By Dan Limmer
The comments from a recent free NREMT review session made us realize that some important items were still being taught wrong—and at alarming levels. This post will highlight some of these substantial falsehoods and misconceptions in EMS.
Before we do that, a bit of history may help clarify why some of these misconceptions exist.
In 1994 the US Department of Transportation released the EMT-B curriculum. This curriculum eliminated any pathophysiology (why??) from EMT education and took a technician-level approach. Many of today’s EMS educators learned during the EMT-B period from about 1994 – 2009. People teach what they learned.
Adding to the problem, EMS is relatively young as a profession and immature in its approach to change. Even the thought that there may be more than one way to do something or that there may be more than one correct answer challenges our “do exactly what our instructor says” mentality.
This leaves some substantial misinformation being taught to students. Here are a few of the sacred cows we found lingering around the EMS pasture.
It seems that oxygen makes us feel better when we administer it. If only it had a benefit to non-hypoxic patients. We still seem to have a group of educators and providers who believe that we should pour on oxygen, but the literature and current guidelines don’t support it. (More on that here.)
Oxygen is a drug and should be provided based on indications…like hypoxia. Our flowchart can help you choose the right oxygenation plan for your patient.
Spinal Immobilization vs. Spinal Motion Restriction
Position papers released in 2018 and supported by the National Registry say that we don’t immobilize patients on backboards any longer. Backboards cause pain—sometimes more than the injury itself. Securing the patient on the stretcher restricts motion and is much more comfortable. Our guide to assessing and performing spinal motion restriction can be found here.
Many students are still being taught to “stabilize” a flail segment with anything from bulky dressings to IV bags. These treatments are old. If a flail segment is big enough to limit ventilation, the only treatment should be to ventilate the patient. Restricting chest movement won’t increase ventilation—and may limit it!
Remember that the chest muscles will splint the flail segment naturally for a while. Paradoxical motion may not be visible initially. You will see that motion more prominently when the patient begins to tire. If the flail segment is large enough, you will need to ventilate.
Probably one of the most commonly taught but very wrong approaches is that we suction every newborn. Since 2010 the American Heart Association guidelines say only suction if there are signs of distress. Even in the presence of meconium, if there is a vigorous baby, we don’t suction.
Suctioning isn’t benign. It can cause hypoxia and bradycardia.
Should you apply a traction splint on an open femur fracture? A recent discussion we had on traction splinting showed differing opinions on this.
We believe you should apply the splint as long as it’s an isolated, mid-shaft fracture. The benefits are: 1.) It gets the bone ends back in line, 2.) it relieves some of the pain and most importantly, 3.) it controls bleeding by leaving less space to bleed into. If you can irrigate the bone ends briefly with sterile saline, OK. But apply the splint. The bleeding control benefits outweigh the risk.
The number of times a traction splint is used is minimal. Again, application is limited to mid-shaft fractures with no other injuries–to the knee or hip, for example. Remember that many patients with these fractures have other concurrent injuries that make splinting the femur a lower priority (over treating for shock and prompt transport).