetrating trauma versus blunt ?) this makes a substantial difference.

Was the decrease in outcome from delay in transport, what was the average transport times(s) of patients ? Was these patients in same region or was the patients in all the same local and region or was there a close proximity of the TC when transported per POV ? Again, the study was poor in addressing any specifics of location(s) of the patient and variables of location. Time of notification from incident to transport time variables. If one is really going to adress and claim that delay caused an increase, one needs to be specific that the patients were from same regional locations as well.

Again the conclusion was not clear nor any recommendations were addressed, which means this was a an initial or preliminary study. In real world terms means this was a study for political reasons to get more money for another study. This might be needed for accreditation purposes. (TC are required to publish research). This is part of the differential from level II and level I criteria according to American College of Surgeons (ACS). I did not see any outcome markers, except initial outcomes. Was the outcomes based on survival rate such as admissions to ICU, rehab or official dismissal ? It was not specific as well in identifying what their definitions as were as survivors.

In conclusion, I feel this was a very poor study. Read what is not said as well as much is said. What was the initial hypothesis, the study and involvement of patient locations and service area regions. It is too late for me to see figure if the numbers are skewed (sorry, I do not always trust their statistician). As well as is there a hidden agenda (if any) to make study a biased one ? (yes, it happens) Unless we see a follow up within two or three years, we can concur this was a "needed academic study".

Be sure to ask to read more into a study than taking a study at face value. I worked in Trauma Studies for 3 years and I know how studies and numbers can be manipulated, dependent on what they want the outcome to be. Even those with the "most respected, scientific"publications. As the final statement described .."Large prospective studies are needed to identify the factors responsible for this difference...Which means they need more funding for another study.. hopefully they will identify factors and be more specific on their findings.

R/r 911

[AnthonyM83]

I did not see where in the study of identifying factors of why EMS transport caused death or why p.o.v. transport increased survival. The main emphasis of the outcome of the study is non directional, so really this is a poor study when they addressed a outcome change without addressing the reason and etiology of such. You just have a poor quantitative study. When you have identifying markers or make such claims, one needs to investigate the reasons and the etiology, not just the outcome numbers. As well review the numbers and make up...

Okay, gotta run b/c I have work, but must remind you that this is how science works. You take baby steps. You have to show there's a disparity between ambulance and private transport FIRST, then you can get into the why's and how's which can be a huge undertaking. We don't know the limits to time/resources they had.

[p3medic]

I don't work in LA, but every piece of footage i've ever watched of them on calls shows them doing everything on scene, engine company starts lines, drops tube, packages pt....eventually an ambulance shows up, and when they are done playing, they send the pt off.....thats another of those every medic on every corner type of system...works real well i see.....

[Ridryder 911]

Okay, gotta run b/c I have work, but must remind you that this is how science works. You take baby steps. You have to show there's a disparity between ambulance and private transport FIRST, then you can get into the why's and how's which can be a huge undertaking. We don't know the limits to time/resources they had.

Anthony, you don't have to remind me of what studies consist of like I stated I worked in trauma research and development as a profession for over three years. I am a big proponent of scientific studies. Then I can say ." I have seen the good, the bad and the ugly" I do read more studies than most, and I as well can tell those followed scientific methods and those that were published just to be published. It happens in the world of academia and medicine that is why a thorough understanding on how to read a study is important.

I have seen great research that was shot down because the end result was not what the powers to be wanted, and as well seen half arse manipulated number crunching and poor controls be published and be praised as great works.

That is why there is always studies that contradict each other. Reading a study on face value without reading into it is foolish and not being very educated. Validity of any study is how well it can be scrutinized. Lack of funding, resources, poor controls and population is how studies are brushed off as having poor credibility.

Reading a study and having a knee jerk reflex off it is common in EMS and emergency medicine. Look at treatment regimes that immediately changed from the initial PASG study . When that study never displayed harm to patients rather it claimed no difference in outcomes; yet those whom even had education in how to read studies failed to read below the label of the study and recommendations. Fortunately, other studies that had better research tools and controls validated their intent. But it is scary on how many medical directors and states will change from one initial study, even albeit to be flawed.

This maybe the reason why there is so many medication(s) being recalled and later to found it to be detrimental to patients. Pushed and tainted studies with heavy hand from special interest influences. For example the medication Cordorone vs. Lidocaine is being pushed per ECC and AHA; although there has been no significant difference to be found as yet. Many describe that would never occur in such an organizations, all I can do is refer them to Bretylol. The same claims was made in the eighties and we see what the outcome was.

Many studies are very legitimate and follow close scientific methodologies, and I honor those that perform such. Unfortunately, there are as many poor ones that discredits and sometimes make bigger headlines.

Medical studies are essential for us to be able deliver the best care. For it is the best scientific method available. With that saying it is the responsibility of the reader not just to read a study but to check and have a understanding of multiple methods of the study before reaching a final opinion.

R/r 911

[northernmedic]

I don't think all trauma calls are necessarily created equal. Presumably the gangbanger study mostly focussed on patients with penetrating torso trauma due to GSW. I think there are lots of trauma patients where EMS can make a critical difference. What about the blunt chest trauma with a life threatening tension pneumo that is decompressed on the way to hospital? Head trauma with airway compromise? Prevention of hypoxemia in these patients prevents a dramatic increase in mortality. I think that P3 raises some excellent points however about load and go. I work in the inner city and we do lots of trauma and probably >90% of the patient management is solid BLS skills and minimizing the scene time as much as possible.

I did post previously on this topic with regard to the Canadian Multicenter Trauma study and the comparison between 3 types of prehospital systems with regard to trauma survival.