Mediocre Medical Management: EMS Edition

Any ideas on what this lovely device was intended for?

While it may look similar to other devices , this is known as an oral screw and was designed to open a patient's mouth during a seizure because we thought they might swallow their tongue.

(A by @CatherineCounts)

Remember how I said we'd come back to backboards?

While they are great for maneuvering patients on scene, their use for spinal immobilization has been heavily reduced to specific circumstances supported by both @NAEMSP & @ACSTrauma https://naemsp.org/NAEMSP/media/NAEMSP-Documents/Spinal-Precautions-Backboard-NAEMSP-Position-Statement.pdf

Anyone ever heard of MAST pants?

Supposedly they helped shunt blood to the body's core post injury, but a trial by @HoustonFire showed they had no improvement on survival and came with some pretty bad complications. https://www.ncbi.nlm.nih.gov/books/NBK534783/

OHCA care used to have two camps: "Stay & Play" vs "Load & Go". Most agencies used to load their patients and do CPR all the way to the hospital. This doesn't help survival.

And the evidence for "Remain & Gain" is only increasing. https://jamanetwork.com/journals/jama/article-abstract/2770622

Lights and Sirens...do they save enough lives to be worth the increased risk to providers and bystanders?

This is a *hotly* debated topic in EMS, but there has yet to be research that ends with supporting their use 100% of the time. https://firstwatch.net/wp-content/uploads/2020/07/Using-Red-Lights-and-Sirens-for-Emergency-Ambulance-Response.pdf

Just like strokes, during OHCA "time is heart".

In 2005 @AHAScience changed their recommendations from 3 stacked shocks to a single shock after realizing that a lot of time was wasted waiting on the defibrillator to charge between shocks. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.105.170809

A flail chest occurs when a section of the ribs breaks off from the rest of the rib cage. This potentially interferes with breathing.

To help correct for we used to place sandbags on the patient...yes sandbags. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150827/?report=classic

We used to push 2 liters of clear fluids into patients suffering from blood loss.

Guess what you need after an injury...clotting factors.

Guess what doesn't have clotting factors....clear fluids.

This is one reason we're trialing whole blood. https://twitter.com/realscientists/status/1353834268603031553?s=20

But hey we've come a long way since thinking that static electricity could reverse any malady from consumption to cardiac arrest.

Besides electrical shocks (functional or fiction) I tried to steer clear of our research on cardiac arrest. Check out my other thread for a list of some more interventions (that mostly didn't work). /fin https://twitter.com/realscientists/status/1353554842707316736