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For You EMS Types, a Teaser for 2013

My writing partner Gene Gandy and I are planning a new series of monthly articles in EMS World Magazine.

Each month, Gene and I are going to take on a particular piece of EMS dogma, myth or obsolete clinical practice, and subject it to the withering scrutiny of current research.

We're still working on the series title, and we're compiling a list of topics now.

That's where you guys come in.

What EMS practices do you think belong in the dustbin of history, next to the discarded Chokesavers, rotating tourniquets and PASG? What is the prophylactic lidocaine, sublingual Procardia or coma cocktail of today? What dogma do you see perpetuated even now, despite all evidence to the contrary?

WHAT PRECIOUSLY HELD SUPERSTITION, MYTH, CLINCIAL OR ADMINISTRATIVE PRACTICE, OR EMS URBAN LEGEND SHALL WE SLAUGHTER FOR YOU, DISMEMBER, AND FESTOON OUR BEDCHAMBERS WITH ITS BLOODY ENTRAILS?

All you have to do is, um, you know, chime in with your comments.

We'll get right on it.

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Comments - Add Yours

  • Can’t say, clowns will eat me

    How about you team with the rogue medic?

  • http://www.facebook.com/people/Jennifer-Reed-Mitch/1542200064 Jennifer Reed Mitch

    I’m not sure this is what you’re looking for Kelly, but would really like it if the powers that be would make up their minds about the most effective way to perform CPR. It has changed a few times in the past few years. Or, honest and true ways to contract AIDs or other communicable diseases. You would believe the stuff I hear. Did you know you can pregnant from a public toilet seat? LOL

    • Ambulance_Driver

      Well, the CPR stuff *is* based on science, and the trend has been steadily in one direction: uninterrupted chest compressions.
      The reason it has been all over the map is not because they can’t decide how to do it or because the science is conflicting, but because they make changes piecemeal instead of just throwing out everything that isn’t proven to work.
      Ineffective and unproven treatments persist even in today’s standards, simply because that’s the way we’ve always done them.

      • http://www.facebook.com/Jamunjio Greg Gilbert

        While working in the ED, when ever compressions were performed, it was non stop. The pt. would be ventilated between the compressions.

  • Can’t say, clowns will eat me

    How about back boarding all shooting victims?

    • Can’t say, clowns will eat me

      I just haven’t found any science to say because they’ve been shot they need a backboard. Have you?

      • Ambulance_Driver

        The science says that they’re more likely to die when backboarded.

        Kelly Grayson

    • http://about.me/gwalter gwalter

      I did not BB my first shooting pt, 30 years ago – turns out he had a slug lodged in C-6. Oops. Still, that is mere anecdotal and it deems research.

  • John Dale

    Not a current piece of dogma but something I was taught in the 70′s that seems to have gone out of fashion and perhaps should be brought back??? – The Hand Shake? Not sure any paramedics or EMT’s shake hands with their patients? Besides the physiological issue of friendly hand to hand contact, what about the information it conveys – heat, tremor, roughness, grip etc?

    • Ambulance_Driver

      I introduce myself and shake hands with all my patients for exactly those reasons.
      Plus, it’s just polite.

      • Dave

        Ewww! How many times a year do you catch cold? ;-)

        • Ambulance_Driver

          Rarely.

          I wash my hands, wear gloves, and don’t touch my mouth with unwashed hands.
          Plus, my immune system is robust enough that it attacks squirrels in the back yard.

    • http://www.facebook.com/Jamunjio Greg Gilbert

      I never thought of that. They never taught that when I was in EMT school, but it makes total sense. I have held pts’ hands though for comfort for a scary scenario. Thanks for the tip.

  • http://twitter.com/samuelkordik Samuel Kordik

    How about backboarding? Or maybe the indiscriminate use of oxygen. Or the hesitation to use pain management, especially for abdominal pain.

    Shoot—you could just address our industry’s unwillingness to follow evidence-based medicine…surely there is some evidence about that.

    • Ambulance_Driver

      Funny you should mention that. Pain relief for abdominal pain patients is the first dragon we plan to slay.

    • http://www.facebook.com/profile.php?id=100000068518248 Christine Dumaine Springfield

      Thanks, partner! ESPECIALLY the pain management thing!

  • Guest

    How about the “high-flow oxygen is good for everyone” mentality as placed side by side with the new research on the oxygen’s vasoconstrictive effect and the end result on CPP

  • http://twitter.com/OmniMedix OmniMedic Solutions

    How about the “high-flow oxygen is good for everyone” mentality as placed side by side with the new research on oxygen’s vasoconstrictive effect and the end result on CPP

  • Medic_erer

    How about you talk about the pros and cons of 24 hour shifts and why companies and responders both don’t want to let them go.

    • http://about.me/gwalter gwalter

      It isn’t 24 hr shifts, it is UHUs that need evaluating. When I worked in a suburban FD, the 24 hr shifts were great – working in a urban ambulance setting, even 12 hr shifts are too much.

  • John S

    Call the column ‘You did WHAT?!’

  • http://www.romduckworth.com/ Rommie Duckworth

    Rotating Tourniquets for CHF. Or am I the only one who still does that?

    Kidding of course, but very seriously looking for ward to this series.

  • 9-ECHO-1

    Let’s see…transporting full arrests, spinal immobilization, dynamic deployment/ SSM, furosemide for pulmonary edema…for starts. On the question of 24 hour shifts, 24/48 vs modified 24 hr with four-day break, vs 24/72 (of course, how about the fallacy of administrators who who harp on 12 hours shifts yet routinely allow personnel to work 36 hour shifts on busy units…yes, a little soap-box statement there). Aspiring administration by Medical Responders. Looking forward to this series…

  • Irene

    Hi Kelly, I’m an EMT friend of your SO in Ct! This is a little off-topic, but the blue-blood myth needs some serious debunking. I am stunned how many folks still believe we have blue blood in our veins-a couple long-time medics included! And I am additionally shocked at how vigorously folks who believe this myth will defend it, despite all evidence to the contrary (although the medic caved when presented with a Vacutainer). Please debunk this and spread the debunking far and wide. Thanks. :)

    • Paxillated

      Not a medic, just interested. I hadn’t thought about it before… it probably comes from the blue color of the veins some of us can see through our skin. My lightening-like mind immediately thought, “Aha! It’s the veins that are blue, not the blood!” Whew! Now I need a rest!

  • http://www.facebook.com/benoit.vaillancourt Benoit Vaillancourt

    The golden hour? I hate to see trauma patients yelling in the mattress, yanking on their collar, stressed because they where immobilized in a hurry, transported lights & siren through pot-hole-city…

    OR spinal immobilisation on seniors who fell, just because they’re old.

  • http://twitter.com/woodlawnmedic david burkhart

    How about the common belief that anyone with one eye and a GED can be a paramedic?

  • http://www.facebook.com/profile.php?id=1787673798 Eric Ford

    I’m not an EMT or medical practitioner. All I do is support the IT infrastructure. Why do Drs and nurses assume we WANT to see surgery patients, gunshot victims, etc…? I want to fix the computer/equipment. There is a reason I’m not in the medical field. Body fluids (all of them) make me want to vomit.

  • Chris Garman

    Just because Mr. Gandy has chided me about this before, but the O2 for everybody should be debunked. Also you should look at the reasons for backboards and debunk the ones that are junk.

  • trixiedell77

    TRENDELENBURG please yes or no. Supposedly the science says no. but all I hear is the “seen it with my own eyes” argument.

    • Ambulance_Driver

      One of the things we plan to attack is the “I’ve seen it with my own eyes” argument.
      There’s a reason eyewitness testimony isn’t nearly as reliable as forensic evidence.

  • SloEd

    Oxygen doesn’t hurt.
    Backboards just because of Mechanism of Injury.
    Running Lights and Sirens to the majority of calls. (My service leaves the station running lights and siren as a default while the call takers/dispatchers go through their questions with the caller and ProQ-A classifies 80-90% of our calls as needing lights and siren response. We then turn around and transport maybe 5% of our Pts lights and siren.)
    24 hour shifts in a busy Unit/Station/Truck.