Bad Medicine & Validation

Opinions are like assholes, some say, in that everyone has one. I’d argue that assholes are much more wholesome than opinions in that people only have one, and they tend to keep it at least moderately clean. Opinions are a much more fecund and foul field. Particularly in medicine.
How bad this can get varies somewhat depending on where you are, at what practitioner level, and what the subject is. At the practicing professional level there are still arguments and opinions, but there is a high level of knowledge-maintenance performed on the wide array of common things and everyone is pretty much on the same page.
This is of course limited at times by the given specialties of the practitioner in question, as their knowledge will be focused on their specialty or area of expertise. But, there is a standard of knowledge maintenance. And that knowledge is well founded, based on scientific research and study – It’s not something their buddy repeated after having a beer with a guy who said he used-to-was an 18 Delta.
I say this because as you move into the less professional realms of medicine, particularly those revolving around providing civilians and non-medical personnel with medical skillsets, you start seeing a lot less of the former, and a lot more of the latter. Now, this is probably not the rule, but it is a hyper-prevalent exception.

Most of the trainers I am aware of who supply this type of training, are up to date professionals, who are either medical doctors or operating under the guidance and curriculum development (or at least assistance there-with) of a medical doctor. Even some of those who run programs without an MD are typically some form of medical professional, or former professional. These are people who keep up to date, and run a tight, well founded, program – Usually.
But, sprinkled around out there are some real “special” types.
There are the former professionals who were, yes, medical professionals – They were a medical billing specialist, or a phlebotomy trained nurses aid – who’ve read the Tactical Combat Casualty Care Guidelines, or one of Dr. Paul Auerbach’s books, and are now teaching some sort of medical class.
There are the people who’ve got no relevant experience, they hurt a guy’s feelings once, and are teaching some sort of class. Most likely, straight out of a book, or they ripped it off from someone else.
Then there are the trainers who really were 18 Delta’s, Corpsmen, Paramedics, Trauma Nurses, or what have you – 20 years ago – Who no longer know what they don’t know. They haven’t kept up to speed on the literature, they haven’t maintained a certification in X-number of years, and they are teaching what once was sound medicine but is no more. Their hearts are in the right place, but their actions are dangerous.
And then there are the people on the internet. Bloggers, forum posters, youtube vidiots, etc. Yes, I am all of these, plus a tweeter, and of course not all of us are idiots. With the exception of Hugh Coffee (unless I’ve missed something) every name I’d suggest for medical training has an internet presence. But, there are plenty of those on the forums who are handing out bad advice – They may be any one of the three types above, from complete fools to well meaning but ignorant professionals, and they still advocate bad things. Unfortunately, as I’ve seen recently, some of them are both professionals trainers with reasonable credentials, and in positions of authority on the forums or website where they “speak”.

Now, that’s not to say you can’t learn something from just about anyone. I’ve learned a lot from almost every human being I’ve ever interacted with. Maybe nothing positive, and only rarely life-saving, but anything can be a learning experience. Unfortunately, some of what is being put out there as “good medicine”, is a quick road to a learning experience about the nature of life after death.
Tonight, I was doing some casual reading on the internet forum of a fairly well know training group, specializing in wilderness and survival skills. I’d never spent any time on their forum, and was curious to see what it had to offer. Of course, I cruised over to the medical discussion. I found some threads that looked interesting, and started reading. That, as usual, is where the trouble began. In a thread where a variety of subjects were being discussed, the moderator, in the space of two posts, made two absolutely ridiculous statements. The first, an entire post on treating snake bite which advocated use of the Sawyer Extractor. Second, a post disdaining tourniquets, repeating the old saw about them causing limb loss, and that they needed to be loosened periodically. He also wrote that pressure was a superior tool. The moderator for this sub-forum is a professional trainer and, according to his website bio, former Corpsman and an ER nurse.
Similarly, on another forum recently, I saw a post from a supposed RN, in which the author was attempting to provide guidance and education on assembling first aid kits. The author, in his effort at “education”, decried hemostatic agents as gimmicks.
Now – I’ll say upfront, I’m a former EMT, and not currently any working medical professional. However, I am quite well read, and in my reading, I have seen more than enough evidence to invalidate all of these statements. Use of Sawyer Extractors is widely disfavored, as they’ve been shown to be ineffective and actually cause tissue damage. Use of tourniquets, and a much lower than previously thought risk of limb loss when used properly (loosening regularly is not proper use), is at this point extremely well documented due to the high incidence of use in current military theaters. The same is true of standard hemostatic agents, such as QuickClot , HemCon and Celox. More to the point, these things have not just been validated on the battlefield, but in independent testing for both the military and civilian medical environments.
If I can know that, then it is certainly possible for professionals to know that. Particularly professionals who provide training services and attempt to speak as authorities. Particularly when the knowledge they lack is, or is rapidly becoming, accepted standard.
More to the point – It is irresponsible for professionals who attempt to speak as authorities to not know that. They are putting peoples lives at risk, because they have not kept current on the literature and standards for the fields which they’re attempting to address.

As students of these skillsets, when seeking out training, it is your responsibility to yourself to seek out professionals, who have the necessary skills and experience to back what they are teaching, and at minimum who’s curriculums are rooted in current, proven, medicine. How can you know this? You have to do the work.
Seek out multiple sources of information. Compare and contrast. Use the open access journals, use the professional resources that are available online, use other training experiences. Do not take people on their word simply because they speak authoritatively, wear an instructor hat or have a professional credential. Use every resource available to validate the things you’re told, and the things you’re taught. Medical skills are hard to pressure test like shooting skills or combative skills – You cannot train snakebite care in an “alive” manner easily, or without detriment to someone. But the resources exist to validate or invalidate information provided to you.
Don’t count on any given expert, instructor or mouthpiece to have validated what they’re teaching – Do it yourself. When handed a gun, even if the guy you got it from says “Naw, I checked the chamber, its empty”, you verify its condition all the same. This is no different. Bad medical information is a loaded gun, and it will eventually get someone hurt.
Why an instructor would fail to stay up to date, or validate, the material they teach is simply beyond me – But time and again, it is obvious that there are those who don’t. Be careful out there.

Oh yeah, and that guy who said he was an 18-Delta? I’ve met that guy. He doesn’t know shit from shinola, and was actually a latrine sanitation specialist in the Air Force Reserves.



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