ER Thoracotomies - Higher Survival Private Transports

[AnthonyM83]

New JEMS article:

http://www.jems.com/news_and_articles/colu...op_and_Run.html

I don't know how scientifically solid this article is...but just another thing supporting that we stay and play too long with our traumas.

[paramedicmike]

Yeah...I don't know.

Part of the problem with this is the fact that they're using Philly Fire/EMS as the basis for comparison. Some of the concern with scene time may not really be scene time but response time. Philly is *constantly* short ambulances. It's not uncommon for there to be waits of up to 30-40 minutes for an ambulance. Articles show up in the Philly news environment every so often about delays and response times.

So rather than question the providers and their on scene time with interventions, I think the system problems need to be considered first...then scene time. (Although, that's not to say there aren't problems with some Philly medics. You're just going to have to trust me when I say that Philadelphia is NOT a place where you want to get sick/injured and need an ambulance.)

I don't think any of us will doubt or argue that the faster one can get to the ER the better chances of a positive outcome. Philly cops are famous for taking trauma patients from the local knife and gun clubs, throwing them in the back of a cruiser and making a mad dash to the closest trauma center. It can be funny to see sometimes. But that's another story.

I just hope this isn't something that people will try to use and turn it around to say we're worthless.

-be safe

[DwayneEMTP]

"For each procedure performed, patients were 2.63 time LESS likely to survive." (From article referenced in OP)

Just my knee jerk response.

It would be interesting to see the entire study. How did they quantify injuries and/or they're physiologic effect on the chances of survival?

Wouldn't it seem logical to assume, that in the 'majority' of cases that the number of interventions would increase with the severity of the trauma?

And the 'working' conclusion that increased interventions = decreased successful outcomes means that "stop thinking, just run to the hospital" (move backwards 20 years) should increase outcomes brings the integrity of the entire study into question in my mind. It's a defeatist, ignorant approach to drawing soft conclusions from data that wouldn't support the development of a decent hypothesis.

"Was it because law enforcement made the decision that they could get the patient to the hospital quicker than waiting for EMS? Were the EMS patients further away from the hospital? Were there scene safety issues that prevented EMS from gaining access to the patient? " (As above)

I'm not clear how it can even be considered a credible study if these questions, amongst many, many others weren't addressed. I guess I'm not really clear if the authors of the study came to these conclusions, or they were arrived at by the doctor writing the article.

Despite what they seem to be attempting here...correlation does not imply causation.

A quote from a sci-fi book my wife made me read, and I like it: "Information is not knowledge." (Sorry, I can't remember the source) But he was speaking about our current generation that, by having access to the Internet and it's myriad of unverified sources, is often no longer able, nor many times interested in, sifting fact from fiction. If a piece of information is interesting, it is accepted a knowledge with very little scrutiny.

It sounds like these folks come up with some interesting information. It remains to be seen if there is any knowledge to be gleaned from it.

Have a great day all.

Dwayne

[zzyzx]

I agree with Dwayne. You really have to question this study. Yes, I think we all agree that with penetrating trauma we need to not do IV's on scene and stupid stuff like that. There may be some things that slow us down that a non-EMS person would not have to deal with, such as spinal immobilzation (in the few cases of penetrating trauma that require it) and our response times. However, we benefit trauma patients by knowing where to take them and having a trauma team ready and waiting for us before we arrive.

[Ridryder 911]

Wow! After all those years, one would expect them to come up with something new to study!

Same old B.S. different verse! Really, why did they not study why they are still performing thoracotomies in the ER? They have been proven worthless with little results..

Wow ! A determination or even a paper written with a study of 192 patients. Hmmm in most scientific research, that would not be enough models to determine Jack Sh*t, especially regards in the different variables and varied injuries. So in other words a very flawed study but, it made the headlines... where in other parts of the medicine, it would never been able to be published or considered seriously.

We see the same crap every ten years, when the same old professors have to be published to keep up tenure for professor.

Shame, they are not really studying and research methods to lower mortality and morbidity within their own department. Everyone in EMS (or at least should know) procrastination increases mortality.

Now, what everyone including surgeons, physicians, researchers, and EMS should understand, there are trauma cases, no matter how long or how short of transport times they will die. Even if that glorious trauma surgeon was standing there when homeboy got shot.. sorry, multiple .357 to the thorax, will have the same results.

I do have a solution, let's place those trauma, research physicians in the back of the box for a while, and see what their "save" rate would be? ...

R/r 911

[Dustdevil]

I agree. Although, it does seem that these researchers came closer to making a valid point than the previous study along these lines. I forget the name, but a story several years back attempted to conclude that, because people who arrive at the ER by POV have a higher survival rate than those who arrive by ambulance, that EMS was somehow detrimental to survival. Of course, a great many idiots without the ability to scientifically interpret such things fell for that nonsense, even though the math just doesn't add up. The sicker you are, the more likely you are to have an ambulance called for you. Consequently, those who arrive by ambulance are statistically more likely to have a fatal illness or injury than those who arrive by POV. Duh! It has nothing to do with EMS!

At least this more recent study attempts to narrow down the pointless generalisations made by the previous study, by focusing on specific traumas. Their conclusion is nothing we didn't figure out a long time ago, which is that seconds count in trauma, and that all this wankeroid dicking around with "skills" is not helpful to the patient. If this study convinces one person to re-evaluate their practice in order to offer their patient a better chance at survival, then that is a good thing. But unfortunately, just like the previous study, too many lame-brains without the common sense to draw a logical conclusion -- as well as the scientific education to understand the implications of that conclusion -- will just react off the cuff with knee-jerk verbal diarrhoea that diminishes the value of EMS.

[Asysin2leads]

Fine, next time I have an unmanagable airway, I'll be sure to let the person choke to death in their own blood. Then their survival rate will improve.

[AnthonyM83]

Rid, I don't understand your reaction to this study. I'm sure there are others out there doing the studies you mention. This people simply decided to study this topic and I'm glad, because there's a lack of studies in the area. The only good one I know of is the USC one and it's starting to age already. I'd like to see 10 - 20 more studies on the topic, so we can start examining different aspects of it.

Not all will have big sample sizes or some new revelation or even claim to be very significant...but I was taught that's the nature of science.

It's like the shock position studies, they're all over the place. If we had several SOLID non-conflicting studies people could probably lay that issue to rest. Maybe this penetrating trauma study will lead to other ones in the future.

[AnthonyM83]

The sicker you are, the more likely you are to have an ambulance called for you. Consequently, those who arrive by ambulance are statistically more likely to have a fatal illness or injury than those who arrive by POV. Duh! It has nothing to do with EMS!

The USC study (the one usually referred to) accounts of severity of traumas...sometimes people don't have the resources (personnel/money/time) to include all factors, but they're usually not stupid and do consider such things...though not always.

And in science, studies (evidence) is needed to support things everyone knows is true...b/c maybe every 1 in 1,000 "truths" ends up not really being a truth. It's an attempt to keep science pure...

[Eydawn]

Every scientific study is flawed. You use what data you have, you try to take into account your detracting factors, but at some point you have to make a conclusion based on what you're seeing.

I dunno. I've been dubious of scientific studies in general ever since I figured out how they calculated the world's species number in order to estimate extinction rates. You ready for this?

Some guy put tarps down under a rainforest canopy on an island, and fogged everything with poison gas... then counted the dead critters. He counted a certain number of species in this area, then extrapolated that area based on the habitable area estimated on earth. Presto change-o we have X number of species and we've counted X number going extinct so our extinction rate is....

My whole class looked at each other like "is our prof serious?" and then accepted the numbers to work with in the class.

My point is... every study, no matter how well it's done or what it takes into account, will have errors in it. Such is the nature of the beast. You work with what you deem to be acceptable error levels, and you draw conclusions and work with what you've got. Otherwise we'd still be sitting here playing guessing games.

Wendy

CO EMT-B