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By Dan Limmer

contemplative zebu gazing into a cloudy landscapeThe 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.

Oxygen Administration

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.

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.

oxygen administration flowchart

Click for details.

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.

oxygen administration flowchart

Click for details.

Flail Segment

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.

Suctioning Neonates

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.

Traction Splinting

A recent discussion on traction splinting showed there were differing opinions on whether you should apply the traction splint to an open femur fracture. We believe you should. 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. Application is limited to mid-shaft fractures—and many patients with these fractures have other concurrent injuries that make splinting the femur a lower priority (over treating for shock and prompt transport).

Which EMS sacred cows have you encountered? What are your thoughts on overcoming outdated teachings? Talk to us in the comments!

Join the discussion 3 Comments

  • David M. Habben says:

    Luckily recent studies have shown the “scared cow” of lights and siren on every call is not only unnecessary, but dangerous.

  • Bill Young says:

    I’m still seeing instructors who adamently advocate for the use of a bulky dressing for flail chest injuries. Not cool people…not cool!

  • Brigan says:

    Infusion of copious amounts of crystalloids into exsanguinating trauma patients.

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