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Mon Jun 15 21:31:29 BST 2009

I have no problem limiting what I do to what is evidence based. 

Although there is not clear data contrasting HEMS fatalities with ground
EMS fatalities, there are people who try to track all EMS fatalities.
The helicopter fatalities are much greater than the ground fatalities.
Are some of the ground fatalities missed? I do not know. 

One of the nice things about the increased information available with
the internet is that it becomes easy to report something like a
fatality. We do need to track this data much better. 

Why do you think I am in favor of high speed ambulance transport? There
should be transport at a reasonable speed. As Dr. Blumen concluded in
the NTSB hearings, HEMS flight crew is the most dangerous job in the US.

When there is any reproducible evidence to suggest that any alternative
medicine is better than placebo, then it will be time to consider
treating alternative medicine with some respect. Until then, alternative
medicine is just made up of a bunch of people who resist scientific
analysis of the treatments they propose and make excuses for the lack of
effect.

Alternative medicine harmless?

Anything that prevents people from obtaining effective treatment with
pie in the sky promises is harmful. There is even a site that addresses
the misleading suggestion that these treatments are harmless.

http://whatstheharm.net/

We do need to be more insistent on evidence for treatments. 

I completely agree.

We have too many treatments that have become standard of care without
anything more than expert opinion supporting them, even decades after
adoption of these standards of care. We should be moving away from
tradition as a basis for treatment.

Tradition is the antithesis of progress.

Tim Noonan.

On Mon, 15 Jun 2009 15:29 -0400, "Robert Schulze"
<Robert.Schulze at nychhc.org> wrote:
> We should be carefull where we throw stones. While Shock-Trauma may be
> trying new therapies, perhaps we should wait and see what the data does
> show over time. 
> I would remind everyone that there is no class 1 data supporting
> appendectomy for appendicitis and in fact there is now brewing European
> data to the contrary. I would also suggest that a high percentage of what
> we do is NOT data driven and many of our esteemed long held mantras and 
> beliefs may be wrong. Since there is no data AGAINST these alternative
> therapies, and since there is no data that they are harmful, let us be
> respectful and just ask to see the data when they are able to compile
> them. If we stop doing anything that is not 100% supported by class 1
> data, we will find ourselves doing very little. As to the helicopter
> argument, the original helicopter system was put in place when there were
> no trauma systems and all there really was MIEMMS.  It should be
> subjected to scrutiny and outcomes assessed. Are we also going to look
> into the accidents that high speed abulances cause and are involved in?
> we must weigh both sides. Unfortuantely Ambulance accidents are common en
>  ough that they do not make the glorious news like a helicopter accident
>  does. 
>   
>  
>  
> Robert Schulze MD FACS
> Clin Asst Dean, Asst Prof of Surgery,
> SUNY Downstate, Kings County Hospital 
> 
> >>> "Gross, Ronald" <Ronald.baystatehealth">Gross at baystatehealth.org> 6/15/2009 2:52 PM >>>
> "Perhaps you should leave discussion of this topic to those familiar with
> the research."
> 
> OBTW - perhaps you should look at the background of those who you send
> e-mails to before you decide who is and who isn't qualified.  
> My mother used to say, "One must learn how to disagree without being
> disagreeable".  The good news is that you have accomplished the first
> half................
> Signed,
> Your favorite charlatan
> ________________________________________
> From: trauma-list-bounces at trauma">trauma-list-bounces at trauma.org [trauma-list-bounces at trauma.org] On
> Behalf Of htaed_rd at 123mail.org [htaed_rd at 123mail.org] 
> Sent: Monday, June 15, 2009 1:40 PM
> To: Trauma-List [TRAUMA.ORG]
> Subject: RE: Alternative therapies (OT)
> 
> Since I work outside of hospitals and generally only comment on the
> truly egregious in-hospital practices, such as Reiki, I do not pay
> attention to the different severity scores among the different ACS">non-ACS
> trauma centers in Maryland. Either way, it is not relevant to the topic.
> What is relevant is the difference in outcomes of the patients flown vs.
> not flown.
> 
> Does delaying the arrival at the trauma center in order to fly the
> patient to that same trauma center make any sense? This is one of the
> practices that has only been stopped over the objections of Dr. Bass and
> Dr. Scalea.
> 
> I do pay attention to the fiasco that is MIEMSS. Until the recent crash,
> Dr. Scalea and Dr. Bass were both supporting an EMS flight policy that
> makes Reiki look scientific. They could not provide any evidence to
> support their position, since there is none. Apparently their energies
> were not strong enough to generate research on this topic.
> 
> Since they have cut flights by almost 70%, there is no sign that
> patients are worse off. When it comes to criticizing EMS charlatanism, I
> refuse to remain silent.
> 
> Perhaps you should leave discussion of this topic to those familiar with
> the research.
> 
> Tim Noonan.
> 
> 
> On Mon, 15 Jun 2009 08:59 -0400, "Gross, Ronald"
> <Ronald.Gross at baystatehealth.org> wrote:
> > I truly do lament the loss of ANY patient and/or medical crew member in
> > the crash of an aircraft.  Whether or not the use of that aircraft is
> > justified will be settled right around the same time we see agreement
> > between the NRA and the anti-gun lobbies, or peace in the Middle East.
> > So I would ask you to ask one simple question - if we forgot the fact
> > that patients arrive to Shock Trauma in an aircraft, and just for laughs
> > and giggles assume that they were to arrive by ground, how would outcomes
> > compare to other institutions that weren't "guided" by some sort of ACS
> > COT/governmental/system arrangement that specified standards and
> > scrutinized outcomes, ISS for ISS, TRISS for TRISS.
> >
> > OK, gotta go now - need to light my incense and open the door for my
> > masseuse!
> >
> > Ron
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org 
> > [mailto:trauma-list-bounces at trauma.org] On Behalf Of htaed_rd at 123mail.org 
> > Sent: Friday, June 12, 2009 5:11 PM
> > To: Trauma-List [TRAUMA.ORG]
> > 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.
> > >
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