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Contemplating life.

Approaching the shrine of evidence

or: I’ve come a fair distance, but have a long way to go.

Just because an idea is true doesn’t mean it can be proved. And just because an idea can be proved doesn’t mean it’s true. When the experiments are done, we still have to choose what to believe.

I recently embarked on postgraduate studies. My thirst for knowledge needed quenching, and my post-graduation emptiness needed filling; I was bored and suffering intellectual directionless. These issues have been rectified with a quite interesting Postgraduate Certificate in EMS leadership and Management.

But back to topic: I remember my first dabbles amongst paramedics…the spoken word of these people surrounding me was at first unintelligible blabber of latin and greek derived technical teminology, but with time and a dictionary, I cut through most of that. I had a basic understanding, and I was proud of myself.

Then came basic skills and principles of paramedicine: I was told about these many things that paramedics do, and I took them in as “that’s what paramedics do”. The occasional question was usually answered with some scientific based background knowledge that I did not possess, but sounded more than plausible.

In my mind, I could picture the shrine of evidence.

Then I got a copy of some clinical guidelines. Thoughts similar to “They must be right, the big people on the ambulance follow them, and I’m sure a lot of time and effort went in to writing them” went through my head.

From a distance, I could see the shrine of evidence.

Then I started studying paramedicine. I entered the beautiful world of evidence based practice. “It’s in a scientific journal, it must be right! They’re scientists after all!”. And along came large Randomized Control Trials. “The peak of trials! Truth! TRUTH!”

The shrine of evidence began to glisten. Polished marbled with golden words in capital letters sparkled from it. a truly majestic and intimidating sight. Upon it written in bold letter:

“Science is evidence is truth.”

Still not completely confident with the world though, more background knowledge on this whole topic was needed, and which is why I did not adopt the above statement.

I want to get closer to the shrine, but my sunglasses aren’t dark enough to ward off the sparkling and shining.

Then my lecturer recommended to read this.

Clouds pull up. The shrine has some ugly cracks in the foundation, and…wow, part of it is built on rotten wooden stilts!

A great read from “The New Yorker” Magazine, by Jonah Lehrer (December 13, 2010).

Read, ponder, and rethink your worlds. After all, we’re all only human.

Just because an idea is true doesn’t mean it can be proved. And just because an idea can be proved doesn’t mean it’s true. When the experiments are done, we still have to choose what to believe.

In Training

As you may have noticed, not much is happening here. I’m back at school, undertaking my final four weeks of training prior to being made up as paramedic, the senior on the van.

So far, the first week has been interesting, and a great learning curve with a few new skills, focus on scene management and heaps of theoretical and practical revision. I won’t go in to too much detail – there are still students waiting to do the course and can’t give away any secrets…

One little tidbit worth mentioning in regards to kinematics and unchallenged paramedic misconceptions: I can’t remember where I picked it up, but I was always under the impression that if two cars collided head on in to each other, their impact speed would added. I never even questioned this logic.

Once I thought about it a mere couple of seconds, reality and physics kicked in. Evidence based practice has once more turned my thinking and practices around:

Watch Mythbusters debunk the myth!

Read you in a months time, and see you in six weeks time at the Paramedics Australasia Conference – where I’ll be presenting myEMStrip!

Learning Sources: a reflection

Everything. I wanted to know everything about ambulances, what’s on the outside, what’s on the inside, what system do they operate in, who works in them, what do they do, and why?

In other words, I was a boy full of questions. I’d read up a bit about what pre hospital care was about, but when I joined the ambulance service as a volunteer, that was the first time I had access to first hand information. The questions never stopped flowing. What is this for, why do we do that, what should we do if this occurs, why didn’t that turn out the way we expected, and yes, parasympatholytic is a bloody cool word.

Changing careers to work in the ambulance service full time exacerbated this. First of all, I needed to know everything to do the job right. How do you learn? You get taught at school, and everything they tell you is the Gospel Truth. It’s based on our guidelines. It is right, and that is how it is done. I remember taking a CPR practical exam, and my instructor stating at the end: “good work, that was textbook. Congrats, passed!” Too easy, I thought.

A few weeks earlier, we were shown a simulated resuscitation at school. Resusci-Anne had died (again), and needed life-saving green men at her side. Calmly, said men walked in with their equipment, checked for any signs of life and started breathing and pumping her heart for her. All this was done in a very quiet, calm and matter of fact manner. It was surreal; this plastic doll lying in the middle of a clean room, with two men serenely doing their routine movements around her as if they were lubing a bike chain. They finished, and I stated questioningly: “That looked far too calm, simple and easy. Surely reality is different!?”. “No” was the short answer, piped in an equally calm and matter of fact manner.

I didn’t believe them one bit.

Fast forward a few weeks, my initial training had finished, and now I was out on the road. And boy was that exciting. From a guidelines point of view I had close to 100% knowledge, but on the other hand close to zero percent experience. More questions then. Mosby’s Paramedic Textbook became a good buddy, and every person I worked with was consulted about this and that. It slowly emerged that different people gave me different answers on the same questions. Why? ‘This is how we’ve been taught’, ‘this is how we did it in the UK’, ‘we always did that in South Africa’, ‘a doctor told me’, ‘my horoscope recommended this’. Hmm, what to do? Ask doctors, surely they should know? Unfortunately, I quickly realized that doctors study much longer than paramedics, so they can different opinions – than each other. Apparently, if two doctors agree on something, one of them isn’t a doctor. Damn, running out of options. What to do? How to treat?

Oh yes, there’s this thing that sucks money out of me, eats up a lot of my time and sends me strange emails occasionally. Maybe academia may have the answer. They must be sending me to university for a reason. Triple blinded, retroprospective and real life lab conditioned trials – could they tell me something? Not only one persons opinion, but third party, unbiased data collected multiple times, coming to a hard conclusion. Might be on to something here.

Evidence Based Practice (EBP) is the future direction of answering questions. And being able to answer the question why. Why do we use wave form capnography for checking the tube? Why is there such a push for compressions? Because these are hard facts, with level 1 evidence to back them up. Why do we give oxygen to everyone? Because there is…oh, never mind. Just follow your guidelines.

That’s where I am at now. I still ask questions, just not quite as many, as I already have a neat amount of answers in my head. And when I hear answers (sometimes of questions I didn’t even ask), I will always listen, but not always take them on board as readily as I used to. After all, critical assessment of the answer is just as important.