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Mon Apr 10 11:08:42 BST 2006

Ben Reynolds <aneurysm_42 at yahoo.com> wrote:   I don't know nor have I ever met David Hoyt; but I'm
sure his motivation to write this follow up paper had
nothing to do with some conspiratorial deep loathing
of paramedics and EMTs who perform prehospital
procedures. 

***********************

  Here we go again
  MD conspiracies, EMS chest tubes, EMS playing on scene, first responders not stopping bleeding... medic nose picking and ass groping
  If repeated enough
  Will actually be believed in some
  And doubt well installed in the many

  Good job

  The point that his clear
  Is prehospital intubation of itself is less successful 
  Less successful than ER
  Wich is less succesful thant Trauma Center's
  Wich is less succesfull than OR's

  Now it could be geography, environment, intubators, Pt/patho types

  I think we know that
  Indeed it's all of those.

  But for now
  For most of us SIMPLY
  Prehosp Intubation = Paramedic Intubation

  How do we know that prehosp intubations are less succesfull
  I meand we know ! No ?

  How much of it is environment ? 
  Pt/Pathos ? 
  Geography ? 
  Intunator ?
  Individual systems ?
  Individuals ?

  What is the "Medic" contribution ?

  Not many prehosp intubation studies not using medics are far and few in between
  The bad ones have never been published (Montreal, Paris... others judge needless )

  One should be wise
  To recognize the complexity of it all the PROBLEMS
  And recognize that the SOLUTIONS may fall
  In the very simple BVM them all (Statisticaly relevant)
  And also
  In the more fine tuned
  Better training, QA/QC, time/space limited protocols, credentialisation of the intubators, usefull adjuncts... and what ever else comes our way

  We are still left with
  Prehosp intubation are less successful
  Less succesful = more harmfull

  As very well possibly attested by the large prospective studies
  Creedances has to be given to these studies
  But also to their innerant weaknesses
  i.e. they are not pure science
  And should not, therefore, categoricaly replace common sense quite yet

  As trauma airway is concerned
  Common sense dictates
  Some thing that points towards BLS airway (in short transoprt)
  But the needle is by no way STUCK ON the BLS end of the gauge

  Charles

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