Question on traction spints

[Asysin2leads]

Training is for the known. Education is for the unknown.

-----Poster at EMS academy

Couldn't have said it better myself. If you ever want to have some real fun, take a bunch of highly trained, but poorly educated people, and put them into a situation they have not been in before. Play the Benny Hill theme while doing so, sit back, and enjoy.

[firefighter523]

I really have no issues, except being told by a brand new EMT-B about the effects of infection, and losing a limb. I agree, I wouldn't mess with an open femur fx unless pulses weren't obtained. That isn't the issue. The issue is soley, his tone in stating what he said about infections. You say, that I haven't taken care of a fx femur, (not the case), nor is it the point I am trying to make. How many infections do you think that EMT has delt with, of fx'ed femurs for that matter? I would guess, not many, if any at all! I think I speak for all of us when I say, nothing aggitates me more than someone that reads for a couple of years out of a textbook, thinks they have it all figured out, and then opens his mouth about how they have seen and done it all. Education, I agree is very important, however, you need to have the field experience to put that education to good use!!

As for you RID, we have had this discussion before. You say you instruct PHTLS, well, if you teach against the guidelines that you are supposed to be teaching, then I am wondering how effective of an instructor you are at all, and maybe it is because of people like you that we are producing the type of EMTs that we have! Guidelines are there for a reason, if for nothing else, we are having a bad day, we can atleast have something to fall back on. I can tell you this, if there are no pulses present, or if the pt is in too much pain, I am NOT worrying about your beloved Osteomylitis, (I know you love saying that word) That can and will be taken care of in the more definative care setting with antibiotics!! Traction, whether open or closed, if warrented IS THE STANDARD OF CARE! Infection care comes later. It goes both ways, ER Doc stated it best, education and experience is relative, it is how you obtained it and are putting it to use that really matters. Remember, my friend, there is someone out there that will always be smarter then the next. All the letters next to your name might make you feel good, but they just might be a drop in the bucket to the next guy that comes along.

And scaramedic, we do carry MS, and I do give it to the people who need it. However, don't you think the analgesics would work a whole lot better if you take away the source of the pain first? Traction has been shown to significantly decrease the pain!! Remember, we learned that in EMT school!! If you stepped on a nail, would you not take the nail out of your foot, before you put ice on it?

Asyn- you seem like a very intelligent person, and a good role model, my only issue is with some of the attitudes on this site! That is all. I have a very happy life, and am VERY commited to learning more and more everyday.

[becksdad]

Firefighter, Congratulations! You made some good friends today! You happened to attempt an insult to 2 of the most respected members of this board. And respect doesn't come easy here. One must prove oneself first, and both Ridryder and Scaramedic have done so. Both of these Medics have demonstrated the knowledge and skill that comes from combined education and experience.

Also, if a patient presented to me with a nail in the foot, I would not remove it, just like any other impaled object.

[Dustdevil]

I can tell you this, if there are no pulses present, or if the pt is in too much pain, I am NOT worrying about your beloved Osteomylitis, (I know you love saying that word) That can and will be taken care of in the more definative care setting with antibiotics!!

Just curious what grade you pulled in Microbiology.

It doesn't appear that you learned much in that class.

Or, more likely, you never took it and haven't a clue what you are talking about.

[firefighter523]

Becksdad, the analagy about the nail in the foot was just that.

[Ridryder 911]

As for you RID, we have had this discussion before. You say you instruct PHTLS, well, if you teach against the guidelines that you are supposed to be teaching, then I am wondering how effective of an instructor you are at all, and maybe it is because of people like you that we are producing the type of EMTs that we have! Guidelines are there for a reason, if for nothing else, we are having a bad day, we can atleast have something to fall back on. I can tell you this, if there are no pulses present, or if the pt is in too much pain, I am NOT worrying about your beloved Osteomylitis, (I know you love saying that word) That can and will be taken care of in the more definative care setting with antibiotics!! Traction, whether open or closed, if warrented IS THE STANDARD OF CARE! Infection care comes later. It goes both ways, ER Doc stated it best, education and experience is relative, it is how you obtained it and are putting it to use that really matters. Remember, my friend, there is someone out there that will always be smarter then the next. All the letters next to your name might make you feel good, but they just might be a drop in the bucket to the next guy that comes along.

Okay... I have bit my lip long enough. I have worked with trained and re-trained more medics that was military and was applying traction splints when you were still in diapers and sucking down formula... so I am not impressed with your "12 years experience".

As well, I cut my teeth with special force medics from the Vietnam era, and work with those from Desert Storm, Iraq etc.., so yes, I have a special place in my heart and respect for those that performed those actions. The first thing they taught me was never to have a pompous attitude. The other was they never liked one with a G.I. Joe attitude and blasting and disrespecting others. In fact they have always presented a respectful attitude, another thing I honored about them. As well "those college boys" that you appear to despise so badly, are the ones that tells you exactly what to do and how to perform care in EMS and in the military as well. Maybe, this is the source of your apparent anger issue.

If you did read the corresponding reply I did state I was quite aware of the change and taught their standards at PHTLS courses, but this does not mean it is the sole "Gospel" it is only their recommendations and one should be able to discuss and follow local policies. No where was there a discussion of a pulseless extremity, as well it is very apparent the standard care is to attempt for realignment with traction for such. (You see, I know a little more than having read more than one text and attending one course on trauma). This same type of ignorance that presumes that the AHA ACLS treatment is Gospel as well.. it is only recommendations from that governing or sponsoring body/organization.

As far as teaching, your damn right I am proud students question..'why & how come" we do things! You see that is there is a big difference between education and training. EMS is medicine and needs education not training... period! To take things on face value as in training is not only wrong but down right dangerous! I do NOT believe in training for civilian medics... there is a thing called differential diagnosis, responsibility of care to the patient, the profession, and yes a little thing called litigation. If I wanted to have a trained object, I'll get a monkey or a dog. I prefer a medic to understand different modes of treatment and the etiology of the treatment as well as what occurs in the body when a procedure is done or not done. For example for a treatment of a headache: Tylenol, Excedrin, Ibuprofen, or Aspirin... each one correct, only if you know what type of headache it is.

Now, have you ever heard of evidenced medicine? Questioning of why, how come, and is it really beneficial to the patient? As well, do you still believe in the trendelenburg position ?...

Do you even know or realize why PHTLS was developed? Why a group of us met in New Mexico to develop the curriculum? It was based upon questioning if what we were teaching at the time was adequate in real trauma care?.... And guess what, it was designed by a bunch of us "college boys".. and the course was primary designed to be placed in EMS schools to reduce the need of previous field experience. It was to cut out the time many needed to see how to do things in a real world situation.

Part of this profession and being a professional is being able to play well with others at all education levels. I believe anyone can pass a Paramedic class & get a patch. It has been demonstrated well on these forums. Like I have said before.. it is too easy to become a Paramedic".. However; it is a different story, to be a damn good medic, patient advocate, good co-worker and a good employee.

I have found those that fear questions, or to be challenged is probably those that are lacking in self confidence, otherwise there would be no problem in answering them and having an open objective mind.

R/r 911

[Dustdevil]

Do you even know or realize why PHTLS was developed? Why a group of us met in New Mexico to develop the curriculum? It was based upon questioning if what we were teaching at the time was adequate in real trauma care?.... And guess what, it was designed by a bunch of us "college boys"..

College GIRLS too!

You know who I'm talking about, Rid! :twisted:

Good times!

[Ridryder 911]

Oh yes!!!... :oops:

R/r 911

[MedicNorth]

Thanks, Rid, for that last post.

I have watched with dismay as intelligent, experienced, and educated people have been abused by someone who may know "stuff" but is so bound up in his anger and animosity that he can't see any other side to the situation. There is no doubt that he will not come around, and as a result I wish that this thread would be locked - there is NO further value in the debate, as all has been said that could possibly be said.

The forums are to educate, illuminate, and entertain us. If we want Ultimate Fighting, we can tune that in on our television sets. Firefighter - let it go, please!

[ERDoc]

OK boys, put the tongues back in the mouth (feel free to PM me with the details). Firefighter, there is no evidence based standard of care. As I stated previously, there is no evidence in either direction, so your standard of care is based on what your medical director likes to do this week. It is obvious that your 12 years of experience has taught you very little about the real world of medicine. The small amount of education that I have has taught me that osteomyelitis is a bitch. It is not as simple to treat as cellulitis or pneumonia. We are talking months of antibiotics, multiple hospitalizations, PICC lines (check it out if you don't know what it is). It can take over a pts entire life and still lead to loss of the limb. The antibiotics are no joke either. We're talking some of the big guns for osteo, which can reek havoc on a body. If they are diabetic or immunocompromised for any other reason, it gets even worse.

Give me an educated person anyday and I can quickly mold them into an experieced provider. I don't think the same can be said for the opposite.