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On the Cult of Mechanism:

Rogue Medic weighs in with his opinion on evaluating vehicle intrusion as a predictor of injury, which was the subject of a recent episode of the excellent EMS Research Podcast. In his post, he states: 

"We want EMS to pay attention to the assessment of the actual patient, rather than the assessment of the possible cost of repair of the vehicle."

Word to your mutha, RM. In fact, I'm stealing that line. Next time one of my co-workers makes a silly decision based solely on what the vehicle looked like, I'm going to ask him, "Are you an EMT, or an auto insurance adjuster?"

I've opined before on the irrational degree of faith EMS places in mechanism of injury criteria. For some, it's a belief system bordering on culthood. MOI criteria were developed as a conceptual tool to give us an idea of where and what to assess, and a rough means of predicting what injuries may be present.

It is not the assessment itself.

The proper use of MOI is to guide assessment, not to dictate treatment and transport decisions.

Further in, Rogue Medic points out:

Why do we treat STEMIs (ST segment Elevation Myocardial Infarctions) with the opposite approach?

The dichotomy is that with trauma triage, we accept a 1,000% to 2,000% overtriage rate, while with STEMI triage, we consider a 5% overtriage rate to be unacceptably high.

The reason is because we're activating trauma centers based on what the car looked like, and we're doing STEMI alerts based on what the patient looked like.

While their pack/day cigarette habit, the number of cheeseburgers they routinely scarf down, and whether their daddy died of a heart attack may be pertinent history, we're activating the cath lab based on presentation.

We should be using the same approach to triage our trauma patients.

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