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Mon, 4 Feb 2002 14:57:36 -0500

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Dr. Zidan,

Nope.

But then, I'm not sure the onus is mine: after all, it is the Cochrane Group
which failed to reach a scientifically supportable, clinically applicable
conclusion, but nonetheless elected to suggest a creative hypothesis--which
people seem curiously attracted to...

Pret Bjorn, RN
The Bjorn Group

 -----Original Message-----
From: alaa zidan [mailto:azidan@batelco.com.bh]
Sent: Monday, February 04, 2002 1:59 PM
To: trauma-list@trauma.org; trauma-list@trauma.org
Subject: RE: Spinal Immobilization question

Hi trouble maker , do you know about a study that disapprove the conclusion
of cochrane group

ANOTHER TROUBLE MAKER

 DR. ALAA ZIDAN   Orthopaedic surgeon&Team leader Accident&Emergency Dept.
Salmanyia medical complex,Manama, Bahrain

-------Original Message-------

From: trauma-list@trauma.org <mailto:trauma-list@trauma.org> 
Date: Monday, February 04, 2002 09:43:24 PM
To: 'trauma-list@trauma.org' <mailto:trauma-list@trauma.org> 
Subject: RE: Spinal Immobilization question

Dr. Coats,

At the risk of waxing uppity (me?), I think the Cochrane Group's conclusions
in this regard are whacked.  

Prefaced by a lack of evidence in any direction (the reader is left to
regard this as unsettling), they nonetheless suggest that spinal
immobilization may result in preventable morbidity and mortality via airway
compromise.  They fail to admit that an absence of randomized controlled
trials is likely a reflection of the empirical value of spinal
immobilization.  A superior study would require half of spine-injured
patients to randomly go un-immobilized.  Love to see that presented to the
Human Subjects Committee.

"Because airway obstruction is a major cause of preventable death in trauma
patients, and spinal immobilisation, particularly of the cervical spine, can
[sic] contribute to airway compromise, the possibility that immobilisation
may increase mortality and morbidity cannot be excluded."

Hmm.  I think I follow.  Let me try one:

"Because serial killers are typically white males, and white men comprise
the majority of western neurosurgeons, there exists the possibility that
your local brain guy may have a freezer full of dismembered prostitutes."

Wow.  That's easy!  Gotta get me a consulting job.

Now, before we go comparing long boards to PASG's, let's be sure we've
zeroed the scales:

A long board is just a Big Frigging Splint (BFS).  Nobody ever promised much
more or less. 

PASG's were long promoted by the military--followed promptly by
manufacturers--under the unsubstantiated assumption that they accomplished
some sort of curious autotransfusion, thereby ameliorating hypoperfusion
with limited untoward effects. Each of these notions has been repeatedly and
scientifically debunked, while the humble claims of BFS's remain unblemished
(see paragraph #1).

I for one would resist packing away the long boards just yet.

Pret Bjorn, RN
Troublemaker

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<DIV><SPAN class=120402519-04022002>Dr. Zidan,</SPAN></DIV>
<DIV><SPAN class=120402519-04022002></SPAN>&nbsp;</DIV>
<DIV><SPAN class=120402519-04022002>Nope.</SPAN></DIV>
<DIV><SPAN class=120402519-04022002></SPAN>&nbsp;</DIV>
<DIV><SPAN class=120402519-04022002>But then, I'm not sure the onus is mine: 
after all, it is the Cochrane Group which failed to reach a scientifically 
supportable, clinically applicable conclusion, but nonetheless&nbsp;elected to 
suggest a creative hypothesis--which people seem curiously attracted 
to...</SPAN></DIV>
<DIV><SPAN class=120402519-04022002></SPAN>&nbsp;</DIV>
<DIV><SPAN class=120402519-04022002>Pret Bjorn, RN</SPAN></DIV>
<DIV><SPAN class=120402519-04022002>The Bjorn Group</SPAN></DIV>
<DIV><SPAN class=120402519-04022002></SPAN>&nbsp;</DIV>
<DIV><SPAN class=120402519-04022002></SPAN><SPAN 
class=120402519-04022002></SPAN><SPAN 
class=120402519-04022002></SPAN>&nbsp;</DIV>
<DIV><FONT face=Tahoma><SPAN class=120402519-04022002>&nbsp;</SPAN>-----Original 
Message-----<BR><B>From:</B> alaa zidan 
[mailto:azidan@batelco.com.bh]<BR><B>Sent:</B> Monday, February 04, 2002 1:59 
PM<BR><B>To:</B> trauma-list@trauma.org; 
trauma-list@trauma.org<BR><B>Subject:</B> RE: Spinal Immobilization 
question<BR><BR></DIV>
<BLOCKQUOTE></FONT>
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      style="FONT-FAMILY: Arial; FONT-SIZE: 10pt; PADDING-LEFT: 7px; PADDING-RIGHT: 7px" 
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        <DIV>Hi trouble maker , do you know about a study that disapprove the 
        conclusion of cochrane group</DIV>
        <DIV>&nbsp;</DIV>
        <DIV>ANOTHER TROUBLE MAKER</DIV>
        <DIV>&nbsp;</DIV>
        <P>&nbsp;<STRONG>DR. ALAA ZIDAN</STRONG>&nbsp;&nbsp; Orthopaedic 
        surgeon&amp;Team leader 
        Accident&amp;Emergency&nbsp;Dept.&nbsp;&nbsp;Salmanyia medical 
        complex,Manama, Bahrain</P>
        <P><STRONG></STRONG>&nbsp;</P>
        <DIV id=IncrediOriginalMessage><I>-------Original 
        Message-------</I></DIV>
        <DIV>&nbsp;</DIV>
        <DIV id=receivestrings>
        <DIV dir=ltr style="FONT-SIZE: 11pt" <i><B>From:</B></I> <A 
        href="mailto:trauma-list@trauma.org">trauma-list@trauma.org</A></DIV>
        <DIV dir=ltr style="FONT-SIZE: 11pt" <i><B>Date:</B></I> Monday, 
        February 04, 2002 09:43:24 PM</DIV>
        <DIV dir=ltr style="FONT-SIZE: 11pt" <i><B>To:</B></I> <A 
        href="mailto:trauma-list@trauma.org">'trauma-list@trauma.org'</A></DIV>
        <DIV dir=ltr style="FONT-SIZE: 11pt" <i><B>Subject:</B></I> RE: Spinal 
        Immobilization question</DIV></DIV>
        <DIV>&nbsp;</DIV>
        <DIV align=left><FONT color=#800000 face=Arial size=2>Dr. 
        Coats,<BR><BR>At the risk of waxing uppity (me?), I think the Cochrane 
        Group's conclusions in this regard are whacked.&nbsp; </FONT></DIV>
        <DIV align=left><FONT color=#800000 face=Arial 
size=2></FONT>&nbsp;</DIV>
        <DIV align=left><FONT color=#800000 face=Arial size=2>Prefaced by a lack 
        of evidence in any direction (the reader is left to regard this as 
        unsettling), they nonetheless suggest that spinal immobilization may 
        result in preventable morbidity and mortality via airway 
        compromise.&nbsp; They fail to admit that an absence of randomized 
        controlled trials is likely a reflection of the empirical value of 
        spinal immobilization.&nbsp; A superior study would require half of 
        spine-injured patients to randomly go un-immobilized.&nbsp; Love to see 
        that presented to the Human Subjects Committee.<BR><BR>"Because airway 
        obstruction is a major cause of preventable death in trauma patients, 
        and spinal immobilisation, particularly of the cervical spine, can [sic] 
        contribute to airway compromise, the possibility that immobilisation may 
        increase mortality and morbidity cannot be excluded."<BR><BR>Hmm.&nbsp; 
        I think I follow.&nbsp; Let me try one:<BR><BR>"Because serial killers 
        are typically white males, and white men comprise the majority of 
        western neurosurgeons, there exists the possibility that your local 
        brain guy may have a freezer full of dismembered 
        prostitutes."<BR><BR>Wow.&nbsp; That's easy!&nbsp; Gotta get me a 
        consulting job.<BR><BR>Now, before we go comparing long boards to 
        PASG's, let's be sure we've zeroed the scales:<BR></DIV></FONT>
        <DIV align=left><FONT color=#800000 face=Arial size=2>A long board is 
        just a Big Frigging Splint (BFS).&nbsp; Nobody ever promised much more 
        or less.&nbsp;<BR></FONT></DIV>
        <DIV align=left><FONT color=#800000 face=Arial size=2>PASG's were long 
        promoted by the military--followed promptly by manufacturers--under the 
        unsubstantiated assumption that they accomplished some sort of curious 
        autotransfusion, thereby ameliorating hypoperfusion with limited 
        untoward effects.&nbsp;Ea</FONT><FONT color=#800000 face=Arial size=2>ch 
        of these notions&nbsp;has been repeatedly and scientifically debunked, 
        while the humble claims of BFS's remain unblemished (see paragraph 
        #1).<BR><BR>I for one would resist packing away the long boards just 
        yet.<BR><BR>Pret Bjorn, RN<BR>Troublemaker<BR></DIV></FONT>
        <DIV>&nbsp;</DIV></TD></TR>
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