Bigger Than a Breadbox

Years ago I noticed that every time that my mother would bring home a loaf of bread that the immediately took the heels out and threw them away. I asked her why and she replied that because her mom did it. When I asked my grandma she said the same, “Because my mom did it.” I asked great-Grandma why she did it and she replied “My breadbox was too small.”

Are we still doing things in medicine because that’s the way it’s always been done? Yes. We longboard our patients despite the fact that there’s never been a study showing them to be effective. I recently read an article by Dr. Brian Bledsoe in which he reminisced that when he started as a paramedic that we were very selective about which patients needed to be “immobilized.” When the DOT came out with the 1984 standards, in an effort to make pre-hospital medicine easier to learn, LSB’s became common place as a means to prevent being sued, rather than used for specific situations.

How many of us have been to a campground with a water pump? What happens during the first few pumps? Nothing. We have to prime the pump before it becomes effective. Our heart is the same way, we must prime it first. What happens when you stopped? You had to start over again. Our current standards for resuscitation have us doing 5 sets of 30 compressions interrupted by breathing. Over 2 minutes we do 150 compressions, but 50 of those are simply re-priming the pump. We end with a net of 100 compressions that circulate blood. 50 per minute wouldn’t be enough to sustain most of our lives, but that’s what we’re using to try to restart the heart. Have you ever tried to clutch start a car? Do we do it slow or fast?

Newer methods allow for the first 6 minutes of compressions only and have had results of approximately 600% greater recovery (8% to 47%). Yet we still stick with 30:2.

We should never rely on the old methods, simply because that’s the way it’s always been done. We must always strive for better. Until we can find a way to save people, prevent illness and prevent trauma 100% of the time, we should never be content with the way it’s always been done.

Perhaps it’s time that we start to look for a larger “Breadbox” of tricks rather than continuing to throw out great ideas.

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