EMS has long been centered around tradition. Our history is certainly something to proud of as we've come a long way. However, I ask is there a part of us that is still stuck in the past and unwilling to accept the most recent evidence-based practices?? How many practices and protocols are still accepted today that are not based on sound evidence and research? Think about your own agency or even the agency down the road. Are some of these practices harmful to the patient? Are they costly? Can they be justified? Are they inefficient? Do they even work? This blog will force you to challenge your stance on current practice and potentially remove some things that true research cannot support. Some may be controversial, but as with anything in medicine, it is still a science that is continually being practiced by all of us.
+ D50 versus D10 for hypoglycemia... which is better?
FICTION: Depends on who you ask, but many agencies have made the switch to D10, it's easy to make, if you don't purchase it outright. If you carry D50 - maybe just give less of it??
+ Long spine boards protect c-spine patients
FICTION: Do I even need to elaborate here?? You know what to do.
+ Heads up CPR is the future
FICTION: Not so fast - more data is needed for every piece of equipment in the image below. This very topic has been discussed in great detail just this month.
+ NTG for inferior wall MI and/or RVI (also is completing V4R even relevant?)
FICTION: AMLS just de-emphasized the need for a right sided EKG. Additionally, with holding NTG in Inferior wall MI is not an absolute -- just use cautious and consider fluids as well.
+ Epi in cardiac arrest
EQUIVOCAL: More data is needed, but some agencies have gone back to focusing on a more BLS approach with great success around neuro intact survival. Consider making incremental improvements to basic measures like CPR fraction and sound BVM technique.
+ Prehospital Antibiotics reduce mortality.
EQUIVOCAL: There are some studies for this intervention and others against it. When compared to groups who didn't receive Abx, there has really been no discernible difference in hospital length of stay or improved mortality.
+ NPA adjuncts in head injury patients is always BAD
FICTION: If severe airway compromise is evident. The risk/benefit profile would allow for this to happen. The risk of penetrating the base of the skull is super rare.
+ KED applications in trauma are endless
FICTION: many agencies have tossed these after they have been found to increase spinal column motion and potentially makes things worse.
+ Don't medicate Abdominal pain
FICTION: Pain could be considered a vital sign.... fix it! Complete a detailed physical exam before the analgesics and include that in your patient handoff.
+ Fluid boluses for hemorrhagic shock is fine, they need volume.
FICTION: Nothing replaces packed red blood cells during exsanguination. Liters of saline promotes the trauma triad of death and dilutional thrombocytopenia. Nobody wants that!
+ Refusals after naloxone is a NO NO
FICTION: Brush up on mental capacity and competence, if some metrics are met, refusals may actually be warranted. Do a thorough exam and make your documentation shine.
+ Yankauer is the only suction device necessary
FICTION: This instrument was invented over 100 years ago and was meant for controlled hospital environments... better alternatives exist today - especially for massively soiled airways.
+ Light & Siren response is always appropriate
FICTION: The time savings is miniscule and in some cases, the risk/benefit profile simply isn't there for you or your patients.
In short, continue to stay educated. Know what constitutes good research versus bad research. Look for selection bias, beware of hidden conflicts of interest. Be familiar with what a p-value is....(hint it's significant) Do your own independent homework before buying the next new device that hits the market.
Have fun discussing these topics at your station -- wrestling fact from fiction will take some critical thinking, but on the plus side, wildly beneficial discussions on the tailboard and at the dinner table will ensue. That fact cannot be argued!!
October 23, 2023
Author: Joshua Ishmael, MBA, MLS(ASCP)CM, NRP
Pass with PASS, LLC.