Poe’s Law?

This is a comment that was posted in reply to my previous post about the KED. This comment was either a crowning achievement in trolling, or exemplifies everything that is wrong with EMS….and I can’t tell which one.

poes

I’m not saying I agree that the device should be continued in the field, but I’m also not saying it should be abandoned.

Below is the comment in its’ entirety as submitted by John Baerlein

First, comparing a spinal immobilization device to an EMT with a bondage fetish is sophomoric and down right losses any credibility you might think you had prior to trying to be a funny guy. Second, if a mobilization device stops just one person from paralysis, let’s say your wife or child, would you spend the time to put it on CORRECTLY, I say correctly, because, as your open letter to no one shows, you don’t even know the appropriate time to apply it. A patient with multi system trauma is not a candidate for the device. Rapid extrication is. Or in your case, just let them stand up and walk out while you hold their hand. I guess you and your argument may be better received if you actually knew the protocol for application. I’m not saying I agree that the device should be continued in the field, but I’m also not saying it should be abandoned. We, at least some of us, are more concerned about patient care rather then how many books were sold about your fetish of bondage. Get over it. I think that the device is over used. But I also feel that actually knowing when to use it, and using good judgement, it is just another tool that can be used in a techs bag of tricks. I’ve used the device rarely as a precautionary piece of equipment, and more as an assist to extricate a patient when we have had to pull them out of the rear window after the vehicle has been cut for us. I’ve also used it in quick or fast water rescue where the device is placed on the patient and hoisted from the flooding rapids. Third, try not to disrespect techs living and working in the backwoods. I would trust some of their judgement over the “big city” techs judgement, as the back woods guys and gals are going to be doing more treatment modalities due to extended transport times. And I’d accept their judgement over a know it all, like you, who has decided that any tool we have in Ems is nothing more then a joke. I’ve been involved in every aspect of ems, from met to medic to instructor to cic. I’ve worked big city with the worst jobs possible and also backwoods ems. I’ve been to scenes where the need has been for 150-200 backboards. Be damned if the “bondage” device was used as a replacement, or stand in for a backboard. You see, as much as the backwoods guys say moi, I’m pretty sure that surviving a plane crash will fit the criterion for some sort of spinal immobilization. How about you? Rather walk them off the plane that’s split in three pieces? Different equipment comes and goes over time. Usually, those wonderful statistics that you cite have a tendency to lean one way. And it’s usually the way the writer wants the stats to be. What’s more important then wanting to be a clown, perhaps actually learning about the device, when to and not to use it, and the proper way to apply it might be a good starting point for regaining any credibility you might have had prior to reading your incredibly crappy article! The best tool an emt or medic has is knowledge and ingenuity. You seem to have neither!

Poe’s Law

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24 thoughts on “Poe’s Law?

  1. Are you serious? Who trolls EMS boards? Being that you have no reply other then trying to discredit someone who’s been in longer, done more, and accomplished more, shows just how much you don’t belong writing about anything EMS related. Perhaps a change of career fields. You article was like your response. A waste of time by a nobody! If you actually cared about another’s opinion, perhaps you would have learned something. Instead, as is way to common in today’s climate, one opinion is right, and I will call you names if you don’t agree with me. Learn your protocols before writing about a piece of equipment you obviously have no clue about.

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    1. I am unsure how you know what I have done or how long I have been in EMS. The fact that you have resorted to an appeal to authority and ad hominem attacks tells me all I need to know. While I can assure you that my EMS resume is more than adequate I will leave it at that.

      There is no need for me to try and discredit you as you appear to be doing that just fine all by yourself.

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    2. This is hilarious. Another shining example of where experience does not equal competence and knowledge. The point of the article went way over some peoples heads. The more I read that reply the more I was shaking my head. I truly hope this person is trolling…. but sadly I think they are serious.

      Liked by 1 person

      1. Funny how you say incompetent, yet you don’t know when to apply the KED properly. Care to comment on that? No just going to continue discrediting yourself?

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    3. You may have been in EMS longer, but that holds no water whether you are right in this case. Unfortunately, I must inform you that, based on all the currently available data, are not correct in this case. Scientific evidence does not support the use of backboard or KEDs for the purposes of spinal immolation.

      I would agree with you that it’s not necessarily about backwoods or not. Rather, it is whether you are practicing progressive or regressive medicine. Backboards are no longer in the progressive camp. What mind of medicine do you advocate for?

      I do not understand your comment about protocol. You falsely assume that all protocols include the backboard. My state is one of the largest in the country to not mandate the LSB. Many others are following suit. Even before the protocol changed, my backboard use was practically nil. Patients deserve to know the risk benefit of any procedure we do… And somehow none of them wanted a rigid backboard with no proven benefit.

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      1. Just because you’re a dinosaur does not mean that what you’ve been doing all these years is actually the right thing to do. The way we have always done things is not the way we should always continue to do things. Sometimes research actually does show the way out of doing things that are not in the patient’s best interest.
        That, and you do sound like a tool. One who I wouldn’t trust to work on anyone I even remotely minded being around.

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  2. And again, no reply for the trash you write. You are far from a voice for Ems. Learn your protocols and how to use a device before vomiting an opinion on that piece of equipment.

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    1. You see this is the issue right here. You believe that I need to learn my protocols and that somehow learning my protocols trumps evidence, science and data. It doesn’t.

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      1. John. what you are describing is the mindset of a decade ago… at least. We know a lot more now than we did then. You keep referring to protocols…… most have ditched long boards for anything other than an extrication device and keds all together.
        It sounds like you worked in a pretty regressive system a while ago had haven’t kept up with the evidence and current practice…. as few places still use these as “protocol”.

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    2. I’m curious. Had there ever been a shred of evidence to support that putting a curved spine on a flat, rigid surface, does any good? If not, what is one’s rationale for doing it other than “it’s in the protocols” or “I’ve done it this way for years”.

      This is just a question. I’m attempting to learn here.

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  3. While I can agree the KED is a tool, and may be useful for extrication, there is nothing rapid about it, and it should come back off as soon as possible, not left on.

    To the commenter, remember, the plural of anecdote ≠ evidence, just as protocols ≠ scientific fact and evidence. You are also not unique in the world of EMS in having experience, urban and rural. Nor are you unique in attempting to ridicule those who accept the proof that backboards and their variations are shown to cause far more harm than good.

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  4. I should clarify that there was no slight intended to people who work in rural environments. I myself work in a rural setting. I was referring to those who do not stay current with EMS practice as new data, evidence and science continues to come out.

    If you live in the woods, more power to you.

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  5. Mr. Baerlein,

    I have known Brian for many years, I can say without doubt that his knowledge, skill and clinical judgement are first rate and I would trust him and many of the others who commented here to take care of both my patients and my family anytime.

    Both your adherence to outdated medicine as well as your lack of knowledge of current medical science and practice seems to me like you have not been keeping up with the latest evidence based medicine nor being passionate about your patients or profession.

    I truly hope you are not “teaching” or “passing on” what you have described here.

    If you would permit me, I would offer you some insights?

    In the 1970’s it was believed and attributed that secondary spinal injury came from excessive movement of patients while being extricated from automobiles which at the time were largely made out of steel and the force of impact more completely transported to the patients bodies.

    In the 1980’s, it was discovered that the major cause of secondary spinal injury is actually from inflammation and subsequent ischemia of the anterior spinal artery. It is for all intents and purposes a compartment syndrome. Adding immobilization devices reduces the compartment, it does not “prevent” secondary damage.

    At least one study has compared an EMS system that does not immobilize patients to a US one who does, it was determined that there were more incidents of secondary injury in the US population. The iatrogenic complications of immobilization devices is well studied, and overwhelmingly, there is no evidence of benefit, and evidence of harm.

    Spinal injury from blunt force trauma hovers around 1% of all patients, and 6% in penetrating trauma. The modern guidelines have removed spinal immobilization from penetrating trauma, and more progressive systems and providers are removing it for blunt as well. Hot pokers and blowing smoke up peoples asses went out and so will spinal immobilization. It is well on its way.

    If your appeal is anecdote, with my experience in 7 countries in some of the busiest trauma centers in the world, in 10s if not hundreds of thousands of patient contacts, I have never seen an incidence of secondary spinal cord injury from excessive motion. I have found not one documented case in the literature.

    If your appeal is to authority, as a former firefighter and medic and current doctor, my field experience easily equals my academic accomplishments, and I am calling malarkey on spinal immobilization, with a ked or otherwise. As an extrication tool, various devices assist in that. Spinal motion restriction is both practical and prudent, and even a fixated halo splint has a 4 degree range of motion. To say nothing of effective splinting requiring immobilization of the joint above and below an injury, or the physiology of self splinting.

    I encourage you to update yourself to modern medical practices, particularly in trauma. There was never ever an instance on Earth when any incident “required” 150-200 backboards and I am sorry you ever thought there was.

    I hope I have provided some valuable information and insights for you to pursue.

    Sincerest respects,
    Mike Smertka, MD, PhD
    (name of employer withheld for social media policy) Depts. of both Surgery and Intensive care.

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    1. One last thing doc, your second to last paragraph puts me on the edge of my seat a bit. Every doc I’ve ever had the pleasure of working for and with have been incredibly helpful, knowledgeable, and always there for a good debate, and/or discussion. While what you wrote was updating and helpful, your comments at the end are rather disturbing coming from someone in a position of using a teaching moment compared to using that moment to demean and redicule. I may be an old salty medic, but as a doc, I would have expected more. Still respect the road you’ve taken. Still respect the updates. Just disappointed at the quickness you used to be an ass, when, let’s admit, there was no reason for it from someone in your position. I’m not an md. I am a proud street medic, even if a dinosaur! A proud vet. And an incredibly proud instructor for hundreds if not thousands of students, which did include pa’s, nurses, and even docs. I do hold a phd, but sadly, it’s in theology, and not in anything medical related! Just mind over matter! Peace! Oh, and God bless! I’ve earned the right to say that!

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  6. Dear John.
    In the words of one of your Presidents, “Sometimes it’s better to say nothing and assume ignorance than to open your mouth and prove it” 😉
    Do you even evidence, bro?! Seriously, most of the ambulance world is moving more and more towards evidence based practice, except perhaps your rural location and their “protocols”. Perhaps your medical director is as old skool as yourself if it’s still in there…
    Cheers, mate.
    P.S. it’s ‘than’, not ‘then’, and ‘loses’, not ‘losses’. Pretending to be literate will help you stop looking like a fool. Get on it!
    Cheers mate.

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  7. Wow. A whole lot of I’m dead wrong, not literate, live in the past, hope your not teaching. Good to know nothing’s changed in Ems! Still into fuck you medicine as it’s always been. And of course the I know better so go screw yourself. I will elaborate on my comments.
    First, I mentioned protocol only because the use of the KED in the main post, was said to be used for multi system trauma. My point was that the correct protocol states its contraindicated in anything but a stable patient complaining of back and or neck pain with significant moi. That’s all. Nothing life shattering there. It simply mentioned the indications for its use, rather then the authors lack of knowing the indications/contraindication of its use.
    Second, and there is no true order here, I’m trying to answer as I go along. Tim Newman, you’ll have to excuse me as auto correct has a tendency to change two words that sound the same but mean different. I’ll be sure to double check prior to posting. After all, that’s what this is about! Medics and English 101. My bad!
    Doc, first off, been there done it isn’t a reason for much of anything. However, I’ll respect the road traveled rather then the road taken. Chinese gymnast breaks neck during competition. The only reason she is able to walk was because of the medics who within a minute of the injury had her completely immobilized. She was transported with a c2 fracture which I’m sure you know is the hangmans fracture. You’re basically decapitated but your head is still attached to your body. There’s your 1 case that doesn’t exist. Also, doc, Avianca crash. Plane runs out of fuel while attempting to land at JFK. Oops, doesn’t make it. Crash. Luckily, no fuel, no fire! To be exact, we asked for 200 backboards asap, as their use was needed to get to our patients, some of whom were literally dangling from an elevated section of the torn up pieces of aircraft. In other words, we needed the fucking backboards to get people out safely due to the incredibly difficult extrication needs of the patients, and sadly, the dead. There’s your one case that also never existed. I won’t even mention the call for resources prior to the and the 24 hours after the collapse of two really tall buildings. God knows we didn’t request as much equipment to the scene as possible, which included ambulances from up to a hundred miles away bringing busses filled with people and boards. Sadly, we requested, but ended up not needing. I guess that’s an accidental two cases that never existed in the history of ems.
    Yes, and thank you, all you fine young medics out there, I an an ems dinosaur. We had a different mindset way back when, and I guess I haven’t been keeping up with all the changes. I’ve been retired for almost 10 years and not active in that time due to two cancers. Adenocarcinoma and hemangiopericytoma spindle cell sarcoma. I’m sure doc will agree that 1 is incredibly rare, and it’s just as rare to have two completely different cancers infecting a body at exactly the same time. Right doc? Prior, I was active in not just doing, but teaching and working with the state, which some of you may agree, as hard as that may be, that doesn’t want to change anything and no doc was willing to be the one to say no more spinal immobilization. Hell, we fought for years just to allow narcotics in buses when it was in protocol, but no one was willing to be the medical director to approve and put their name on the dotted line. Sorry doc, our docs were way way back in advancing ems. We went from the forefront to the caboose due to negligent morons who wanted nothing changed in decades of street medicine. Oh, sorry, one more thing doc, I taught the ked and spinal immobilization until the day I retired. And I have zero, none, nada, zip regrets for showing and teaching the proper use, indications, and contraindications of the use of both. And as I mentioned, the devices do come in handy when improvising tools, overcoming obstacles, and adapting to the needs of each individual case. As I’m sure you can agree, no two patients, no two traumas are exactly alike! Sometimes it takes ingenuity and adaptation to get a job done for the benefit of your patients.
    For those claiming scientific fact, just remember that in the end, the person who will take the blame is always the first one to touch the patient. It’s so easy to blame a street medic then to acknowledge deficiencies in protocols and updated modalities.
    As for the author, perhaps an out stretched olive branch will put an end to this. My generation of medic is outdated, and I guess my stance has been proven to be useless by a cadre of very competent, very helpful, enlightened new medics that look at us dinosaurs as useless old timers that didn’t know shit. Here I thought that that label was for the dinosaurs that came before me. It’s hard to admit you’re getting old and out of touch with main stream ems Main Street. My apologies.
    Timmy, one thing I’ve always found useful in life is to know when sarcasm becomes being a dick. I appreciate you wanting to correct my errors in writing, but coming from someone who writes ” do you even evidence, bro” proves your point of shut up, you’re ignorant and proving it by criticizing my text. That’s kinda when you went from a know it all, to a fucking dickhead who criticizes while committing the same, if not worse sin! Cheers fool!

    Brian, I don’t have a copy of your cv, just as you don’t of me. My apologies to you. Doc, thanks for the updates and not knowing that their was a time when we did want and ask for more resources then we needed at scenes that no one should ever have to repeat, replay, or redo ever again in a lifetime. One thing I learned as a cic and DOJ instructor was never say never. Because if you do, and someone did, your entire argument goes no where. Not saying your comments went no where, they did. And I appreciate that. But you can’t say never when it actually did occur. On morebthen one occasion. Peace to you. Timmy, cheers, and thanks for reminding me of the many assholes in ems. One thing I had always hoped would change, you’ve proven has not. But here you go. A whole new post to ridicule for grammatic errors! Have at it mate!

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    1. After doing some cursive research, doc, wow, you’re full of shit. As for nys changes, it wasn’t decades ago, it was August of 2015 and, if you bother to read my original letter, what I stated is exactly what nys did. Yes, the lbb is not required, however, proper spinal immobilization is. You guys are truly fucking idiots. You think you are from a progressive mind set. Sadly, no docs but the quack above believe it! And to think I was buying into your bullshit. Mikey, nice job pretending you’re an md. Kinda found you on other sites. Talk about a troll! Fuck, you guys are morons. I may be an Em’s dinosaur, but you guys are the most ignorant fucks around. Fake writer, fake md, fake bullshit post. Assholes!

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      1. John,

        I would encourage you to perhaps talk to some one about your anger issues. I have decided to block you from commenting further on my blog. sorry man, I know you are passionate about backboarding but you went too far.

        I am fine with swearing, but ad hominem attacks at the level you are performing are more than I am willing to tolerate.

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