Everything We Know Is Wrong

My brother-from-another-mother Gary Saffer and I do an EMS lecture called “Deconstructing EMS: Everything We Know Is Wrong,” in which we challenge some of the long held assumptions about Emergency Medical Services. Most of these assumptions have no basis in fact and indeed, most are disproven by scientific research.

During the Epic Hog Hunt of 2010, Alan, Matt G., Daniel, TOTWTYTR and I had a lively discussion centered on the theme that most conventional wisdom is ill-informed, if not downright incorrect, and how most people hate to have their assumptions challenged.

Medical professionals are not immune to the phenomenon. Some of our practices in EMS are accepted by our peers as articles of faith, even when very little evidence supports it, and a growing mountain of scientific study disproves it.

Like the idea that paramedics save lives.

Or spinal immobilization is proven beneficial.

Or helicopters are the ultimate means of EMS transport.

Or that supplemental oxygen might actually be harmful for some people.

Or that endotracheal intubation is the Gold Standard of airway management.

Or that recently deceased people need chest compressions and breathing to be successfully resuscitated.

That last one confounds me no end. I have plenty of colleagues in EMS that steadfastly refuse to accept the fact that artificial ventilation in cardiac arrest does not improve outcomes, it in fact worsens them. Yet still they rationalize all sorts of reasons to keep stopping chest compressions to breathe for the patient, or invent excuses to intubate a patient based on little more than habit and organizational inertia.

This is not some wild idea masquerading as fact, this is proven science. What we were taught 10 and 15 years ago was the wild idea masquerading as fact.

In the past 3 years, I’ve had more successful resuscitations (people who walked out of the hospital alive) than I’ve had in the 14 previous, once I accepted the fact that a) breathing ain’t all that important once you’re dead, and b) we only take an arrest victim to the hospital if they’re no longer in arrest. And the research supports my n=1 experential anecdote.

If you still doubt that artificial ventilation in cardiac arrest is unnecessary, or if the stultifyingly boring video in CPR class left you snoring gently before you could absorb that lesson, I have it in layman’s terms for you on Alan’s blog.

You’re welcome.