Wikipedia talk:WikiProject Medicine/Emergency medicine and EMS task force

Navbox usage

I've noticed that many EM/EMS pages have been tagged with lots of different navboxes that are inappropriate for the specific article. Generally, navbox templates should only be placed on articles that appear as a link in the navbox. Navboxes are for navigating between related articles, rather than encompassing all articles within a project. Previously (above), Emrgmgmtca proposed creating additional navboxes, and I think it is time to revisit this.

My goal is to expand upon the hierarchy of medicine-related navboxes without overlap of end-articles (meaning articles that do not also have a template named after them). Currently, you can start at {{Health care}}, which links to {{Allied health professions}} and {{Medicine}}, which links to {{Emergency medicine}}. Maybe we should create a template just for EMS-related articles (separate from {{Emergency medicine}} and {{First aid}})). These EMS-specific items could then be removed from {{Emergency medicine}}, which would need to be reorganized. And how about creating a template just for procedures/skills and medical equipment used in emergency medicine (the overlap between EM and EMS)? This should add to the hierarchy with "Emergency medical services" as a child of {{Allied health professions}} and {{Emergency medicine}}, with a potential "Emergency medicine procedures and equipment" as a child of "Emergency medical services" and "Emergency medicine". {{EMSworld}} can stand on its own, as is typical with any "by country" navboxes.

To start this process, we'd need to figure out how to organize the templates. Some ideas include vehicles, people, regulations, and patient moving devices. I'll probably go ahead and start creating a prototype, but ideas are welcomed. --Scott Alter 23:46, 5 February 2009 (UTC)

I just created {{Emergency medical services}}. If anyone adds articles, please only include items specific to EMS (without EM or first aid overlap). --Scott Alter 00:42, 6 February 2009 (UTC)

Should Medic be listed in the 'people' section? WhatamIdoing (talk) 19:19, 6 February 2009 (UTC)

I don't think medic should be listed. Although it is an overview article, it is really just a disambiguation page. All of the people who may be called a "medic" within EMS should be listed separately in the "people" section. --Scott Alter 23:44, 9 February 2009 (UTC)

There is room for everything under the template {{EMSworld}}. Also useful would be a section called Legislation and Standards (vehicle standards being the obvious one). Models of care would be another potential addition. Additional short courses (ACLS, ITLS, etc.) would be another. Subspecialities (aviation, dive, marine, tactical, wilderness, farm) could also be added.Emrgmgmtca (talk) 12:59, 9 February 2009 (UTC)

You might want to take what is currently under {{EMSworld}} and refocus it a bit. Perhaps when you click on Paramedic (or for that matter Emergency medical services) you get both the generic article and the 'by country' listings. You might also wish to consider listing all of the individual provider organizations under Emergency medical services by their country of origin (eg. Emergency medical services=>Emergency medical services in Canada=>British Columbia Ambulance Service). Just a thought, and might encourage people to revisit and expand all of those individual service stubs and starts that they've left lying about.Emrgmgmtca (talk) 12:59, 9 February 2009 (UTC)

Do you mean that all of this should be included in {{EMSworld}}, or that {{Emergency medical services}} should be placed on articles with {{EMSworld}}? I strongly oppose listing the "by country" articles in the same general EMS template. The articles in {{Emergency medical services}} should be the articles of highest importance to EMS (and the project). All of the "by country" articles are of mid importance to the project, as they are not relevant to all of EMS. I'm not sure what you mean by "get both the generic article and the 'by country' listings" for paramedic and emergency medical services, but I think both {{EMSworld}} and {{Emergency medical services}} should appear on these two articles.

A "Legislation and Standards" section would be a good addition to {{Emergency medical services}}. I am unfamiliar with the current/existing articles relevant to this category, so someone else can add them (or at least note them here). Which articles would fall under "models of care?" I'd like to keep the courses (ACLS, ITLS, etc) in a separate template, since these are used by a variety of medical providers and not just EMS. As for the subspecialties, I'm not sure they are actual subspecialties of EMS or of medicine in general. Because the articles on these topics are not specifically tailored to the EMS aspect of the specialty, I think articles like aviation medicine, wilderness medicine, diving medicine, and military medicine could be listed as related fields instead of subspecialties. Each of these fields also deserves their own dedicated navbox templates, so I do not think we should include items specific to any of these fields in the EMS navbox.

Regarding the individual service articles, I do not think we should be encouraging their creation, as most are not notable. British Columbia Ambulance Service is a rare example of a huge agency that covers an entire province/state. Most regions have tons of smaller agencies. The current way (and I think one of the best possible ways) to find individual services by country is via Category:Ambulance services by country. If we start listing these agencies in a template, there would be no limit as to how many would be included. Would you want all EMS agencies in the world listed in the same template? Or even all of the EMS agencies in templates by country? I think it would be useless to have as a navbox. Rather than listing individual service articles in an EMS template, if they are placed in any type of navbox, the most appropriate type would be a template for the city/region that the agency serves. --Scott Alter 23:44, 9 February 2009 (UTC)

I was thinking more along the lines of a cascade type effect. At the top of the hierarchy we have the existing navboxes, but (as an example) at the bottom of the Emergency medical services generic article, there would be a different navbox directing to EMS by country articles. At the bottom of those articles would be navboxes directed to the articles on the individual local services. At each tier the navbox would include a 'Back' option, which would return the reader to the next article up the hierarchy. The other question that I would ask is why we would have a category for Ambulance services by country, when we already have one for EMS by country, and the two are essentially different names for the same thing. Just my thoughts.Emrgmgmtca (talk) 11:54, 10 February 2009 (UTC)

Task force scope

After looking through some of the articles currently tagged for this task force, I found that some medical emergencies were included. Do we want to include types of medical emergencies within our scope? Could we include some and exclude others? Should we include all articles in List of medical emergencies (and Category:Medical emergencies)? --Scott Alter 00:31, 6 February 2009 (UTC)

This will be a difficult area. Emergency medicine sort of contains a bit of everything in medicine from glaucoma to stubbed toes. Were one draws the line between emergency and none emergency is highly debated and variable.--Doc James (talk · contribs · email) 14:47, 6 February 2009 (UTC)

I agree Doc. The term 'emergency' is somewhat subjective, isn't it? The other thing that I'm not sure about, and I think we would need to seek an answer from some sort of 'higher authority' before we get too far into this, is exactly how such information would be presented. If we are simply going to address the nature of the condition, its pathophysiology, and a general description of how it is treated medically, then we are probably fine. If, on the other hand, someone starts providing specific instructions for the care and management of a condition, and that information happened to be incorrect, and then someone acted upon it causing harm to another person, what is the extent of our liability? Given the number of twits wandering around here simply vandalizing pages, it would only be a matter of time before something occurred. I'm less concerned about the medical professionals who contribute than I am about the vandals and the lay readers. To begin with, it introduces a whole new type of vandalism, but more importantly, the reader may not be able to distinguish in some cases, and may regard this as authoritative information. Kind of like telling a 60 year old with a history of hypertension and an acute onset headache to 'take an aspirin'. Perhaps I'm overreacting, but it is worth considering and obtaining advice. What are your thoughts? Emrgmgmtca (talk) 15:24, 6 February 2009 (UTC)

Wikipedia medicine pages already give lots of bad advice. But there is bad advice in all sorts of sources from self help books to other web pages. Everyone should realize that they need to double check what they read. This applies to more than just wikipedia. Take drug advertising for example. I do not think there is much for legal concerns. The thing is all of medicine is really in the scope of emergency medicine. What is emphasised is what is acutely fatal and what is common.Doc James (talk · contribs · email) 15:43, 6 February 2009 (UTC)

I don't disagree...I just wanted to raise the issue. While we're chatting, tell me...do you think that the changes that seem to be occurring in a lot of EMS are likely to change the fundamental nature of the Emergency Room, making it less an acute care setting and more of a family practice setting? My thoughts are that STEMIs now go direct to the PCI lab, we're looking at serious changes to how cardiac arrests are managed (we're currently looking at paramedic-induced hypothermia, followed by direct transport to the PCI lab for post-arrest patients), traumas no longer go to local E/Rs, but to specialized trauma units. In Toronto, the same thing for pediatrics, burns and strokes. Sexual assaults also have dedicated facilities. When you combine that with expanded scope of practice for some paramedics (Paramedic Practitioners in the UK for example), providing more comprehensive primary care and referral in the field, with an objective of keeping low acuity patients OUT of the E.R., do you ever begin to wonder what is going to be left? Emrgmgmtca (talk) 16:32, 6 February 2009 (UTC)

The articles should follow WP:MEDMOS, as far as what information should be provided. A treatment/management section mentioning drugs and interventions is appropriate, but it should not be written as a how-to manual. Generally, specific information (like medication doses or how a procedure is performed) is inappropriate. Liability is not something this (or any other) project should be concerned with. Just because an article is tagged with the project's banner does not mean we claim responsibility for the content of the article. It simply means that we are interested in looking after the article. There is no duty for us to patrol articles for verification of accuracy. --Scott Alter 21:02, 7 February 2009 (UTC)

Well, we are all here for the patients best interest. If the patient has a STEMI they should go directly to the cath lab if that service is available. It isn't in most of Canada. Trauma centers are great, if there is one. Most of trauma services are still run by ER doc even in larger centers. Also there are still many acute MI patients who come in with there family and not by EMS. Decreasing scope of practice is happening in many areas of medicine. The only reason why we have kept the name general surgery is historical. There is nothing general about a general surgeon any more. They are abdominal surgeons. And that is before they super specialize. If you work outside one of the large centers (Toronto/Vancouver general hospital) you will deal with everything and this is not about to change any time soon. What is of concern is the increasing number of patients with out family doctors. This is what is adding the walk in clinic to the ER. And then the lack of beds is turning it into a general medical / surgical floor.--Doc James (talk · contribs · email) 17:33, 6 February 2009 (UTC)

A few points:

• Whatever our own motivations and interests, Wikipedia is not written for patients (or professionals).
• Only a fool would base his critical medical treatment solely on a website like Wikipedia. See WP:Medical disclaimer.
• We can reduce the risk of real-world harm by carefully avoiding how-to details and advice about what should be done, or what patients should know, etc.

As for what should be considered within the scope of this project:

I would probably include any condition/procedure/test that is primarily handled in the emergency setting, or whose article has a substantial emergency/first aid component. So Myocardial infarction seems like an obvious thing to include: First because if someone seems to be suffering an MI in, say, a solo practitioner's office, the basic response would be "call an ambulance; he must go to the emergency room immediately", and secondly because of Myocardial infarction#First_aid.

Does that seem sensible to other people? Does it seem like a rule of thumb that you could usefully apply, without including too many articles or excluding too many? WhatamIdoing (talk) 19:48, 6 February 2009 (UTC)

That seems sensible, but it will be difficult to draw the line between what should be included or excluded. "Things you call an ambulance for" is a good start, but we all know that EMS and emergency rooms are often abused with non-emergency issues. Although "emergency" is a subjective term, maybe we should try and come up with more objective guidelines. There are obvious acute medical emergencies that should be included (Myocardial infarction, Anaphylaxis, Cardiac arrest, Respiratory failure). But what about chronic medical problems that may have acute episodes (Atrial fibrillation, Heart failure, Asthma, Chronic obstructive pulmonary disease, Angina pectoris)? And things that cause medical emergencies (Embolism, Thrombosis, Bleeding, Hypoglycemia, Dehydration)? What about signs, symptoms, and other descriptors (Dyspnea, Chest pain, Urticaria, Hypoxia, Tachycardia, Hypotension)? Or non-life threatening issues (Epistaxis, Bone fracture, Wound)? An argument could be made to include all of these articles. Can anyone think of items or categories that should definitely not be included. --Scott Alter 21:02, 7 February 2009 (UTC)

EMS in Iceland

Emergency medical services in Iceland is now completed. Have a look and let me know what you think. All comments welcome.Emrgmgmtca (talk) 15:56, 10 February 2009 (UTC)

EMS protocols

I am sure all have seen this. It is interesting as it gives how good the evidence is for different EMS treatments.

http://emergency.medicine.dal.ca/ehsprotocols/protocols/toc.cfm --Doc James (talk · contribs · email) 23:20, 11 February 2009 (UTC)

EMS in New Zealand

Emergency medical services in New Zealand is now completed. Have a look and let me know what you think. All comments welcome.Emrgmgmtca (talk) 13:53, 12 February 2009 (UTC)

Assistance Required

Could someone please add both Emergency medical services in Iceland and Emergency medical services in New Zealand to the EMSworld navbox? I have no idea how to do this. Thanks.Emrgmgmtca (talk) 11:04, 16 February 2009 (UTC)

• Done. --Scott Alter 12:05, 16 February 2009 (UTC)

List of emergency medicine topics

Have started this page. I know we have a category but this might be a good format aswell.--Doc James (talk · contribs · email) 16:35, 26 February 2009 (UTC)

Emergency birth

(Intentional) Unassisted birth refers to "emergency birth" in the lead. I can't find an appropriate article. Do we not have anything? WhatamIdoing (talk) 06:32, 26 March 2009 (UTC)

Unassisted birth is not the same as emergency birth IMO. They should have there own pages. An unassited birth is a home birth and has been how babies have been delivered for most of human history and is still how babies are delivered in most areas of the work. A recent study ( ie this week ) found that home birth were as safe as hospital births for low risk women.--Doc James (talk · contribs · email) 17:47, 15 April 2009 (UTC) http://news.bbc.co.uk/2/hi/health/7998417.stm

True -- well, if by "home birth" you mean "home birth attended by a trained and licensed medical professional", and not "home birth while the mother is completely alone or attended only by untrained friends and relatives," which is what this article seems to be about -- but the lead of that article makes a distinction from a planned (medically) unassisted birth and an unplanned unassisted birth. Do we have (or want) an article about "baby appeared while mother was still packing for a long-planned trip to the hospital"?

It's an interesting and important distinction. From an EMS perspective, most medics believe that the most common births that they are called to attend are second children, with the mother being misled by the length of her first labour. It would be interesting to determine exactly how accurate this particular perception is, but we don't do research here. Another point to be raised is that, particularly in North America, home births with midwives in attendance appear to be on the rise. Another factor to be considered is the nature of the article... Are we going to discuss the topic in general, or describe delivery techniques? I'd be happy to participate in the development of this article. Emrgmgmtca (talk) 10:19, 16 April 2009 (UTC)

Request for assistance

I wonder if somebody from this task force could assist me with re- writing Devon Air Ambulance Trust. I've made some headway from the shape it was in when I first cam across it, but I think it could do with a fresh pair of eyes- I've done quite a few re-writes, but this isn't really my area! Please get in touch via the article's talk page or my own. Regards, HJ Mitchell (talk) 17:00, 15 April 2009 (UTC)