List Archives

Fri Jun 12 23:02:54 BST 2009

10% is not that bad, although far from ideal.  In Maryland the rate has been
variously reported at 50-70%.

On Fri, Jun 12, 2009 at 5:59 PM, Molly Berkowitz <moy96 at optonline.net>wrote:

> Helicopters have their place in the EMS system. But as soon as we introduce
> commercial enterprises in to the mix, we are going to increase the use of
> this high priced high risk item. In NJ we have recently seen the addition of
> a few "not-for-profit" agencies getting involved in air transport, and I am
> skeptical at best regarding appropriate triage. They feel that a 10% treat
> and release rate after flight is appropriate. As I said, I am skeptical.....
>
> ----- Original Message ----- From: <htaed_rd at 123mail.org>
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Sent: Friday, June 12, 2009 5:11 PM
>
> Subject: RE: Alternative therapies (OT)
>
>
>  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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-- 
Stephen Richey, CRT

"It is not unreasonable that we grapple with problems....Our responsibility
is to do what we can, learn what we can, improve the solutions, and pass
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