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o p r m c e p i H m m q l d t G c J o r p r p p t t n t would be nice, in this 25-year retrospective, to note the emarkable progress we have made since “Of Crashes, atheters, and Confusion” was written. It would be nice, ut it would be fiction. To be fair, there have been some changes. In aviation, ight engineers are no longer part of a contemporary ockpit crew, and the airlines have continued to improve heir already excellent safety record. Unfortunately, neiher airline customer service nor the safety of air medical ransport has followed suit. In emergency medicine, we ave come to accept the term “ER” as firmly ingrained in ur television culture, and the alternative and previously referred term “ED” has instead become irreversibly ssociated with older males taking little blue pills. The erm “M&M” (morbidity and mortality) has also given ay to “CQI” (continuous quality improvement), a hange that may again have more to do with culture than ontent. But despite our switch from M&M to CQI, we till have the same appalling lack of standardization and he same unnecessarily muddled and confusing system of omenclature and measurement that we had 25 years go. In fact, some things may have changed for the worse. wenty-five years ago our defibrillators lacked standardzation, but at least they used the same energy levels. ow we have machines with differing waveforms and iffering recommended energy levels. This is despite any vidence that one waveform results in any better clinical utcomes than any other. The American Heart Associaion suggests that if you don’t know which biphasic efibrillator you have (rectilinear or truncated), just use 00 joules. Don’t know? That would be like saying if |
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