9 Dec 2008

I read medical articles and feeds fairly regularly. They give me ideas for future articles and commentary but in the end they pile up, collect dust and never see the light of day. Starting today, I am going to try to communicate about what is on my mind more regularly. Please let me know what you think.

If you are not familiar with Dr Bryan Bledsoe, you might consider checking out some of his columns at the Journal of Emergency Medical Services web site (www.jems.com). I don’t know him personally so I cannot describe his personality but he does seem to have a penchant for skepticism and he calls out nonsense when he sees it. His column last week was particularly good. In it he lists the 10 articles about EMS/emergency medicine that he finds most interesting.

Number one on his list is the Hauswald et al article that calls into question the universal utility of spine packaging(1). It is an article that we have referred to regularly as we have evolved our philosophy around spine management in the field. It is a good reminder that there is no good scientific evidence that shows that spine immobilization does anything to prevent spinal cord injury following a column injury. In fact, claims to the contrary (10% or more), cord injuries caused by movement after the initial injury are rare. If this procedure is of questionable value and potentially dangerous, why do we keep putting so many people on boards and in litters? When do the benefits of technical rescue because of a perceived need for full spine stabilization (e.g., mechanism of injury, unable to clear the spine) outweigh the inherent risks involved in many of these efforts?

An article by Lerner and Moscati was new to me (2). In it they looked at how the concept of the “Golden Hour” for trauma management was conceived by its original advocate, Dr. R. Adams Cowley. You guessed it, they could find no scientific basis.

He also includes two tongue and cheek articles (3,4). Each year around Christmas/New Year, the British Medical Journal (www.bmj.com). publishes a couple of funny, off-beat, wickedly insightful articles. The two on his list were among my favourites.

I think that this list of 10 is a good idea. Maybe I will try too. This is not just about debunking, it is about finding out what is factual, reasonable or fanciful.


1. Hauswald M, Ong G, Tandberg D, et al: “Out-of-hospital spinal immobilization: Its effect on neurologic injury.” Academic Emergency Medicine. 5(3):214–219, 1998
2. Lerner EB, Moscati RM: “The golden hour: Scientific fact or medical ‘urban legend’?” Academic Emergency Medicine. 8(7):758–760, 2001.
3. Smith GC, Pell JP: “Parachute use to prevent death and major trauma related to gravitational challenge: Systematic review of randomised controlled trials.” British Medical Journal. 327(7429):1459–1461, 2003.
4. Green RJ, Pierce JM: “The ideal tool for decorators: A novel use for disposable laryngoscope blades.” British Medical Journal. 333(7582):1297–1298, 2006.

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