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The Morning Report - 25 Apr 2013

I sat in a class once with a very interesting and entertaining individual who took the participants through a world of medical practices that were no longer proven to work.  In this he discussed medications, techniques, and procedures that had lost favor in the medical community, but some facets of the field would not, or could not let them go. 

I have been in multiple conversations where I was the sole spokesman against certain techniques, but the argument against removing it was because they had seen it work.  One of the first was the argument of the trendelenburg position.  Dr. Trendelenburg was a famous surgeon in his day and created a position that would make it more feasible to conduct abdominal surgery.  Soon people thought the position would help treat those in hypovolemic shock by increasing pressures back to the heart and brain.  This was a large part of the treatment of hypotensive patients until the past decade.  Even the Doctor that created the position said it would work, yet the field still uses it to this day (many have removed, but I saw it this past weekend). 

There are many, many others, but the movement towards evidence based medicine has taken another procedure and placed it square in the crosshairs of those investigating.  That is the process of spinal immobilization.  First, if you are anything like me and somebody simply said we are hurting people, I would be like "yeah right"!!!  I'm here to help and its helping prevent further injury.  But what if I came to you and said were not preventing injury, and we are causing more harm than good, but I also provided evidence.  That is where the field of medicine is right now. 

The National Association of EMS Physicians (NAEMSP) presented an abstract at a conference earlier this year on the biomechanics of spinal immobilization.  The results, wait for it!!! We are hurting people, and yet we keep doing it. 

I know that there is a movement to change the way we conduct spinal immobilization, in fact my medical director is looking for options to the way we currently do things, but we must also continue until these changes are made.

I ask you this question though, when does the legal side catch up with medicine.  Now, any good lawyer would be willing to make a case either way, but what if somebody received further injury because they weren't on a spine board.  I think that is what is preventing a lot of people from taking on this bold change in prehospital medicine. 

Look for it, it is on the horizon. 

Take Care and Stay Safe!
The Combomedic

twitter.com/dsblev

Rogue Medic
EMS World


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