EMS Fallacies

It seems that logical fallacies run deep in EMS, and not just the appeals to tradition as we most frequently see. Some are also appeals to common practice (which could be seen as an appeal to tradition), appeal to consequences, and a number of other distortions or ignorance of fact or truth or creation of the legal “boogey man”.

Let’s take spinal immobilization as an example. There is no evidence supporting or denying that spinal immobilization has any long term benefit, or any benefits at all for that matter. Research simply can not say it helps or hurts. This is for a few reasons. It falls to several logical fallacies as to why no one wants to steh long term effects. Mainly it falls to appeals to common practice and appeals to consequences (creating the legal boogey man) because we have been doing it for so long out of fear of a lawsuit that we dare not do it. This is an example of a fallacy. It may even fall to a few others, but there are so many different arguments that I don’t want to get carried away. It’s a little amusing to me that patients still show up in emergency rooms on backboards simply because they were in a car that was involved in any crash, despite physical evidence (and proven research) to the contrary that one was even needed. EMS providers can perform a proper assessment will increase suspicion of the need for a backboard. Read the NEXUS study or the multiple articles about the Maine Spinal Clearance Algorithm. It will open your eyes.

Another one I have been focusing on recently has been Dextrose 50%. Despite excellent research and even economic factors, we continue to use D50 even though it has been proven to cause more severe blood sugar spikes in hypoglycemia patients resulting in longer hospital stays and worse outcomes. Research has shown that alterntives like D10 and equivalent doses of D5 contain the same amount of dextrose as the 50mL D50 vials and can be delivered with more patient safety and better long term outcomes. When we administer dextrose as a drip instead of a massive bolus, we can titrate the flow rate and effect to the patient and give the body just the amount it needs to regain and maintain proper brain function. This results in less severe blood sugar spikes, shorter hospital stays, and possibly much better longer term outcomes. This better line of thinking falls to appeals to tradition, “we’ve always used D50.” Yeah, this is true, but when faced with something proven better, it makes more sense to switch when it is both safer, just as if not more effective at producing better outcomes, and not to mention cheaper. You can buy a case of D5 in the 500 mL bags for the price of 2 or 3 of the D50 50mL vials.

So how can you avoid these fallacies in discussions with your crew mates and co-workers? Keep well read. The journals and magazines always have solid foundations in research when written, and this will give you some evidence to go on when someone presents you with an argument and keep you from falling into using a logical fallacy to defend or present an argument.

  • Anonymous

    Actually, there is a growing body of research that demonstrates that spinal immobilization may be harmful.

    Still none that shows it does a bit of good, however, even for patients with spinal injuries.

    And you’re right, we should be actively questioning dogma in EMS. D50%, spinal immobilization, antiarrhythmics, indiscriminate oxygen therapy, response times…

    … there are plenty of fallacies that could stand some focused study.

    • I didn’t want to get carred away, just some focused examples I wanted to lay
      down to encourage debate.

      —–Original message—–

      • I almost got tarred and feathered for suggesting, in the latest case on EMS 12-Lead, that the fictitious patient shouldn’t have been boarded and collared. I obviously should have made up different numbers…not that the patient assessment findings would have changed!

    • Too Old To Work

      Unfortunately my good friend, response times are always driven by politics and not science. That’s the only complaint that politicians really respond to because that’s the one that gets the most media attention. Most of the public and all of the media know nothing about what we actually do other than drive people to the hospital.

  • Actually, there is a growing body of research that demonstrates that spinal immobilization may be harmful.

    Still none that shows it does a bit of good, however, even for patients with spinal injuries.

    And you’re right, we should be actively questioning dogma in EMS. D50%, spinal immobilization, antiarrhythmics, indiscriminate oxygen therapy, response times…

    … there are plenty of fallacies that could stand some focused study.

    • I didn’t want to get carred away, just some focused examples I wanted to lay
      down to encourage debate.

      —–Original message—–

      • I almost got tarred and feathered for suggesting, in the latest case on EMS 12-Lead, that the fictitious patient shouldn’t have been boarded and collared. I obviously should have made up different numbers…not that the patient assessment findings would have changed!

    • Too Old To Work

      Unfortunately my good friend, response times are always driven by politics and not science. That’s the only complaint that politicians really respond to because that’s the one that gets the most media attention. Most of the public and all of the media know nothing about what we actually do other than drive people to the hospital.

  • Too Old To Work

    AD beat me to it. There is pretty decent evidence that the immobilization we do and the reationale we use are causing harm to patients. Unfortunately, until there is a financial (as in a large judgment) incentive for medical directors to stop including useless immobilization in our protocols, it will continue.

    Same goes for using D50, although I’ve not seen first hand the harm you envision. What I have wondered about of late, is if we could give just half a pre fill and get the same benefit. Maybe we should rethink the “one dose fits all” mentality when it comes to D50.

    • Rogue had a post about D50, and there was an EMS Research podcast about
      hypoglycemia treatments. I think the research referenced used only the whole
      D50 dose or D10. The thought is that D10 produces the same effect as D50,
      but doesn’t have the issue with blood sugar spikes hours down the road.

      —–Original message—–

  • Too Old To Work

    AD beat me to it. There is pretty decent evidence that the immobilization we do and the reationale we use are causing harm to patients. Unfortunately, until there is a financial (as in a large judgment) incentive for medical directors to stop including useless immobilization in our protocols, it will continue.

    Same goes for using D50, although I’ve not seen first hand the harm you envision. What I have wondered about of late, is if we could give just half a pre fill and get the same benefit. Maybe we should rethink the “one dose fits all” mentality when it comes to D50.

    • Rogue had a post about D50, and there was an EMS Research podcast about
      hypoglycemia treatments. I think the research referenced used only the whole
      D50 dose or D10. The thought is that D10 produces the same effect as D50,
      but doesn’t have the issue with blood sugar spikes hours down the road.

      —–Original message—–