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Wed Jun 8 16:40:34 BST 2005

Steve--
I thoroughly agree with your reasoning here that interventions in the field should be supported by meaningful data--and you of course agree that the mere ability to do the intervention is not meaningul data supporting benefit.  So, after saying this, tell me once again how you reconcile this principle with doing U/S in the field, for which there is also no meaningful data supporting its benefit ( rather than simply showing it CAN be done?) 
ERF

-----Original Message-----
From: flysurg at aol.com
To: trauma-list at trauma.org
Sent: Wed, 08 Jun 2005 11:02:44 -0400
Subject: Re: should i stay or should i go

Again yo are over-reacting, but here we go. Several recent studies have called 
into question the benefit of intubation in the field (including RSI). Several of 
these papers demonstrated worse outcomes!  Providing supplemental oxygen or bag 
mask valve ventilatory support can be accomplished in route; No reason to stay 
in play! Applying external pressure to bleeding sites can be done in route: No 
reason to stay and play. MAST and EOA were mentioned because these have been 
forwarded as field interventions which were useful. We all know this to be 
false. So I again ask you to provide some meaningful data supporting 
interventions in the field. I suggest that you objectively address this issue 
rather than decoming defensive and spouting dogma.

Best Wishes,

Steve Smith

-----Original Message-----
From: medic245 at mindspring.com
To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
Sent: Tue, 7 Jun 2005 22:21:54 -0700 (GMT-07:00)
Subject: Re: should i stay or should i go

-----Original Message-----
From: flysurg at aol.com
Sent: Jun 7, 2005 4:48 PM
To: trauma-list at trauma.org
Subject: Re: should i stay or should i go

All of those interventions should take place in route, not by delaying tranport 
and "playing" in the field. Nothing good can happen in the field! The data are 
conflicting whether ANY prehospital intervention positively impacts survival. 
There is nothing to suggest that delaying transport is helpful. Shouldn't you 
add MAST, esophageal obturators, etc, to your list of "good things" that occur 
in the field? We all know how useful these devices are (not). Again, unless you 
can provide data to the contrary. NOTHING GOOD CAN HAPPEN IN THE FIELD. 
Temporizing during transport is a different subject
-----------------------------

Ah, so you define "in the field" as only "on the location of the accident," and 
thus anything done enroute, even if it's done in a moving ambulance, on a rural 
highway, 45 miles from the closest on-call GP, is not done "in the field."

That's pretty funny.

And who mentioned adding MAST, EOA, etc. to the list?  Certainly such comments 
didn't come from here.

Tell ya what:  Next time, I'll bring you a trauma victim with no airway, no 
oxygen, no ventilation assistance, no hemorrhage control, and a 15 second scene 
time, and you and try to tell me how "good" my "field" care was. 

Next?

Best, 

Jeff Brosius
Paramedic, etc.
Phoenix
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should i stay or should i go