List Archives

Fri Jun 12 22:11:02 BST 2009

How does good treatment inside the hospital justify flying patients with
minor injuries, or without any injuries?

The comparison of outcomes between, before the HEMS crash and after the
crash, have not been published yet. However, nobody seems to be noticing
any difference after cutting flights by almost 70%. It will be
interesting to see how they deal with the results of an actual study of
EMS.

Am I supposed to encourage the use of helicopters to fly patients with
body damage to their vehicles, because they usually limit themselves to
evidence based medicine inside the hospital? Maybe just a bit of Reiki
because somebody forgot their risperdal the week they set the Reiki
program up?

Flying everyone is not evidence based, regardless of their record with
patients with serious injuries. This is also a way of preventing the
prehospital providers from developing an ability to assess and treat
trauma patients. MIEMSS acts as if the medic's only job is to prepare
the patient for transfer to the helicopter crew. Start an IV, run it
wide open, give high flow oxygen, hook up the monitor, and fully
imobilze the patient. The helicopter program, with just one
cross-trained provider in the back, is seen as a substitute for
insisting on good paramedics. That isn't my description. Dr. Bass (CEO
of MIEMSS) has repeatedly stated that having helicopters is the state
plan for rural EMS. that does not mean that their medics are not good,
but that they accomplish this in spite of MIEMSS.

The quality of the hospital does not justify endangering HEMS crews and
patients on whimsical flights. 

Delaying arrival at the trauma center, just to put the patient in a
helicopter is one of the practices that Dr. Bass and Dr. Scalea have
tried to defend. It certainly isn't based on science. Maybe it is
something one of their Reiki Masters came up with.

I do not know how good they are at trauma, but they have an approach to
EMS that is even less scientific than Reiki.

Their treatment inside the hospital has nothing to do with their magical
helicopter rides.

Tim Noonan.

On Fri, 12 Jun 2009 15:30 -0400, "Gross, Ronald"
<Ronald.Gross at baystatehealth.org> wrote:
> Tim,
> Have you taken any time to compare Shock Trauma's outcomes, ISS for ISS,
> TRISS for TRISS?  I suggest you do before making allegations about magic
> helicopters and the like.
> Ron
> 
> -----Original Message-----
> From: htaed_rd at 123mail.org <htaed_rd at 123mail.org>
> Sent: Friday, June 12, 2009 12:42 PM
> To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
> Subject: RE: Alternative therapies (OT)
> 
> 
> Shock Trauma continues to encourage the belief that putting a patient in
> a helicopter creates a magical healing aura around the patient. If
> pressure were not put on them after the recent fatal crash, they would
> still be singing the praises of delaying transport, just to put the
> patient in the magic helicopter.
> 
> They get away with it because they tell the voters that it is Free. As
> if there is any such thing. Now they are promoting Reiki as Free. The
> question is, are they as good at medicine as they are at selling snake
> oil? Do you trust real medicine from a snake oil salesman?
> 
> Acupuncture has been repeatedly studied. Acupuncture does not do any
> better than placebo. Even fake acupuncture has done better than "real
> acupuncture" in studies. This is not medicine. This is snake oil.
> 
> In discussing medicine that is evidence based vs everything not evidence
> based that is presented as medicine, why do you bring religion into the
> conversation?
> 
> This has nothing to do with religion, unless you worship at the altar of
> R Adams Cowley's "Golden Hour."
> 
> Maybe you believe that Dr. Scalea is divinely inspired in his direction
> of Shock Trauma.
> 
> Bringing religion into this is nothing but misdirection. This has
> nothing to do with religion, although in Maryland things do take on more
> than a religious tone, when you suggest that an ambulance could actually
> drive to a trauma center. Oh, the horror!
> 
> Research seems to be the one thing absent from EMS in Maryland.
> 
> Not that I have an opinion on the matter.
> 
> Tim Noonan.
> 
> 
> 
> On Fri, 12 Jun 2009 11:54 -0400, "Rick Tappan" <rtappan at gwu.edu> wrote:
> > I guess you don't put much in faith either? Not saying science and
> > medicine
> > should not be evidenced based, but in 30 years I have seen things I
> > cannot
> > explain and stopped trying. By the way on the rants about Shock-Trauma in
> > Baltimore, it is an integral part of the University of Maryland Hospital
> > and
> > trains military surgeons in preparation of their work overseas. It also
> > trains those individuals from the military who go off and do interesting
> > things in far away places. My point being that while not ACS level one
> > verified, it still has to meet all JCAHO requirements. Not that JCAHO is
> > the
> > end all and be all.
> >
> > Rick Tappan
> > 703 726-3734
> > rtappan at gwu.edu
> > "Who Dares, Wins"
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org
> > [mailto:trauma-list-bounces at trauma.org]
> > On Behalf Of Fiona Wallace
> > Sent: Friday, June 12, 2009 4:27 AM
> > To: Trauma-List [TRAUMA.ORG]
> > Subject: Re: Alternative therapies (OT)
> >
> > Oh, for goodness sake.
> >
> > The plural of anecdote is not data.
> >
> > It is well recognised that sticking needles in people has definite
> > physiological effects, however it DOESN'T MATTER where you put the
> > needles.
> >
> > There is no such thing as 'life energy' except the stuff that comes
> > out of defibrillator paddles (and then only when it works)
> >
> > My prescription is for a year long course of Pharyngula, Skeptic's
> > Guide to the Universe and Quackcast (Google them if you haven't come
> > across them). Alternative 'medicine' is no different from any other
> > sort in only one respect - it needs an EVIDENCE BASE and sound
> > physiological underpinning before it's used in a clinical context.
> >
> > /rant (but happy to continue the discussion elsewhere)
> >
> > Fiona Wallace.
> >
> >
> > On 12/06/2009, at 5:32 PM, Lorick Fox, MPAS, PA-C wrote:
> >
> > >
> > > We may want to be slow to totally scoff at some of these therapies.
> > > I must admit I generally (still) do, but:
> > >
> > > About 7 years ago I ended up doing an informal consult on an
> > > Egyptian (in
> > > Cairo) with marked LV systolic dysfunction who had refused
> > > revascularization.  Despite having some really good cardiologists and
> > > cardiac surgeons in Egypt, somehow an "American opinion" was valued.
> > > I ended
> > > up joining his family for dinner one night.
> > >
> > > At that dinner I met a Japanese practitioner (who spoke no English)
> > > who was
> > > present because the family had flown him to Egypt from japan to use a
> > > "laying on of hands" therapy for a patient with ALS. He specialized
> > > in care
> > > of neurological disorders and despite the language barrier, with
> > > translation, we had an interesting conversation.  I think I still
> > > have his
> > > business card somewhere.
> > > Now, I did NOT see the patient with ALS, nor a medical record to
> > > verify the
> > > diagnosis.  However, the family was well off (to put it mildly) and
> > > the odds
> > > are they had high end neurological evaluation.  (The cardiology
> > > evaluation
> > > of my patient had been first class, the patient just made bad
> > > choices.)
> > >
> > > The remarkable thing was that, after the "treatments" the previous 2
> > > days,
> > > the family agreed that the patient (who had reportedly not been out
> > > of bed
> > > without a lot of assistance for > 1 year) got up and walked
> > > unassisted. Now
> > > I understand placebo effect, but anyone (regardless of dx except
> > > perhaps
> > > psyc dx) who has not been ambulating for a year suddenly doing so
> > > independently is pretty remarkable, regardless of dx.
> > >
> > > Since that time, I have spoken with MD acupuncturists, Korean and
> > > Japanese
> > > traditional medicine practitioners (usually with a translator) and
> > > anyone
> > > else I found with experience and/or knowledge in the area.  I have
> > > become
> > > fairly convinced that there is far more to acupuncture than sticking
> > > needles
> > > in the right places.  It appears to me that successful
> > > acupuncturists have
> > > some ability to manipulate energy (?Chi? for lack of a better term),
> > > and the
> > > use of a battery connected to the needles just doesn't make up for
> > > that
> > > lack. This "life energy" what the Japanese practitioner told me he
> > > manipulated with his hands.
> > >
> > > Interestingly, I have also been told that some people are "Chi
> > > sinks" - i.e.
> > > can soak up a patient's energy and thus they feel worse after tx, not
> > > better.  I met one MD who did at least a month in California learning
> > > acupuncture, and had almost no positive responses, and some patients
> > > felt
> > > worse.  He was indeed a competent physician, based on working in close
> > > proximity daily for years. He abandoned the use of acupuncture.
> > >
> > > It would be really nice to get a better handle on this.  Just
> > > because most
> > > of us can't sense, much less manipulate, this alleged energy doesn't
> > > mean it
> > > doesn't exist and can't be of therapeutic value.
> > >
> > >
> > > Lorick Fox, MPAS, PA-C
> > > Gianaclis Support Complex
> > > +20-3-448-2335 or +20-45-240-9450
> > > Fax +20-45-243-1191
> > > Mobile +20-18-230-4448
> > >
> > >
> > >
> > > --
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> >
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> >
> >
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Alternative therapies (OT)