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Fri Jun 12 23:14:53 BST 2009

Louis N. Molino, Sr. CET
FF/NREMT/FSI/EMSI
Typed by my fingers on my iPhone.
Please excuse any typo's
(979) 412-0890 (Cell)
LNMolino at aol.com

On Jun 12, 2009, at 17:02, Stephen Richey <stephen.richey at gmail.com>  
wrote:

> 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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>>>>>
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>>>>>
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>>
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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
> them on."- Richard Feynman
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