As if the news that 1 in 4 UK lap dancers has a college degree isn’t funny enough by itself, the more specific details of the finding are absolutely howl-worthy (emphasis all mine):
The researchers found arts degree graduates were most likely to report that they had turned to dancing after being unable to find other work.
and:
The main attraction of the work was the flexibility it offered
You don’t say? Here, I thought the flexibility was a job requirement….
Here’s a study on something I never would have even thought to study: implementing national guidelines. More specifically, how long does it take to change over from old practices (in this case, the 2000 AHA guidelines) to new ones (the 2005 recommendations). As with most things in medicine, the answer comes down to: it depends.
The study looked at the time between the publication of the guidelines (12/13/05) to the end of the training period when all personnel began using them. The first hint of any problems begins even before the results section: 2 agencies were excluded from data analysis because they had not yet begun using the 2005 guidelines when the agencies were surveyed…in March 2008. Keep in mind that surveys were sent strictly to members of the Resuscitation Outcomes Consortium, who (in theory at least) should be a bit ahead of the trend.
Of the remaining agencies, there was a huge amount of variation: agencies crossed over as quickly as 49 days (wow!) and as slowly as 750 days, with an average of 416. With a median of 415 days, there were just as many agencies below the average as above it.
Interestingly, larger agencies seemed to implement the guidelines faster: agencies with more than 10 vehicles made the switch more than 50 days earlier, on average, which probably reflects more personnel dedicated to training. BLS-only agencies took longer than their ALS-offering counterparts (about 65 days difference), and non-transporting agencies took longer than their transporting counterparts (by almost 80 days). The only difference looked for that didn’t reach statistical significance: agency type, with fire, non-fire governmental, and private agencies performing statistically similar.
This is just another way of pointing out that “once you’ve seen one EMS agency, you’ve seen one EMS agency.” With uptake times of 2 months to 2 years or more, and every number in between, it’s pretty obvious that the care you receive is determined more by where you call 911 than any other factor.
(Not to be confused with Golden Shower, incidentally–that’s something quite different.)
The concept of the “Golden Hour” has been so heavily ingrained in trauma care for so long that it’s proving nearly impossible to get rid of it–and EMS isn’t the only offender, though certainly a prominent one. Its creation is generally credited to the father of modern trauma care, R. Adams Cowley, but claims of where he got the concept are hard to verify. (One source suggests French WWI data, but my reading of the data shows that there is a golden three hours–where the mortality jumps from 12% to 33%.) We’re constantly told to get patients to a trauma center within that magical hour–but does it actually matter?
While there’s no doubt that earlier is better than later when it comes to caring for severely injured people, the notion of some cutoff is silly. (For a ruptured aorta, there’s a “golden 30 seconds,” for a small subdural, a “golden week.”) That’s why it’s not surprising that a fairly large study of the relationship between prehospital time and survival came up with nothing. It was actually a prospective study looking at almost 3700 patients with abnormal vital signs or altered mental status, and no matter how many ways they sliced the times (minute by minute, in 10-minute blocks, by quarters of the group, or by less/more than an hour), the results were still the same: no association between prehospital time and death.
Perhaps someday this notion of a Golden Hour (and its cousin, the Platinum Ten Minutes) will be something that’s merely worthy of mocking. In fact, that gives me a great idea for an EMS Drinking Game….
If you pay taxes for a government service, it only makes sense that you should be able to see how well your money is being spent, right? In that spirit, one man has thoughtfully compiled what little publicly-available data there is on various EMS systems on a website entitled EMSCompare.
If you have data not already up there, Mr. Clemans’ email is right at the top of that page. I have to imagine he’d welcome any additional numbers to flesh out his site (but didn’t ask).
One of the mantras I’ve heard, from my EMT class on, is that “too much oxygen never hurt anybody.” It makes some sense at a gut level, and it’s resulted in the treatment of many, many patients with oxygen–far more than will ever be treated with it in the ED. I know I’m not the only person who’s given oxygen to patients with abdominal pain, for example.
However, that’s one of the EMS truisms that needs to be erased from our collective memory. While not proof of the concept that too much of anything can be bad for you, a new study in JAMA is certainly very suggestive. I barely need to say very much if I just include the key table:
As you can see, among almost 3600 cardiac arrest victims, the mortality was lowest in the group with normal oxygen levels (45%), lower than both the hypoxic group (57%) and–more significantly–the hyperoxic group (63%), which actually had the highest mortality. Even worse, the hyperoxic group was also less likely to be discharged home after surviving.
Now, the study itself was not structured to prove that too much oxygen is proven to harm: it was just using observed data, not testing anything, so the best we can see is an association–not a cause. However, it’s consistent with experimental data (mostly in pigs) suggesting that high levels of oxygen after ROSC can be harmful.
This is the sort of data that won’t change EMS practice overnight (unless you happen to already have a portable blood gas analyzer in the back of your ambulance–in which case, I’m extremely jealous). However, it should help decrease our willingness to claim that “more is better.”
I’m very sorry that I missed the IIHS 50th anniversary crash when it happened–a perfect example of modern injury-reduction technology (a 2009 Malibu) versus what we used to have (a 1959 Bel Air).
Fortunately, they didn’t pick any sort of car that I have any attachment to–it would have been a waste of a perfectly good classic car.
I don’t know if this is an error of the dictator or of the transcriber, but I ran across it and it made me laugh, in a sick sort of way, because I’m quite certain that it was incorrect:
The patient`s family succumbed to complete cardiopulmonary collapse
I doubt that one very much–it was certainly the patient himself who expired.
Engadget is mostly a consumer electronics site, so it’s kind of odd that they would have a brief blurb about the Lifepak 15–but at least they came up with a great title for it:
Medtronic’s LIFEPAK 15 defibrillator for extreme conditions, or extremely clumsy paramedics
My employer is handing out T-shirts with this logo for EMS Week, rather than using the official slogan. I think this one is much more appropriate, don’t you?
